Agenda item

The Integrated Care Board (ICB) submits a presentation to update the Commission on the Leicester Neighbourhood Approach.

The Integrated Care Board (ICB) submitted a report to update the Commission on Leicester City Our Neighbourhood Approach. The following was noted:

·       The approach was not new but was now progressing through a 10 year plan.

·       There had been considerable debate regarding the configuration of neighbourhoods in Leicester. While not strictly geographical, the model had been designed to work across partner organisations.

·       The approach aimed to develop new ways of working that maximised staff capacity and involved the public more effectively.

·       Two health related priorities had informed the model, namely increased attendance at Accident and Emergency and rising emergency admissions. Although performance was comparatively better at University Hospitals of Leicester, it was recognised that too many people were attending hospital unnecessarily. Outpatient pressures within the city were also highlighted

·       It was emphasised that neighbourhoods mattered in delivering care closer to home. Distance to treatment and ease of access often led people to attend A and E as it was perceived to be simpler. It was noted that individuals often experienced multiple interconnected issues, for example asthma linked to housing conditions or mental health concerns in children associated with screen time and lack of exercise. Supporting residents to help themselves was described as crucial.

·       A strong partnership was described between health, social care and the voluntary sector, with a focus on directing people to support within their local communities and ensuring fair access for all.

·       The overarching aim was prevention. The 10 year plan was structured around three key areas: shifting care from hospital to community, moving from analogue to digital systems including use of artificial intelligence and technology to reduce waiting times, and embedding prevention. It was noted that this was a long term transformation and that plans needed to be measurable and auditable.

·       Key challenges included deprivation, life expectancy gaps, cancer outcomes and low vaccination uptake.

·       It was reported that there were 4 city neighbourhoods. Funding became available in pockets over time and partners would need to be creative in progressing priorities.

·       University Hospitals of Leicester had identified patterns of A&E discharge by area, including patients discharged without the need for treatment.

·       A neighbourhood steering group and workshops had been established to influence future practice. The Integrated Care Board, University Hospitals of Leicester and Public Health were developing a data pact to assess needs and inform priorities.

·       The model was moving towards a multi year locally led planning approach covering 2026 to 202

·       Proposed targets included reducing timeframes for cancer assessment and undertaking a full review of community paediatrics, which had not been analysed for some time.

·       The Initial priorities would focus on achievable improvements in 2026 and 2027, recognising that neighbourhood and provider level change would take 2 to 3 years to embed.

In response to members comments the following was noted:

·       Members expressed concern regarding what was perceived as another reorganisation and questioned the rationale behind the size differences between neighbourhoods. It was noted that one neighbourhood appeared significantly larger than another and this was seen as potentially inconsistent with the principle of fair access for all.

·       Members queried how areas had been grouped together and whether some areas, such as Stoneygate and Highfields, aligned well from a health inequality perspective.

·       In response, it was explained that the current configuration was a starting point and could evolve. It reflected what worked best for partners, including Primary Care Networks, and all partners had agreed the model.

·       Members reiterated concerns regarding population size differences between neighbourhoods and questioned whether resources would be proportionate. Assurance was provided that resources would be allocated proportionately.

·       It was emphasised that the focus should not solely be on population numbers but on building effective relationships between partners within neighbourhoods. Services themselves would remain unchanged.

·       Concerns were raised that combining areas such as Knighton and Spinney Hills could mask health inequalities, including significant differences in life expectancy between communities.

·       Members highlighted the scale of the transformation at a time of significant staffing reductions and asked for clarity on implementation timescales.

·       It was explained that the national programme remained in its early stages and there was no formal go live date. The approach would evolve over time, with further work planned in areas such as frailty and vaccination.

·       Members stressed the importance of strong local leadership and understanding of local communities. A lengthy debate took place regarding the value of local links and representation within leadership structures.

·       It was confirmed that Public Health had been involved in developing the areas to ensure deprivation data could be analysed appropriately.

AGREED:

1.     The Commission noted the report.

2.     Assurance be provided that data would continue to be maintained and analysed at community level to avoid masking health inequalities.