Agenda item

To consider the attached cover report of the Principal Overview and Scrutiny Officer, Durham County Council and an associated presentation by Alan Foster, Chief Executive of North Tees and Hartlepool NHS Foundation Trust and STP lead for Durham, Darlington and Tees ;Hambleton, Richmondshire and Whitby STP.

Members were provided with a report that gave background information in respect of the development of health and care system Sustainability and Transformation Plans.

The Committee then received a presentation that updated Members on the progress made to date in respect of their development and submission to NHS England. The main information provided could be summarised as follows:-

-           Better Health Programme had become a key part of the local Sustainability and Transformation Plan covering the sub-region.  The STP Footprints had been determined nationally.

-           Organisations agreed that North Durham CCG would move into the Northumberland Tyne and Wear STP, and so no longer be part of the Better Health programme.

-           STPs were designed to address the health and wellbeing gap, quality of care, and finance and efficiency.  Local challenges included the need to reduce variation, ensuring success in relation to cancer mortality was repeated for other diseases, and standardising the approach to care across the area, including the care that was already available seven days a week.  This could for example mean increased access to specialists, and often involved the frail elderly.

-           STP needed to add value and stop variation.  Existing plans would be used and built upon wherever possible.

-           Details of the BHP model of care and the possible scenarios that were

being considered.

-    The Better Health Programme proposals included provision for a reconfiguration of acute care, but it was not planned that any hospital would close.  All sites would stay open but would deliver care differently.

-           Specialist hospitals would allow for patients to see a consultant who was a specialist in their condition or in that service. Currently this did not happen; patients may see an experienced doctor who would not always be a specialist in the condition the patient was at hospital for.

-           A timetable for the STP was provided with consultation on service change beginning in June 2017.  Also provided were October’s public engagement event dates.  Consultation had been moved back to 2017 in line with other STP timetables and no decisions had been made.

-           Some capital funding would be needed to change services, and each STP would be making bids to the national Investment Committee.  The local STP needed to be realistic about what it could secure.  National approvals would therefore not be given until March 2017.

Members were given opportunity to ask questions/make comments that could be summarised as follows:-

-           Representatives from North Yorkshire highlighted that during previous service reviews, residents had been reassured that although some services may be moved from the Friarage Hospital, Northallerton, they would still be accessible at Darlington Memorial Hospital.  It was noted that under the options being put forward, this may not be the case in future.  It was noted by the Programme Team that the CCGs in North Yorkshire were being engaged through the process.

-           Members queried the process of securing capital funding through the STP process.  It was noted that a bid would need to be made for funding for the period covered by the STP, although this would need to be ambitious but realistic.  Other sources of funding including via CCGs and money that individual Trusts could generate would also continue to be explored.

-           If no changes were made, the current estimated gap in funding between resources and demand would be £259m by 2020/21.  The STP would need to include both efficiencies and service improvements. The detailed finances of the local STP were still being finalised, but the local NHS would need to work within the overall financial limits imposed nationally.

-           It was important that consultation described all scenarios so the public were fully informed on what each would mean.

-           It was noted that future presentations should make clear that the Major Trauma Unit at James Cook was being retained, as this was not clear in the version presented to the Committee.   It was agreed that better descriptions of current and future services needed to be used.

-           Thought needed to be given to the different scenarios and how it would impact on some of the more rural areas in terms of distances to services.  It was agreed that distance would need to be factor in the options analysis.   It was explained that a big driver regarding services was the work force available to give a better 7 day service.

-           Engagement on the STP and BHP needed to be continually improved, including more events in the North Yorkshire area.

-           Members noted that workforce pressures had been a continual theme in recent years and queried whether there would be a concerted effort to attract staff.  The STP lead noted that there was a national training programme and that the local NHS was recruiting from the same pool as the rest of country.  There were not enough training places nationally, but efforts were being made to attract people to this area.

-           When considering the different scenarios, parking at the hospitals needed to be taken into consideration.

-    Members highlighted the importance of promoting genuine choice in maternity care, for example home births.

The Committee recorded the concerns of a Durham County Councillor in relation to the future place of North Durham within the region’s planning processes.  The area would in future be covered by the Northumberland and Tyne and Wear STP, but had previously been considered as part of the Better Health Programme, and would continue to be covered by an acute provider Trust that spanned both STP areas.

It was noted that 85% of North Durham patient contacts were via North Durham Hospital, and the next highest used providers were Gateshead and Sunderland.  For future planning processes it was suggested by the BHP that it made sense to include the area in the northern STP.

North Durham CCG would continue to engage with both the regional STPs.

Resolved that the information be noted.