Isolated elderly residents could “fall through the cracks” of a major revamp of how health and social care is commissioned in the region, councillors fear.

South Gloucestershire Council health scrutiny committee members raised concerns about the Government’s white paper for a new Health and Care Bill, including worries it would result in a “cost-cutting exercise”, writes Adam Postans.

Health chiefs said the wide-ranging reforms would improve services by requiring closer cooperation among providers, the NHS and local authorities, while the legislation would also scrap the mandate for all health service contracts to be put out to competitive tender.

CCG functions, including commissioning, will be taken over by integrated care systems (ICSs) which will work above a network of integrated care partnerships (ICPs) to be up and running by next April.

But councillors were skeptical and said they had seen previous attempts at greater collaboration fail because there were too many stumbling blocks.

Labour Cllr Andrea Reid said: “I am always for integrating systems and making them more streamlined and care more effective but I am always cautious of it being a cost-cutting exercise rather than an increase in resources which are needed as a result of Covid.

“The impact of inequalities on mental health has been vast.

“Can you reassure me this is not a streamlining of services but an increase in resources?”

Bristol, North Somerset and South Gloucestershire (BNSSG) CCG integrated care partnerships programme director David Moss said: “Initially this is community mental health.

“We needed to pick something where we could make change without turning the whole table upside down.

“For that explicitly, that’s new national money, a recognition of what is already invested in community mental health and saying to our partners ‘You already have these services, are they talking to each other sensibly, and by the way here’s some new money, tell us how you can best make that work’.

“There is no intention to take any funding out at any point.”

South Gloucestershire director of public health Sara Blackmore said: “It does feel like an opportunity.

“Governance and organisational boundaries aside, the opportunity is we can start to develop outcomes for our population and develop them based on the needs of our communities.

“We’ve learned a lot through the last 18 months in terms of listening to our communities and this builds on that process.”

Conservative Cllr Robert Griffin told the meeting at Kingswood Civic Centre on Wednesday, June 9: “I do appreciate a total revamp of care.

“The biggest problem I have is having a rural patch with a lot of elderly, isolated residents who don’t have any access to transport.

“How will they be dealt with in this new system?

“When it came to vaccinations we had to run around and get people to take them to vaccination stations.

“Normally even if they can get groceries they do need some help and I feel these people are the ones at the bottom who will fall through the cracks.”

Mr Moss: “It is a really valid point.

“I hope our integrated care partners will best understand those individuals and how they struggle to access those services and we will be able to prioritise how that’s managed as they did through Covid, because what we saw through Covid was great learning.”

He said the mental health impact of the pandemic had not yet reached its peak of demand so the time was right to make the changes to improve access to services.

Lib Dem Cllr Tony Davis said: “As a local member I’ve been through a lot of reorganisations of the NHS which seems to be ad nauseum.

“I am sure all these people are trying their best to make it work but until you get the actual person on the street who knows what the hell they can do and where they go to find information you have failed.

“This is what happened in Yate. We have a very nice surgery, we’ve got the drop-in centre, but the number of times the criteria has changed for when you can go into it and what you can go into it for is legion.

“So I’m sorry but I would like you to reassure me you’re going to make sure the average Joe on the street understands what he or she has to do to get access to these services.”

Mr Moss said one of the aims was to create a 24/7 service for community mental health, similar to A&E where people go “because they know it’s open”, and that they were determined to make the big cultural change needed.

Labour Cllr April Begley said: “We tried integration in the BNSSG area.

“Stumbling blocks previously have included IT systems and staff terms and conditions.

“What are we putting into place this time to ensure success of integration?”

Mr Moss said: “You’re right. We have looked at this, at who had done what elsewhere and how this was technically enacted, where it had gone well and what the blocks were.

“Terms and conditions and digital are really challenging.

“On digital since Covid, hospitals, primary care and other segments do not get their capital budgets individually any more, it’s one budget for the system and they talk through how it’s spent.

“That will start to unblock some shared priorities [for the money] to be spent in one way.

“None of this is quick but that is a big step.”

CCG area director David Jarrett said: “Oversight and responsibility for integration will be through this NHS ICS body at a system level and with current providers in the ICP.”