Board Meetings

22 March 2024

Meeting Papers
Appendices

PQ No1 re Helath Hubs

PQ No 2 re MSKservices 

8 December 2023

Board papers
Board Appendices

Public question 1 Q&A - Wixams surgery

Public question 2 Q&A - NHSE recovery of primary care services

29 September 2023 (including Annual General Meeting)

Main meeting pack

Item 8.1 Update from Place Based Partnerships

Item 8.3 Appendix A & C

Background reading for items 6.1 and 7.2

QUESTION FROM A MEMBER OF THE PUBLIC

Given that stroke is a leading cause of death and disability, with stroke survivors leaving hospital with an average of 7 disabilities, many needing complex and life-long care and contributing to delays in discharge and pressures across the health and social care system, how does Bedfordshire, Luton and Milton Keynes ICB plan to appropriately fund and resource East of England (South) Integrated Stroke Delivery Network as the essential delivery mechanism for meeting guideline level standards of care and achieving the Long Term Plan’s stroke commitments?

What protection and security can you provide to the committed and valuable stroke network staff who are working tirelessly to improve the quality and safety of local services for this clinical priority? 

ANSWER (given by Dr Sarah Whiteman)

BLMK ICB understands that stroke is a leading cause of death and disability, and the resultant pressures across the health and social care system within BLMK. The ICB is committed to ensuring more residents live as many years as possible in good health. We are committed to working closely with health and care partners to support residents who have experienced a stroke, or who are providing care for a loved one in this position.  This includes longer term support for stroke survivors and their carers such as the Stroke Recovery Service delivered by the Stroke Association.

We acknowledge the hard work of all local health and care staff who provide direct or indirect support to individuals and families affected by strokes.

The ICB remains committed to the concept of Integrated Stroke Delivery Networks and is working with partner ICBs, and regional and national colleagues, to consider how these could best be supported in an affordable and sustainable way.

30 June 2023

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Agenda Item 6.1 Background Reading Documents

Agenda Item 6.2 Background Reading Documents

Agenda Item 7.3 Background Reading Documents

Board meeting 30 June 2023 summary 

1 July 2022

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29 July 2022

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30 September 2022  

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CCG annual report and accounts

Auditors annual report

25 November 2022

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On Friday 25^th November, the Board of the ICB met for the fourth time in the Council Chamber at Luton Town Hall.  As we approach our sixth month since our formation, the Board agreed two important strategies that will bring the voices of our residents and our work with the voluntary, community and social enterprise sector into the heart of our work as an integrated care system. These were the ‘Working with People and Communities Strategy’ and a Memorandum of Understanding with the VCSE.  As part of the discussion, the Board heard from Rachael Bickley (ICB co-production lead) an inspiring story of how the YMCA in Milton Keynes has worked with its residents to work in partnership and improve the support it offers, which had increased residents’ independence. 

With a focus on our four places, the Board heard about the development of neighbourhood teams based around Primary Care Networks, which is part of our response to the Fuller Stocktake Report. The Board also discussed reports on the important work of each of our four place-based boards. Looking to the future, there was a good discussion on how we were working as part of the BLMK Health and Care Partnership to develop our integrated care strategy, which in the first instance will be a mobilisation strategy for system working.

In the operational section of the meeting, the Board discussed the lessons from the East Kent maternity report and the work we are doing to learn from this report for our residents.  Operational pressures across the system were also discussed, with the Board praising the excellent work by all system partners to keep our residents safe over the winter.  

Our next meeting will be at 10am on 27^th January 2023 in Bedford Borough Hall and members of the public and partner organisations are always welcome to join us in person or on-line.

A link to the Board papers is available here: https://bedfordshirelutonandmiltonkeynes.icb.nhs.uk/about-us/board-meetings/ 

If you have any queries regarding this summary please contact: blmkicb.corporatesec@nhs.net

27 January 2024

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Response to Questions - download pdf document

Question:
Could you give us some evidence of how need and facilities for Leighton Buzzard are being assessed in relation to the pressures on hospitals and the effect that active prevention could have on the pressures on GPs and the questions below are the obvious questions that come to me as a lay person in assessing what is needed.

Question 1.1:
What is the pressure on the three hospitals in BLMK and Stoke Mandeville from Leighton Buzzard patients who access A&E from Leighton Buzzard when they should be accessing Primary Care?

Response:
In November 2022, Leighton Linslade Connections Primary Care Network (PCN) practices provided a total of 27,291 appointments. This is 588.07 appointments per 1,000 population. The PCN rank consistently well.

For the period April 2021 to November 2022, Leighton/Linslade Health Connections (LLHC) PCN had an A&E attendance rate of 471.3 per 1,000 population. That is the fourth lowest rate of all our 23 PCNs.

At our A&E departments in BLMK, we have services streaming patients away from A&E/hospital services if they would be better seen by a primary care service such as being directed to an urgent treatment centre.

Question 1.2:
What economic case or the evidence in this area for services such as a minor injuries clinic, Xray, CCT Scans, ultrasound scans and blood tests and other hospitalised services in Leighton Buzzard taking pressure off the three hospitals in BLMK and Stoke Mandeville. Or is the economic model that everyone should travel to hospital for their treatment.

Response:
The Integrated Care Board supports the provision of care closer to home where possible.

We routinely review travel distances/times when assessing access to services.

Question 1.3:
What is the economic case for following the example of some London surgeries where the GP has the patient with them in the consulting room and has a teams call with the consultant in the hospital.

Response:
As part of our BLMK Fuller Programme for the transformation and integration of primary care, we have an ambitious plan to develop neighbourhood teams; review how we provide same day primary care; ensure continuity of care to the population who have the most complex health needs and embed prevention. 

We are working with partners to develop ways of working to improve patient experience, including through the use of multidisciplinary teams.

The ‘Working Together in Leighton Buzzard’ programme is a multi-agency and multi-disciplinary approach to supporting the population with a range of complex health needs.

Question 1.4:
What is the economic case for  supporting venues so that  community groups could  play a significant role in prevention following the   report from the All Party Parliamentary group on the effectiveness of arts and culture on health in reducing demand for GP appointments by 37% https://www.culturehealthandwellbeing.org.uk/appg-inquiry/

Response:
The proposed neighbourhood teams will build an in-depth understanding of all resources that are available in and for communities. 

Our work to develop social prescribing and health coaching will grow access to non-medical services, supported by the proposed neighbourhood teams as part of the “Working Together in Leighton Buzzard” programme.

In November 2022 our data shows that 57% of appointments in the LLHC PCN were delivered by professionals other than a GP, demonstrating the diversity of the primary care teams.

Question 1.5:
What work is happening on recruitment and in making Leighton Buzzard a really attractive facility to train in and develop as a GP so that the low numbers of GPs in this area can be addressed?

Response:
Our Primary Care Training Hub hosts a number of specific initiatives to locally grow and retain our GP workforce including;

• a comprehensive GP trainee expansion programme,
• GP Fellowships to aid retention and develop integrated posts,
• New to Practice Programme,
• New to Partnership Programme,
• Supporting Mentor Scheme,
• Digital Staff platform to provide flexible working options and bespoke local initiatives to retain our experienced GPs and support our GP Educators and GP trainees.

Leighton Buzzard has one GP training practice with the capacity to host a number of GP trainees and we work with the Primary Care Network to ensure all their GP trainees are aware of the packages of support they can access to retain them within the area.

The Training Hub provides bespoke support to all practices with the advertisement of their vacancies and the development of attractive recruitment packages.

Question:
Can Biggleswade be considered a special case for investment in a Hub due to its exceptional circumstances with a practice handing back its GMS contract and planned building of 1500 houses east of the town?

Response:
The broader Hub programme falls outside the scope of the prioritisation exercise on which decisions were made at the extraordinary meeting of the Primary Care Commissioning and Assurance Committee on 11 January 2023. We continue to work with our health and care partners to develop proposals for integrated health and care hubs across BLMK.

The ICB will continue to support practices and PCNs with addressing operational pressures as necessary, as we are already doing in the Biggleswade area. The ICB is pleased to be increasing its expenditure on primary care estates to just under £11m per annum by 2025/26.

24 March 2023

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ICB Board meeting Summary 

Response to Questions - download pdf document

PQ1 - Relating to Bad Diet, Poor Health Epidemic and Environmental Issues

Question - Do the members agree that bad diet (junk food, processed meats, red meats, cheese, refined foods, foods high in sugar, fats and salt, and low in fibre, fruit and vegetables) is causing an epidemic of poor health (heart disease, cancer, obesity, diabetes etc), as well as causing environmental problems?

Answer -

Members agree that an unhealthy diet and lack of physical activity are leading risks to health, and adopting a healthy diet helps to protect against malnutrition in all its forms, as well as non-communicable diseases, including obesity, diabetes, heart disease, stroke and cancer.

Members recognise that food needs to be grown, processed, transported, distributed, prepared, consumed, and sometimes disposed. All these steps create greenhouse gases that are contributing to climate change. Moreover, at current consumption levels, certain foods, particularly red and processed meat and dairy , are causing damage to our health and the planet. On the other hand, increasing our consumption of fruit, vegetables and legumes will reduce our risk of non-communicable diseases and help protect the environment. Ultimately, it is recognised that the current food system needs to adopt healthier, more equitable and more sustainable ways of producing and consuming food (Agroecology).

Question - If so, do you see it as part of your responsibility to tackle this cause of ill health and planetary destruction, and not just to treat the symptoms (which is what the NHS does)?

Answer -

In accordance with the government’s food strategy, steps need to be taken to create a more prosperous agri-food sector that delivers healthier, more sustainable and affordable diets for all. The strategy identifies a number of measures to achieve this, targeting a variety of actors across the entirety of the food supply chain.

In the Long Term Plan, the NHS recognises its role in supporting healthier diets, introducing healthier food options for staff and patients and improving nutrition training in health professional education. Furthermore, in ‘Delivering a Net Zero NHS’, the NHS recognises the contribution of food and catering to its carbon emissions and acknowledges that the diet recommended by the government’s EatWell plate is low-carbon as well as healthy.

In the Bedfordshire, Luton and Milton Keynes Integrated Care System Green Plan, BLMK has identified food and nutrition as a key theme that will support the BLMK five priorities for health and social care and reduce its environmental impact. The councils have also noted the importance of improving locally sourced food options, providing more opportunities to grow food locally and reducing food waste in their climate action plans and food plans.

• Bedford Borough Council – Carbon Reduction Delivery Strategy 2020-2030
• Central Bedfordshire Council – Sustainability Plan
• Luton Borough Council – Climate Change Action Plan and Food Plan 2018-2022
• Milton Keynes Council – Sustainability Strategy 2019-2050

Luton Council has also developed a Climate Change Guide that provides advice on how to take action in different areas from making changes in your home to how you travel and the food you eat.

Question -

What are you prepared to do and what are you doing to promote plant-based foods and to help restrict meat, dairy, and junk foods?

Answer -

Locally, our aspiration is to support the formation of Local Food Partnerships that bring together councils and partners from the public sector, voluntary and community groups, and businesses to reduce diet-related ill health and inequality, while supporting a prosperous local food economy. Councils are also exploring what policy levers are available to them in their capacity as local authorities to address their local food environments.

The Bedfordshire, Luton and Milton Keynes Integrated Care System has committed to reducing food waste across our sites and facilities, phase out plastic packaging, and provide healthier, more locally sourced, and sustainable food choices. We will work with key stakeholders across the system to deliver these commitments.

The NHS National standards for healthcare food and drink set requirements for healthy and sustainable meals for patients, staff, and visitors. All NHS organisations are required to meet these standards. More detailed local actions on food and nutrition are also specified in the Milton Keynes University Hospital and Bedfordshire Hospitals NHS Foundation Trust Green Plans

PQ2 – Ivel Medical Centre, Biggleswade Closure / Board of the ICB

QUESTION

The Partners of the Ivel Medical Centre in Biggleswade have handed back their GMS Contract back to the Bedfordshire, Luton and Milton Keynes Integrated Care Board (ICB). Since this announcement, the ability to obtain a doctor’s appointment has become even more difficult. What are the ICB actively doing to resolve the issue, including the hiring of additional staff to serve the increasing population of Biggleswade?

I know a new hub is being considered but this may be rejected, so what is the plan? These are difficult times for us all in Biggleswade, communication from the ICB on progress would be much appreciated.

ANSWER

The partners of Ivel Medical Centre resigned their General Medical Services (GMS) contract giving 6 months’ notice. Their contract will terminate at midnight on 31 May 2023. The partners continue to be responsible for providing primary medical services during their notice period. We have written to all patients to confirm that we do not need them to take any action, and that we will keep them updated of any developments.

The most recent data confirms:

• The total number of appointments recorded at the practice is steady and the % of GP appointments has increased from 48% to 59%.
• Face-to-Face appointments each month are between 92-95%, (national average of 68%)
• Appointments booked on the same day have increased to 57%

There are weekly meetings with the practices to support the safe handover to a new provider, and the partners of the practice are working closely with the ICB to support and retain staff during the notice period. The employed staff are aware they will Transfer under Protected Employment (TUPE) rights to the new provider on 1 June 2023.

The ICB is providing additional dedicated management support to the practice to help to recruit to vacant posts. In the last week, the partners have confirmed they have successfully recruited an experienced receptionist who will transfer to the new provider on 01 June 2023.

The ICB has a responsibility to secure a new provider from 1 June 2023 and as such is currently undertaking a procurement process. Given the commercially sensitive nature of this process the ICB cannot provide further updates, but expects to be in a position to announce the new provider in mid April 2023.

As regards new hub in Biggleswade, we continue to work with our health and care partners to develop proposals. No decisions have been made about new integrated health and care hubs in BLMK.

PQ3 – Living Wage Foundation Meeting – in relation to Health Inequalities

QUESTION

As BLMK work to reduce inequalities in everything they do, and are specifically looking to reduce systemic inequality, would Felicity Cox agree to meet with leaders from Citizens UK and a representative from the Living Wage Foundation to discuss the benefits of becoming Living Wage accredited. The real Living Wage rates are higher because they are independently-calculated based on what people need to get by.

Luke Larner, Priest, St Paul's Church Bedford

Catherine Butt, Vicar at St Frideswide's Church Bletchley

Rebecca Stockman, Affordable Housing Development Consultant, LivShare Housing

ANSWER

Thank you, Father Larner, Reverend Butt and Ms Stockman.

We would be very pleased to meet with leaders from Citizens UK and the Living Wage Foundation to discuss the matter of the ‘Living Wage’ and to understand Living Wage accreditation.  We are grateful for the contact you have made and look forward to meeting with you.