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Strong Integrated Care Systems Everywhere

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received Royal Assent on Thursday 28th April. So missed the original 1st April deadline but clearly in place before ICSs come into effect in August. The Act puts ICSs on a statutory footing. The proposals within the Act mean that each ICS will be led by an NHS Integrated Care Board (ICB), an organisation with responsibility for NHS functions and budgets, and an Integrated Care Partnership (ICP), a statutory committee bringing together all system partners to produce a health and care strategy. When ICBs are legally established, Clinical Commissioning Groups (CCGs) will be dissolved.

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This follows a national naming convention, but is likely to be controversial as people in North East and North Lincolnshire do not see themselves as Humber and many from York don't see themselves as North Yorkshire folk either. Sue Symington is our designate Chair and Stephen Eames the designate Chief Executive. Sue was formerly Chair of York & Scarborough Hospital NHS Foundation Trust and has strong connections with the city.​

We are being told very firmly that 80% of ICS work will still be done locally, at place. These are York, NYorks, ER, Hull, NLincs and NE Lincs. There is some talk though of 2 subregions, Humber, and North Yorkshire. So we expect there to be more work taking place across North Yorkshire and York too.​

It is widely expected that the Place Lead will be a local authority appointment, probably the Chief Executive. Place Directors are NHS appointments and likely to be known to us already too. Some areas have announced their appointments (e.g. NHS Cheshire and Merseyside ICB have published theirs already) so we're expecting more news imminently.

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Humber and North Yorkshire Integrated Care Board (ICB)

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NHS Humber and North Yorkshire Integrated Care Board (ICB) NHS Humber and North Yorkshire ICB is a statutory organisation accountable for NHS spend and performance for 1.7million people. The ICB is a core member of the Humber and North Yorkshire Health and Care Partnership, alongside NHS providers, local councils, health and care providers and voluntary, ...

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Humber and North Yorkshire Health and Care Partnership

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Our vision is ambitious and will not be achieved overnight. We have identified priority areas to deliver the vision we have set out.
View our work

Key documents and publications, outlining our policies will be published here.
View documents

We work with a range of partners including the NHS, local authorities and those in the Voluntary Community and Social Enterprise sector.
View our partners

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Humber & North Yorkshire Health & Care Partnership

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Our vision is ambitious and will not be achieved overnight. We have identified priority areas to deliver the vision we have set out. View our work Key documents and publications, outlining our policies will be published here. View documents We work with a range of partners including the NHS, local authorities and those in the Voluntary Community and Social Enterprise sector.

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Item 3. York Health and Care Prospectus draft v 1

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Q: Will Place Board have meetings that are open to the public?

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Q: Will Place Board have meetings that are open to the public?

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A: Yes they should. But questions around the accessibility of such meetings. HWY support with providing information, gathering views etc

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Q: Where will the 20% of commissioning decisions be made if not at Place level? 

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Q: Where will the 20% of commissioning decisions be made if not at Place level? 

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A: At ICS level e.g. Mental health services, hospitals, perhaps dentistry

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Information provided by the ICS is difficult to access. Long and inaccessible language. Poor website in comparison with other ICS.

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Involve volunteers from Universities?
Involvement of local funding providers e.g. Joseph Rowntree Foundation?

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Workforce – reforming work experience – getting everyone to see what health and care services do

Healthcare workers in care homes should be valued – pay to reflect the valuable service provided

Joined up social care and health to reduce need for hospitalisation – more treatment at home

Recruitment – high agency, unfamiliar workers, running on minimum numbers, staff working above hours regularly

Tackle work force development issues locally and nationally

Difficulty recruiting volunteers within the community

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Child mental health services –access – pathway – better communication

Crisis team – not accessible – potentially ableist advice – can't cope with demand (6 agree)

Lack of eating disorder knowledge in primary services

Effect of cost of living on eating disorder treatment and recovery

Lack of treatment for bulimia, AFRID etc. ED services very anorexia focussed

Lack of autism and ADHD knowledge within CMHT

CMHT off-load people with SMI to GPs

Mental health support – sometimes no beds in hospitals for people who need admitting

It seems impossible to get any early intervention – esp. MH – which just leads to bigger more expensive care and treatment needed in the longer term

Mental health services – waiting times, discharging if not attending appts, accessibility

My daughter waited 11 months for a CAMHS appointment

People with eating disorders been referred to the health trainers which are not a suitable service

SMI physical health checks not happening

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People struggling to access or afford care

Lack of carers for core plans (too long to implement)

Lack of choice of social care providers and also poor availability

Lack of time for people who really need help – patched up and sent on their way when they really needed further care

Lack of affordable respite for carers (cover burn out)

Accessing and paying for care within own home

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Hospital waiting times

Blood testing facilities seem to be stretched with longer waits

Appointment times are getting worse for hospital services

Long waiting lists

People being discharges and then readmitted to hospital within a few days

Hospital waiting times

Staff at hospital doing an amazing job but just completely overwhelmed

Lack of help with meals in hospitals

Long stays in hospital leads to loss of mobility

Recruitment – lack of social workers in local authority – delaying decisions

Waiting times, discharges, access to mental health services

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A big issue for older people. This has become worse as a result of isolation and fear of covid (5 agree)

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NHS dentists!

Dental care – lack of provision leading to much bigger health and social care (3 agree)

How to register with an NHS dentist

No NHS dentists – too expensive if need private treatment

NHS dentistry and how expensive treatment is!

Lack of access to dentists

Dentistry – how many peopole in York are affected? Invest in prevention I.e. campaign for a check-up for 1) children 2) older people 3) other

Access to dentists – waiting times, strikes, emergency care access, bed blocking

Lack of dentists / specialist dental services

Dentist!! NHS – used to be a school dentist – perhaps should re-introduce so that all children have access to dentistry!!

Dentistry and contract reform. Good ICS gets it, bad they inherit something awful...

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Waiting times at A+E (3 agrees)

A+E waiting times

Ambulance and A+E waiting times

Lack of timely responses from ambulance service

Long waits for duty psych at A+E – people getting very distressed or just leaving

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Access to support for benefits etc. Waiting times for support – services over run

Respiratory illness in current rising costs of living

Very high threshold to access support/ care

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Rarely meeting accessible info standards

Lack of accessible taxis and public transport

Blue badge issues affecting people’s ability to get to appointments

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Community engagement – what do we mean by community? Not an amorphous mass, do we target particular groups?

Get some early successes to demonstrate how we can make a difference – this will help engagement and clarify purpose and priorities

Improved preventative health checks – only access GP services when needed – no health check service – if there is is not made aware of it

Will co–production really work? Will overstretched services stop being overstretched?

Government incompetence at managing pandemics and large public health concerns

Lack of accessible information

Communication with the public needs to be two way and real!

Lack of communication between primary and secondary services

Lack of day services for people with incontinence

Lack of communication between services

Language and the underpinning of our system. Patient as problem e.g. bed blocking, house bound, non-compliant

Integration – is it really going to happen if we don’t all figure out how to get along? Issues of who gets on with who, money, power agendas, values- missing bits

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Mental Health

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GP waiting times – barriers to seeing somebody face to face

Medication shortages

Needs assessment taking too long

Price of prescriptions! Tell people their options e.g. block pay, benefit entitlement etc

GP online service only – hard to get an appointment if digitally excluded and getting past the reception team

Access to GPs via the online system

GPs and communication – PPGs – concerns not open to all – have they ever got going post pandemic – part of solution to our engagement problem?

Lack of timely access to GPs

Lack of face-to-face GP appointments for people with dementia

Accessing GP appointments – long wait list times on phone GP for medication issues not just appointments

GP services – face to face? How do they compare across York? Booking appointments online

Difficulty getting GP appointments – e consult not accessible to all

Inability to see a know/family GP for people with cognitive impairment

Lack of preventative intervention, leads of crisis in home (so costs more in the long run)

Waiting for GP answering services seems to be worsening in some areas

Unable to access GP services – unable to get through / book appointment

GP access and communication – getting through the gatekeepers – digital or in person

Access to GPs – booking online – digital exclusion or vaccines etc - COVID boosters (4 agree)

Great service from community response (via paramedics)

People feeling dismissed, invalidated or ignored by health services

Getting a GP appointment – it' easier to go through 111 and then get care at the hospital – increasing impact on hospital services

Lack of GP annual reviews

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How residents, volunteers and professionals want to engage with the ICS

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How residents, volunteers and professionals want to engage with the ICS

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Focus on communicating your aim

Focus on what’s important to us – GPs – Dentists – care

Work in existing public places e.g. libraries

Proactive engagement

Plan for digital exclusion – leaflets and posters

More visible messages – what do you stand for?, what do you want to tell us?, how do we get involved?

Information packages for community organisations - so we can share information

Make the info accessible and plain English

Make use of LACs – gather views and disseminate info

How do people find out about meetings, ways to be heard?

How would the digitally excluded ever be involved in this?

Awareness raising needs to come with real opportunities to be involved

Lots of different channels so need to share them all – lots of people won’t come to meetings

Thinking about what everyone sees – importance of repetition of messages

If I didn’t work in it I wouldn’t know anything about this

Lack of information about new changes

Should be talking to the voluntary sector

How do we share the worries of the service users?

We have access to the voices of service users – we should be asked

Willingness but lack of information

We need up to date information to advise our clients

New acronyms?

So many people in community sector need to know how to advise clients

How will the theory become practice?

What are the aims at the top?

How do we support clients if no info from the top?

What is going on? Here to learn

What is the system are we getting value? For us all to come together

Managing expectations – painful choices are they being transparent

I have no idea how anything fits together in health and social care – I am a citizen of York

Access to GPs, health and social care, micro vs macro

What is the intended purpose – the why? More people you introduce the better

Not sure how this all fits together – influence, but what? Seen Healthwatch...

Which body in terms of accountability- place based is the why to so!

Having ability to talk to the ICS

I’m not invested in the structure – I am concerned with the service (structure not of concern to the customer)

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Women's Health

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Join up public services

Decouple menopause and women's health over 75+

Improve access to HRT

Awareness raising/education, health professional training, women’s health clinics and proper health checks at relevant ages, community approaches to public health e.g. drugs, alcohol, obesity, accessible inclusive welcoming general services e.g. walk in Monkbar and not helpful using language chat masks e.g. frail and older women as everything 50+

Improving access to mental health services – reducing wait times e.g. for counselling

Breastfeeding stigma/public places- list of supportive places women can go to feed?

Inclusion- different languages, nationalities – having enough translators for appointments so women understand what's happening

Nursery places for free childcare hours – not enough in areas of York with high demand for places (e.g. Tang Hall)

Lack of education – public, employers and medical staff – medical staff need to be trained so that they understand the difference in presentations/ symptoms for illnesses ion men and women

Stress – have more talking shops

Acknowledgment and research into conditions that may be experienced differently if a person is female e.g. response to medication

Consent and pressure – schools consent project, better curriculum, mention during contraception appointments and social media

Cervical screening (age) - proactive social prescribing, accessibility, trauma informed, improve language barriers, drop ins

Menopause and support – bigger emphasis during training, more holistic approach, respect, peer support, understanding from work places and fit for purpose medication

Joining things up properly to work together across; public health, health, social care and VCSE

Survey of women, what gets in the way of accessing health services, what would you like to see different

Access to safe gyms

Educations around safety in schools

Consider the person not just a collection of symptoms

Access to childcare

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Individual’s responses to the Healthwatch York cost of living report 

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Individual’s responses to the Healthwatch York cost of living report 

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You need the community groups – such a vital part of the community

Understanding how we help tenants when landlords not helping

How do you support the people who are helping? This breaks the work/life barrier

More info re mould and respiratory conditions

Why is it so complicated to access help? Eg – gov £67 every energy company doing it differently

Hard when there is no end in sight

Even besom are inundated – can't do xmas boxes for everyone

Proportion of people affected is enormous

People will get sicker, putting more pressure on overstretched services

Gas and electric comments

Having to eat – gluten free chimes with me, people considering foods that will make them ill

Service managers are worried, how are support workers?

The words “depression” and “anxiety”

Fear of the unknown is the worst thing

Nothing in York that is difference?

Emergency response – no stigma – these we for you... more supermarkets offered

We've some back with post crisis mode- what can wer do! Ask what we’re allowed to do!!

So what? What is this telling us? What can we do? From health and wellbeing

Warm spaces – libraries / folk hall – non- stigmatising

Nothing does surprise me – relative impact onm some groups is higher?

Predatory practices – putting up prices for no apparent reason – rent – fuel

Seems no end to it and don’t know how it might end

Students getting more in debt, struggling

People who were already vulnerable – even more so now

Basic services – seeing a GP / getting an ambulance so much harder to cover the basic care

We are plugging the gaps in health and social care – we struggle to care for higher level of need

Going back to black outs!

Paying more for council tax for fewer services

Use of agencies paying so much more for agency bank staff – need to use resources to train new staff

Anything you disagreed with? - theory is good and how do we move forward?

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HWY Listening to people with dementia: Update report 

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HWY Listening to people with dementia: Update report 

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LGBTQ+ Health and social care

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Your thoughts on HWY 2023 - 24 priorities 

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Your thoughts on HWY 2023 - 24 priorities 

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How LGBTQ+ people's health can be improved

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How LGBTQ+ people's health can be improved

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Listen to and involve service users.

Co-produce training for staff.

Work with the community sector.

Respect gender and identity.

Face to face support rather than self-help kits.

Replicate the trans drop in.

Continue York LGBT Forum referrals from GP/health services to access social support.

Review forms and information gathering to ensure questions are appropriate

Ask and then use the appropriate pronouns all the time.

Don’t assume.

Provide information about what people can expect and what GPs can do.

Develop standardised information and guidance for healthcare organisations and professionals, including about shared care.

Have trans specialist GPs, like those for menopause.

Tackle prejudice and bias.

Provide more empathy and understanding.

Speed up waiting lists.

Introduce mental health check-ins.