ICS Development Update and Vision for Healthier Together Community

ICS Development update 8thSeptember 2021

Our shared vision for the people of BNSSG Healthier Together is the health and care partnership for people in Bristol, North Somerset and South Gloucestershire. We work together to improve the health of our population and make sure services work for everyone. Our vision is for people in Bristol, North Somerset and South Gloucestershire to have the best start in life, and for the places where we live to be healthy and safe. Everyone will have the opportunity to live longer in good health. When people need support from our services, they will be high quality and easy to access. People will be better supported to take control of their own health and wellbeing, and become equal partners in care. Working alongside our communities, we ll build on strengths and tackle inequalities together. We ll make it simple for health and care staff to work better together for the benefit of the people we care for nurturing talent, removing barriers and acting on views and concerns. Our vision for delivering our ambitions is to join up care at locality level and across our hospital systems to respond to what people with complex needs tell us matters to them

Our system goals Reduce the inequality in how many years people in BNSSG live in good health, particularly improving healthy life expectancy for those with the poorest outcomes Reduce our adverse environmental impact in energy, travel, waste, water, food, biodiversity and land use Make it easy for people working in health and care to work with each other Become a place where health and care services fit with people s lives and makes sense to the people engaging with them Increase the number of years people in BNSSG live in good health Our communities are healthy, safe and positive places to live Our workforce is healthy and fulfilled

An overview of our ICS The 10 Healthier Together ICS partners are: We are developing integrated care partnerships (ICPs) in six localities: Population: 1m Clinical Commissioning Group: BNSSG CCG Place: 6 Local Authorities: Bristol City Council North Somerset Council South Gloucestershire Council CCGs: 1 Providers: 5 Healthcare Providers: Avon & Wiltshire Mental Health Partnership NHS Trust North Bristol NHS Trust Sirona Care and Health South Western Ambulance Service NHS Foundation Trust University Hospitals Bristol and Weston NHS Foundation Trust Local authorities: 3 PCNs: 18 GP Federation: One Care (BNSSG) Ltd We were designated as a maturing Integrated Care System in December 2020, in recognition of what we have achieved together . The next phase of journey involves transition to a new statutory form by April 2022 April 2022 ICSs operating in new statutory form 2020 ICS designation Feb 2021 White Paper published Sept 2021 ICS Memorandum of Understanding 2019 Long term plan 2016 Partnership formed

As a Partnership we have agreed the principles for how we work together as an ICS 1. We work to achieve our vision to meet our citizens needs by working together within our joint resources, as one health and care system. We will develop a model of care and wellbeing that places the individual at its heart, using the combined strengths of health and social care. Citizens are integral to the design, co-production and delivery of services We involve people, communities, clinicians and professionals in all decision-making processes. We will take collective, considered risks to cease specific activity to release funds for prevention, earlier interventionand for the reduction of health inequalities. We will focus on the causes of inequality and not just the symptoms, ensuring equalities is embedded in all that we do. 2. 3. 4. 5. People @ the Centre Decisions taken closer to the communities they affect are likely to lead to better outcomes. The default expectation should be for decisions to be taken as close to communities as possible, except where there are clear and agreed benefits to working at greater scale. 6. Subsidiarity Collaboration between partners in a place across health, care services, public health, and the voluntary sector can overcome competing objectives and separate funding flows to help address health and social inequalities, improve outcomes, transform people s experience, and improve value for the tax payer. Collaboration between providers across larger geographic footprints is likely to be more effective than competition in sustaining high quality care, tackling unequal access to services, and enhancing productivity. Through collaboration as a system we will be better placed to ensure the system, places, and individual organisations are able to make best use of resources 10. We prioritise investments based on value, ensuring equitable and efficient resource allocation, and we take shared ownership in achieving this. 7. 8. Collaboration 9. 11. We are coming together under a distributed leadership model and we are committed to working together as an equal partnership. 12. We have a common understanding of the challenges to be addressed collectively and the impact organisations can have across other parts of the system. We engage in honest, respectful, and open dialogue, seeking to understand all perspectives and recognising individual organisations agendas and priorities. We accept that diverse perspectives may create dissonance, and we seek to understand and work through any disharmony, and move to conclusions and action in service of our citizens. We strive to bring the best of each organisation to the partnership. 13. We adhere to a collective model of accountability, where we hold each other mutually accountable for our respective contributions to shared objectives. 14. We develop a shared approach to risk management taking collective responsibility for driving necessary change while mitigating the risks of that change for individual organisations. Mutual Accountability & Equality 15. We pool information openly, transparently, early, and as accurately and completely as practical to ensure one version of the truth 16. We work in an open way and establish clear and transparent accountability for decisions. Transparency 4

We are using a national policy framework on ICS partnership structures to identify key questions and working assumptions Summary of functions and responsibilities (per NHSE/I guidance) Local working assumptions System-level jointworking enterprise (not a corporate body) Required to prepare a health and care partnership plan (HCPP) to address the health, social care, and public health needs of the system May take on formal decision-making powers (e.g., form and delegate to a joint committee) The HT Partnership Board will evolve to become the ICP Terms of Reference will need reviewing and potentially updating (including membership) Decisions will be made similarly to today (by ratification by sovereign bodies) unless all organisations agree to delegate; we may build on and expand the degree of delegated decision-making in our partnership over time Integrated Care Partnership (ICP): Partnership Board Responsible for day-to-day running Responsible for NHS planning and allocation All current statutory CCG functions will transfer to ICB Take delegated/transferred commissioning responsibility from NHSE Provide system oversight and support regulatory intervention The ICB will be responsible for delivering the Health and Care Partnership Plan developed by HCP Expect model constitution by Q1 We want to retain and build on the operational partnerships we ve achieved, including through the Executive Group as a decision-shaping forum between NHS and LAs Integrated Care Board (ICB) Focus for NHS collaboration to meet the healthcare needs of local populations Focus for operational partnerships across NHS, local government, VCSE, others Responsible for designing and delivering joined-up care with local population Our 6 localities will become ICPs ICPs primary function is the deliveryof integrated care to meet the needs of a local population ICPs will report into HWB and be accountable to the ICS for resources/spend ICS commissioning will be informed by place-level insights Place-based Partnerships (ICPs) Partnerships involving two or more providers working across places - TBC At Scale Provider Collaboratives 5

Integrated Care Partnerships (ICPs) These will build on localities in Bristol. Bring together systems to support integration. Place-based joint working between NHS, local government, community health services, and the voluntary and community sector. Place level commissioning and contracting where applicable and locally beneficial.

South Bristol Shadow ICP Progress 8 September 2021

Shadow ICP Board Members AWP BNSSG CCG Bristol City Council Adult Social Care Public Health Community Development Commissioning BS3 Community Development Care & Support West General Practice Healthwatch Bristol Knowle West Health Park OneCare Sirona UHBW Vita Health Group

Where we are now Organisational Development programme underway to: strengthen collaboration improve understanding of each other s roles/organisations build a partnership culture understand our relationship with the Integrated Care System and Primary Care Networks develop our governance and ways of working Our Collaborative Agreement defines our vision, goals, values and priorities Agreed commitment to a person-led and asset-based community development approach

Our Vision Our vision is to deliver meaningful care and support that enables individuals and communities in South Bristol to optimise their own wellbeing. 10

Our 3 Priorities Develop a new whole life model of integrated community mental health support with a wellbeing and prevention focus, using the Community Mental Health Framework to help us deliver it. Work with residents of South Bristol to identify what matters to them, focusing initially on Covid-19 then young people and families. Ensure that we provide meaningful information to communities and staff to help them manage their wellbeing. Broaden multi-disciplinary team (MDT) ways of working to enable proactive support for vulnerable people of all ages, achieved through different ways of working together. 11

Learning / What is working well Partners agreed to provide consistent representation on the Board which has helped build stronger relationships, trust and commitment Process of writing our Collaborative Agreement helped articulate our vision and values and ensure we are all working together towards the same goals Importance of investing time in partnership development to enable us to become an effective ICP Need to involve local people and communities moreto understand what matters to them 12

Next Steps Integrated Care Partnership Delivery of integrated Community Mental Health services: 13

ICS Development High Level Timeline* for 2021/22 Q2 Q3 Q4 Agree principles & ways of working Finalise governance arrangements Complete transition Engage on ICS MOU (principles and ways of working) Sign off System Oversight MOU with NHSEI Begin design of governance arrangements for April 2022 Designate Chair and Chief Executive in place and begin appointing additional ICS executive roles Finalise governance arrangements Design our future operating model, describing how we will work together Refresh long term plan (post-Covid) Complete ICB constitution and functions / decisions map Transfer staff, assets Complete due diligence and preparations for staff and property transfers to ICB Health & Care bill passage through parliament*: 2 Nov 21 Q3/ Q4 Q4 1 April 21 6 July 21 14 July 21 7 Sept 21 1st reading House of Commons 2nd reading House of Commons Committee stage House of Commons Report stage House of Commons Bill passes through House of Lords Royal assent Bill becomes law *Dependent on final bill and guidance DRAFT: for discussion purposes only

Thank you @htbnssg www.bnssghealthiertogether.org.uk