Presentation – Representatives of the Better Health Programme will give a presentation to the Joint Committee updating members in respect of the Phase 3 Engagement process including further information regarding the potential long list scenarios/options and evaluation criteria to be used during options appraisal
Minutes:
Ali Wilson, HAST CCG on behalf of the Better Health Programme Executive delivered a presentation which included a summary of the information the Committee had received so far including the details of the NHS England’s Five Year Forward View.
The presentation went on to inform Members about the Sustainability and Transformation Plans (STPs) which were being developed to deliver the NHS England Five Year Forward View. Local NHS organisations and local authorities were developing their plans for health and care in their area by 2020/21. There are 44 geographic areas – known as ‘footprints’. There are no statutory bodies, the STPs were collaborations of organisations working together to ensure there was a shared strategy. Work was currently on-going in local communities between the local authorities and the CCGs etc.
Working in a larger geographical footprint ensured benefits from economies of scale but the plans would ensure that local information was not lost.
The STPs acted as an ‘umbrella’ plan and included plans for certain challenges, for example: improving cancer diagnosis; mental health care; transforming urgent and emergency care services; and providing more care outside hospital.
Footprint areas should build on existing engagement through health and wellbeing boards and other local arrangements. Each area was responsible for engaging local people and stakeholders on their draft proposals.
It was acknowledged that the introduction of STPs and the Better Health Programme, along with other local engagement could cause confusion for the public, when they are being asked to comment and get involved with the wide range of consultation on different issues.
The draft STPs were submitted in June for review by NHS England and NHS Improvement. The Better Health Programme (BHP) was included as a key element for the Durham, Darlington and Tees footprint. The link between the STP and the BHP was based on how people currently used the services and how the services could work together. Discussions had taken place on whether or not health officials had got the footprint right and work was ongoing in that respect.
Work that had taken place with regard to the BHP meant that the Durham, Darlington and Tees Valley area was well ahead of many other areas in developing plans. BHP representatives explained that in considering patient flows across both the North East STP (covering Northumberland Tyne and Wear) and Southern STP, suggested changes to the ‘footprint’ of the southern STP had been put forward during August to remove North Durham CCG from the Southern STP and BHP footprint and add it to the North East STP Area. This had been put forward to take into account patient flows from North Durham into Tyne and Wear and meant local commissioners could influence the pattern of services to the North. These recent developments across the 2 Regional STPs would have an impact on the original timescales envisaged for the BHP and formal consultation and the original timescale of November 2016 appeared unlikely.
Councillor Martin-Wells expressed his concerns that the STP was just another name, people have little faith and that the lack of scrutiny of the STP concerned him. In response Ms Wilson outlined that the STP was not an entity or organisation that makes decisions.
Councillor Cook agreed that the STP needs scrutiny to ensure some form of checks and balances were applied.
Mr Gwillym confirmed that the statutory and legal responsibility for the establishment of this committee was to examine any substantial developments or variations in services the proposals might create along with associated proposals for consultation and engagement.
Councillor Clark outlined his concerns that the STP was part of the NHS family and a partnership of NHS, local authorities and the voluntary sector. He asked if additional funding would be available through STPs and areas would be asked to bid for funds. Ms Wilson outlined that there was a funding formula, and therefore a variation in who gets what when they bid for monies. She outlined that unfortunately the NHS can’t give everybody everything they want and that tough decisions have to be made.
In terms of the BHP progress, the committee was informed that a process of scenario development had been undertaken. The modelling process had created a long list of 13 scenarios, which required refinement and evaluation.
The long list was defined by what the area was required to have nationally and that couldn’t be changed. The major trauma centre has to be at James Cook due to national and regional configuration of trauma units. Vascular services and Critical Care (levels 1-3) have to be present at the same site.
There are 9 scenarios for the key services – the Committee was provided with the details of each of the scenarios.
In terms of scenario development, reference was made to the discussion earlier around the potential changes to the BHP footprint and how that might invariably lead to re-modelling of scenarios prior to formal consultation. The Committee was also advised that all STP submissions were required by NHS England in October, which would also include potential implications for the Better Health Programme. The Committee requested that details of the STP submissions be brought to a future meeting of the Joint Committee alongside details of the re-modelling work undertaken for scenario development together with details of the work undertaken to date in respect of Not In Hospital activity/services.
Councillor Dryden stated that it was hard to get a picture of how it would all look and lots more ‘meat was needed on the bones’. He asked at what point in the modelling process does a service reach a critical mass and become overwhelmed. Ms Wilson explained that they were working with ambulance colleagues to look at the percentage shift in overall activity and when it might not be sustainable.
Cllr Dryden asked when the committee would receive that information and was told that it would be given in the phase 3-4 engagement.
Cllr Martin – Wells stressed the importance of having accurate scenarios developed alongside a deliverable implementation plan and associated consultation and engagement strategies.
Ali Wilson HAST CCG indicated that the move to 24/7 acute services across those disciplines covered by the BHP would lead to improved outcomes for patients. To reference this point, Mr Cruikshanks cited the development of Major Trauma Centres and that this had reduced Major Trauma mortality rates by around 30%.
The committee were presented with an update from John Pendleton regarding the phase 3 engagement that had been undertaken, which was an independent assessment of the consultation process that had been undertaken to date.
There were come general concerns amongst Members about the numbers involved but the Committee heard that it was on par with public engagement for this sort of event. Cllr Newall said that for the main part those who attended were health professionals or Councillors and that efforts should be made to make the sessions more accessible, perhaps removing the prior registration aspect. Edmund Lovell indicated that should any local authority wish to have a drop in session for BHP then steps would be taken to try and accommodate such requests.