Agenda item

The Committee considered the following reports:-

(i)   From the Chief Clinical Officer, North Durham Clinical Commissioning Group that gave an update on the Northumberland, Tyne and Wear and North Durham Sustainability and Transformation Plan (STP) (for copy see file of Minutes).

The Commissioning Manager, North Durham CCG advised that the engagement phase of the draft Sustainability and Transformation Plan had ended on 20 January 2017 and work on the consultation process was being developed in February but that consultation was not expected before June 2017.

(ii)From the Chief Clinical Officer, Durham Dales, Easington and Sedgefield CCG, and Clinical Chair Durham Dales, Easington and Sedgefield CCG that gave an update on the Durham, Darlington, Tees, Hambleton, Richmondshire and Whitby (DDTHRW) draft Sustainability and Transformation Plan (STP) (for copy see file of Minutes).

The Chief Clinical Officer, DDES CCG advised that the draft plan had been published at the end of November 2016.  He went on to explain that all STPs had been asked to look for gaps in the system and highlight funding and efficiency savings. The Southern STP is chaired by Alan Foster.  The wider agenda was being looked at including out of hospital care and how much more could be done in the community closer to the patient.  He stated that clinicians were of the view that only 2 emergency centres were required for the area.  The James Cook Hospital was one and the location of the other was still undecided.  The STP team were currently working through the decision making process. There were four key priority areas and he believed that the quality of the service and the workforce were the important areas although there was a financial driver and a financial efficiency was expected.

The Clinical Chair, DDES CCG added that the engagement process involved over 50 events.  He further advised that Phase 5 would begin this week with Maternity and Children’s Services and the number of units that were to be provided.  Due to the workforce and sustainability issues there would be fewer units.  The engagement events would also target the hard to reach groups.

The Chief Clinical Officer gave a reminder of the timelines and advised that the preferred option would be expected or consulted on in June 2017.

The Chairman said that she was pleased that the STPs had been pro-active in sending information out and engaging with the wider communities.  However, she had received a number of queries and questions from members of the public regarding the STPs.    People found that the information was not always clear and she suggested that improvements are required in putting the message across in a clearer way.  She also suggested that better communication was needed for the next phases of engagement. She further added that people need to be informed as to the reasons why the number of hospitals could not be sustained. She also asked who would sign off the final plans and what the process would be for that.

The Chief Clinical Officer, DDES CCG advised that this was not a new topic and had been discussed for the past 5 years in terms of proposals for the Southern STP. He said that there were significant issues regarding the sustainability of the acute hospital workforce. He said that it was important to look at newer working models as medicine continues to advance.  The Chairman re-iterated her point about letting the public know this and to be open and honest about the whole process.

The Chairman referred to the Accident and Emergency Department at University Hospital Durham and the plans to extend this and asked what the future held.  The Commissioning Manager explained that originally North Durham was part of the Southern STP and as the footprint changed this became part of the Northumberland, Tyne and Wear and North Durham STP.  She advised that as this was early in the process, relationships were being built with providers and work was being learnt from the Better Health Programme.  It had been a frustrating process and so far specific plans for this STP were not developed.

The Clinical Chair, North Durham CCG added that it would be unfair for the acute trust to put extension plans on hold while the STP was developed. He said that there was a chronic lack of A&E capacity at present at UHND and the changes would be a huge benefit.

The Chairman asked how the STPs would link into the NECA Public Health proposals.

The Interim Director of Public Health County Durham said the NECA recommendations would be taken forward.

The Corporate Director of Adults and Health Services added that the recommendation was for the whole footprint of Health and Social Care to be included in this prevention work.

The Chief Clinical Officer, DDES CCG said that it was difficult as NECA did not cover the whole of the region. 

The Chairman asked what message had been received from local people throughout the engagement events.  The Commissioning Manager responded that people were frustrated and nervous of what would happen.  They had expressed concerns about where their local hospital would be and where to access services.  She believed that people were aware of the financial challenges and that they had the responsibility to use facilities appropriately.

The Clinical Chair, DDES CCG found that people had come along to the events with a view and by talking to clinicians it had helped them to understand the issues. The public had been able to see that what we had now was not sustainable.  Ultimately, people wanted to know where the changes would happen.  He advised that no decisions had been made as they were still at the engagement phase.

The Corporate Director of Adult and Health Services was aware that the feedback on the draft North STP had ended on 20 January 2017 however she had asked for the Integration Board to consider the implications for both STPs. 

The Chief Clinical Officer, DDES CCG reported that some changes would not require consultation and that they would allude to that.  The public facing document would be made available to the Board.  He advised that people would be informed where to access Emergency and Urgent Care Services.  He added that transport was key and the STP were working through issues to ensure that other services were on board to help support any changes.  He mentioned that they did not want to change the BHP branding as it was part of the STP.  Workforce is a key consideration as part of the STPs.

The Corporate Director of Adult and Health Services referred to the sign off process involving two footprints.  

Councillor Allen said that it was important to have the best outcome for all, including the best clinicians and to learn lessons going forward.  From speaking to the public she was aware that there were concerns in rural communities.  Those people often did not have transport to get to hospital or to visit relatives in hospital on a daily basis for a number of weeks at a time.  She asked if information about outcomes of patient flow was available.  She added that it would be a big challenge to get people where they required treatment and to ensure transport and parking issues were addressed.

The Chief Clinical Officer, DDES CCG said that returning people home after a hospital visit was also important.  

Councillor Johnson was aware that the general public were concerned about the process.  He asked what would happen following the Phase 5 Maternity and Children’s Services process.  The Clinical Chair advised that engagement events would take place in February and March 2017 and taken back to the STP board that would determine what options would go out for consultation.

The Chairman of Healthwatch asked NHS colleagues to elaborate on what was happening with University Hospital North Durham as he had been led to believe that it was not being considered as part of the STP.  The Commissioning Manager, North Durham CCG advised that it was no longer part of the BHP and Southern STPs considerations.  She further explained that the Northern STP had not reached that stage of the engagement process.  The Chairman of Healthwatch said that the concerns of local people needed to be addressed.

The Director of Integration said that access to services and the development of services within the local community would give re-assurance to people.  She advised that an update would be available at the next Board meeting.

Resolved:-

(i)            That the contents of the reports be noted;

(ii)          That comments on the draft Northumberland, Tyne and Wear and North Durham STP be received;

(iii)         That comments on the draft Durham, Darlington, Tees, Hambleton, Richmondshire and Whitby STP be received.

(iv)         That a letter be sent to the STP leads from the Health and Wellbeing Board outlining additional issues as part of the engagement process be agreed.