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

Ali Wilson, Hartlepool and Stockton CCG delivered a presentation in respect of the formal publication of the draft Durham, Darlington and Tees; Hambelton, Richmondshire and Whitby Sustainability and Transformation Plan (STP).

The Draft STP plan had been published on 24 November 2016 and was available on the respective CCG websites. The Committee were advised that NHS England has not yet given feedback on the plan. 

Ali Wilson set the national context for the introduction of STPs and the challenges that they are intended to meet.

The presentation stated that the STP is not about cuts to funding and that funding to the NHS is increasing but these increases are being outstripped by increases in demand and rising costs of interventions.

The Better Health Programme Board had recognised that the initial work on STPs had been NHS led but that it required a broad partnership of agencies and organisations if it is to deliver improved health outcomes for people.

Ali Wilson reported that the STP offers opportunities for significant economies of scale to be achieved in the delivery of health services.

It was noted that the footprint had been amended to reflect North Durham CCG moving across into the STP for Northumberland, Tyne and Wear.  The total population covered by the STP is now 1.1million.

Four priority areas were identified within the STP, NAMELY:

•           Preventing ill health and increasing self-care – identification of those at risk, screening, early intervention and prevention

•           Health and care in communities and neighbourhoods – integrated community teams, improved access to mental health services (throughout the life course), rapid response to prevent hospitalisation

•           Quality of care in our hospitals – most routine procedures kept as local as possible, specialist/emergency services available 24/7, reduce cancellations of operation, improve outcomes

•           Use of technology – to support people in more remote, rural areas and to promote people living independently in their own home.

The financial challenge was stated to be a projected deficit of £281 million in 2021, if nothing different is done.

Ali Wilson outlined the engagement that had been undertaken to date with members of the public and key stakeholders.

Public concerns raised included: safety; transport; access to primary care; access to mental health services; and hospital discharges.

Formal, public consultation planned for June or July in 2017.  In the interim, the Respective partners were seeking ‘transformation funding’ from NHS England to enable the implementation of the STP, once agreed.

Members of the Committee then asked a range of questions about the draft STP plan, as summarised below:

A question by a Member for Middlesbrough Borough Council was raised about the financial assumptions, specifically how the current tariffs for planned and urgent care affected decision making and whether the resulting re-distribution of funding was fair.  In response, Ali Wilson outlined that an “in principle” agreement was being developed between commissioners and providers so that future service commissioning will be based upon a more equitable, system-wide payment approach.

Ali Wilson agreed to provide further information on the tariff system, both what is currently in place and that which may be proposed under the STP process.

Derek Cruikshank emphasised that one of the aims of the STP was to promote collaboration and end some of the competition across the health economy that had prevented a system wide approach.

Cllr Jim Clark stated that North Yorkshire County Council will not be signing the STP plan and was calling upon the Secretary of State for one STP for North Yorkshire.  He went on to acknowledge the support given to North Yorkshire at a recent Parliamentary debate by the Rt Hon Jenny Chapman, Member of Parliament for Darlington. 

Janet Probert emphasised that the most important issue was that people received the highest level of care, wherever it was available.  The STP is a vehicle to achieve this.  She urged members to move on from discussions around boundaries and look at making the STP work.

Cllr Clark stated that devolution was also a factor in the discussions around the STPs, particularly in North Yorkshire.

Cllr Sonia Bailey raised concerns about the existing discharge to assess processes, the financial pressures upon adult social care services and the risk that patients would be discharged when community support was not sufficiently in place.

In response, Ali Wilson stated that the right thing for the patient is to move them out of hospital and into their own homes as soon as possible.  The challenge is to ensure that there is a joint approach to providing a range of support packages that enable this and promote independence.

Cllr John Blackie raised his concerns that the draft STP plan was dominated by the NHS and that little regard was being paid to the role of other organisations, such as local authorities and Great North Air Ambulance.  He also highlighted the issues faced by the more remote communities in the STP area and the distances that they would have to travel and so journey times to specialist and urgent/emergency services, should local services be downgraded.

Cllr Lorraine Tostevin stated that the process to date had been engagement and not consultation.  She acknowledged that processes were being worked through but stated that detailed information had not yet been brought to the Joint Scrutiny Committee.  There is a need for data and analysis to be brought forward to enable planning to be scrutinised.

Cllr Owen Temple noted that the engagement process had highlighted that there were opportunities to look at savings and efficiency gains from small changes to existing practices in the NHS, as opposed to large scale changes to structures.

Ali Wilson recognised that they process had been difficult and that more could be done to form the broad partnerships to necessary to design and deliver the STP.  Also, that the STP was a plan in progress and that it was evolving over time.

Stephen Gwillym requested that the plans for formal consultation be brought to the Committee prior to release for overview and scrutiny.  This was agreed by the Committee.

Resolved that the:

•           draft Sustainability and Transformation Plan be noted.

•           plans for formal, public consultation be brought to the Committee prior to release

•           further information be presented to a future meeting of the Committee regarding the Tariff system of payments for urgent and planned acre within the NHS system.

Public questions

Jo Land, ‘Call 999 for the NHS’ queried how the projected deficit of over £200 million could be eliminated whilst also increasing the quality of care.  She highlighted a number of gaps and omissions, asked that the plans not be signed off at this meeting and that the plans be referred to the Secretary of State.

Stephen Gwillym confirmed that the role of the Better Health Programme Joint Health Scrutiny Committee was not to sign off the STP plans but to oversee the development of the STP and the associated implications for the Better Health Programme.  He stressed that the Better Health Programme Joint Health Scrutiny Committee is not a decision making body in terms of approving either STPs or any proposed Better Health Programme service reconfigurations.  He acknowledged that Health Scrutiny legislation included the power to refer any proposed service reconfigurations to the Secretary of State for Health for review. However, in respect of the Better Health Programme, each of the constituent local authorities within the BHP Joint OSC membership retained the power to refer to the Secretary of State and it does not sit with the Joint Health Scrutiny Committee.

A member of public from Hartlepool questioned as to who will look after the people who are discharged into the community from hospital.  There are existing staff shortages and a lack of community services.

In response, Dr Boleslaw Posmyk stated that as part of the STP process resources would be freed up by patients leaving hospital to make community based services more robust and resilient.  A report will be brought to this committee in the new year

A member of the public queried whether the senior management structures in the NHS were being reviewed to reduce salary costs.