NHS England and NHS Improvement

Chair Appointments – BNSSGJune 2021

Healthier Together was established as a partnership to improve health and wellbeing for the people of Bristol, North Somerset and South Gloucestershire (BNSSG)

2016

Partnership formed

2020

ICS

designation

2019

Long term plan

Sept 2021

ICS Memorandum of

Understanding

The 10 Healthier Together ICS partners are:

Clinical Commissioning Group:

• BNSSG CCG

Local Authorities:

• Bristol City Council

• North Somerset Council

• South Gloucestershire Council

Healthcare Providers:

• Avon & Wiltshire Mental Health Partnership

NHS Trust

• North Bristol NHS Trust

• One Care (BNSSG) Ltd

• Sirona Care and Health

• South Western Ambulance Service NHS

Foundation Trust

• University Hospitals Bristol and Weston NHS

Foundation Trust

We are developing integrated care partnerships (ICPs) in six localities:

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

Feb 2021

White Paper

published

Trusts (Acute and MH): 3

Local authorities: 3

PCNs: 18

Population: 1m

Place: 6

CCGs: 1

CCGs, Local Authorities, and Providers and CQC Ratings

CCG Local Authority (LA)

NHS Bristol, North Somerset and

South Gloucestershire CCG

• Bristol City Council

• North Somerset Council

• South Gloucestershire Council

CCGs and LAs

Provider Current CQC rating

North Bristol

Hospital NHS Trust

• Overall: Good

• Safe: Good

• Effective: Good

• Caring: Outstanding

• Responsive: Requires improvement

• Well-led: Outstanding

University Hospital

Bristol and Weston

Foundation

Trust (UHB &

Weston acute sites)

• Overall: Outstanding

• Safe: Requires improvement

• Effective: Good

• Caring: Outstanding

• Responsive: Good

• Well-led: Outstanding

Avon and Wiltshire

Mental Health

Partnership Trust

• Overall: Requires improvement

• Safe: Requires improvement

• Effective: Good

• Caring: Good

• Responsive: Requires Improvement

• Well-led: Requires improvement

Providers and CQC ratings

CCGs, Providers and Local Authority – Accountable officers & leadership

CCG

Organisation Chair Accountable

Officer

NHS Bristol, North

Somerset and

South

Gloucestershire

CCG

Jonathan Hayes Julia Ross

Providers

Organisation Chair CEO

North Bristol

Hospital NHS

Trust

Michele Romaine Maria Kane

University Hospital

Bristol and Weston

Foundation Trust

Jeff Farrar Robert Woolley

Avon and Wiltshire

Mental Health

Partnership Trust

Charlotte Hitchings Dominic Hardisty

Local Authorities

Local Authority Leader Chief Exec DASS DPH Combined

Authority

Elected

Mayors

Bristol City Council Marvin Rees Mike

Jackson

Hugh Evans Christina

Gray

Dan Norris,

West of

England

Combined

Authority

Mayor

North Somerset

Council

Don Davies Jo Walker Sheila Smith Matt Lenny

South Gloucestershire

Council

Toby Savage Dave Perry Chris Sivers Sara

Blackmore

Gold

Silver

Bronze

Partnership Board

Executive Group

System Oversight

Planning & Oversight

Operations Performance

Performance subgroups

Finance Planning

System planners

& DDOFs

DOFs Deputy

DOFs

Business Intelligence

PMO System Transformation

Integrated care

Acute care collaboration

Urgent care

Population Health, Prevention & Inequalities

Mental health & LD

Children & Families

People Digital Estates

Clinical Cabinet

Strategic comms

System transformation• Core ICS function• Overseen by Steering Groups• Each Steering Group is Chaired by an

Executive Group member/sponsor

System planning• Cyclical function• Overseen by Planning and

Oversight Group• Coordinated by PMO and system

planners• Each cycle requires Executive

oversight

System oversight• Core ICS function• Overseen by Planning and

Oversight Group• Supported by system

planners and Deputy DOFs (DDOFs) group

• Supported by system performance subgroups on

• Planned Care• Urgent Care• Integrated Care• Primary Care• Mental Health

EPRR• Incident control function• Manged through

command and control structures

Function leads groups• Informal structures, not currently part of system governance• Facilitates cross system collaboration between functional leads• Helps to align organisational and system level working• Supports system performance and transformation functions

System enabler functions• Business intelligence and PMO capabilities• Supports system oversight and transformation functions

System governance groups

Covid-19 incident control functions

Functional leads groups

ICS functions

Key

Key focus areas for System Oversight function

System enabler functions

COOs group System planners group

System change group

HRDs group

Directors of Finance• Financial planning and reporting• Risk and control total management• Financial advice on transformation

(costs, savings and affordability)

Localities

Inner City & East Bristol

North & West Bristol

South Bristol

Weston, Worle & Villages

Woodspring

South Gloucestershire

BNSSG Gold command has the same membership as the Executive Group

BNSSG Locality footprints

BNSSG ICS Governance Arrangements (Current)

ICPsInner City & East Bristol

North & West Bristol

SouthBristol

Weston, Worle & Villages

Woodspring South Glos

North Somerset HWB South Glos HWBBristol HWB

ICS Partnership

People in their communities

Agrees Integrated Care Strategy

Delegates functions, decisions, funding; defines leadership

and governance ICPs accountable to ICS for NHS-funded care

ICPs report to HWB and have regard to the JSNA and JHWS

Local HWBs: • Set local priorities for

ICPs• ensure health

inequalities focus• enable integration of

health and social care at LA boundary

HWBs produce JSNA and JHWS for ICS to regard

Joint HWB

Responsible for developing an integrated care strategy that addresses the wider health, public health, and social care needs of the system

Responsible for the day to day running of the ICS; lead and oversee planning and delivery of NHS services across the system

Acronyms: • HWB: Health and Wellbeing Board• JSNA: Joint Strategic Needs Assessments • JHWS: Joint Health and Wellbeing Strategies

‘At Scale’ Provider Collaboratives

Work in progress – does not currently include key functions, such as: • Clinical and professional leadership• System planning and performance oversight• Quality improvement and oversight • Health and wellbeing transformation and enabling programmes

BNSSG ICS Governance Arrangements (Future) Work in progress

Key principles for how we work together as an ICS:

➢ Individuals @ the centre

➢ Subsidiarity

➢ Collaboration

➢ Mutual accountability & equality

➢ Transparency

BNSSG ICS NHS Body

Our shared vision for the people of BNSSG

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

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.

BNSSG Strategic Priorities

1. Developing our Partnership and transitioning to a statutory ICS: evolving our ways of working as an ICS to ensure our system is fit for purpose to achieve our goals for the people we serve and support our staff in the transition

2. Developing ICPs (x6): transform experience of health and care (starting with community mental health) through fully integrated preventive, proactive/anticipatory and personalised services:• Focused on local people’s health and wellbeing• Building on the asset base of individuals and communities• Embedding the voluntary sector and working with community and faith groups…• …to make the community the default setting of care 24/7, 365 days a year

3. Recovering from the covid pandemic: increasing access to our services through online, telephone, and face-to-face appointments; reducing waiting lists and supporting our staff

4. Adopting a new value-based health and care approach to meet the aims of population health by focusing on achieving the outcomes that matter to people, services that work for them and are culturally appropriate, and making the best use of resources• Working with the community to optimise access to services and prevention/early intervention • Promoting wellbeing for the whole population, and not just those who present to services • Ensuring equitable and efficient resource allocation • Progressing to long term financial stability

5. Improving our performance: driven by the outcomes we want to see for our population; raising standards, e.g., faster diagnosis and treatment for cancer and improved access to physical healthcare for people living with learning disabilities and serious mental illness

6. Redesigning pathways to transforming health and care services for the people we serve (e.g., stroke, mental health, learning disabilities, autism, children's health)

7. Provider collaboration across the sector to improve outcomes and consistency of care, transform patient experience, and delegate and optimise use of resources• Acute care reconfiguration • Community provider collaboration • Mental health collaboration

8. Developing our People: collaborating on recruitment, retention, and learning and development and increasing diversity to make BNNSSG the best place to work

9. Developing our role as an anchor organisation – investing in and working with communities to impact the wider factors that make us healthy, addressing root causes of health inequalities and promoting social and economic development

SW Strategic Priorities

• Reduce health inequalities

• Work in partnership

• Become digitally enabled

• Address mental health needs

• Put in place regional diagnostic hubs

• Make the SW the best place to work

• Develop improvement capability

Strategic Priorities 2020-2025

In-year objectives 20/21• Regional co-ordination of COVID, winter and EU Exit operational

responses

• Delivery of flu and COVID vaccination programmes

• Recovery and restoration of services

• Maintain business critical and statutory regional functions to keep patients and staff safe

• Make the South West the best place to work

View of the South West Region

6m

Population

(9.7%)

SW England

9,200 square

miles (18%)

20/21 Allocation

£11.2bn125,000

NHS Workforce

The South West in numbers

5/5 life expectancy

and causes of death

indicators better than

average

4/5 Child Health

indicators are better

than average and

some the best in the

country

2nd/3rd lowest

under 75

mortality rates

for CHD/cancer

2nd worst

diabetes

detection rates

2nd highest

suicide rate

9.3 year

difference in

male life

expectancy

Lowest number

of G&A and CC

beds per 100k

popn

11 |

Features of our South West Operating ModelThese are areas of work that can be led by relevant directorates

NHSE/I Operating Model

SW Regional ICS Development Programme

Na

tio

na

l

A1 ICS

Governance &

accountability

A4 People &

Culture

A3 Digital,

Technology, Data

& Intelligence

ICS Policy Design Workstreams

ICS Implementation Programme

ICS Development Steering Group

Bi-Weekly – Attended by Regional Directors, ST&T National Directors, ST Directors

A5: Provider

CollaborativesDesign Test Site

(Glos)

A2 ICS Financial

Framework

Somerset +

CornwallBSWDorset TBCDevon

Syste

m

Collaborative

Commissioning

Group

Strategic

Commissioning

Workstream

A6: Direct

Commissioning

TBC

S7a

Commissioning

workstream

Specialised

Commissioning

workstream

Primary Care

Commissioning

workstream

People & Culture

Working Group

Re

gio

n

SPOC

3-Weekly System

Check-in

Development

PlansDelivery Plans

SW ICS

TeamSW PD forum

System Leaders twice weekly sessions

SW WLT ICS Development