Agenda item

Sarah Dugan summarised presented information regarding the Sustainability and Transformation Plan. Board members were familiar with the concept of addressing the triple aim gap of Health and Well-being, Care and Quality and Finance and Efficiency; but following meetings with the national team the Programme Board was particularly focussing on what money would be available in 5 years' time – what future allocations would be given to CCGs rather than what would be done differently with the current spend.

Under the structured budget prioritisation work, 14 different work programmes had been identified, each one led by a Chief Executive Officer – but prevention and children and young people were themes which ran through all the different programmes. Analysis was taking place to find benchmarks which could be compared to other STP areas. The analysis would help to ensure that Herefordshire and Worcestershire were being as efficient as possible. Help was being received from the Commissioning Support Agency who had supported Board members in a programme budgeting exercise.

All areas of investment should show a decrease in costs elsewhere. For example investment in care at home should see a decrease in acute care costs. Back office and infrastructure efficiencies were also being sought across the public sector.

All local STPs had an allocation which could be invested in areas of national priority such as the digital agenda, 7 day services and parity for mental health services. The requirement for provider efficiencies was not yet included in the plans but once the plans had been worked up they would be brought back to the HWB and also to scrutiny.

Engagement with Healthwatch and the VCS was on-going and once draft plans had been completed engagement would occur with a wider group of stakeholders. Sue Harris had been working on an engagement strategy which would include public, patients and staff.

The next submission would be made on 21 October and as there would be a very tight turnaround it was proposed that proposals would be emailed to members of the HWB for comment. A full report would then be brought to the meeting on 1 November.

During the discussion, Board members queried how the consultation would be approached:

·         The plan was the beginning of the process and then specific consultation would occur and inform some of the detail before various parts of the plan were implemented;

·         The strategic plan being submitted on 21 October would outline the series of changes that would need to happen and then consultation would occur on those proposals as appropriate. Cabinet Office guidelines suggested best practice should be for consultations to be for 12 weeks but it depended on the size of the changes;

·         Board members felt that although consultation would happen prior to the implementation of certain proposals, they felt that general issues such as prevention, self- care and back office efficiencies should be communicated to the public straight away. Also the STP should be discussed at each HWB so that all members could take details back to their organisations. There was a need for the process to be as open and transparent as possible;

·         National guidelines about engagement and what should be revealed publicly were expected to be announced, but there had been on-going communications regarding core issues such as self–care and healthy communities and there had been a consistent message about why things needed to change. However it was accepted that the public now needed to understand what the changes would look like and how it would affect them;

·         It was pointed out that the changes were needed because of workforce challenges as well as financial ones;

·         The programme Board, made up of all the statutory organisations with an independent Chairman, was overseeing the development of the STP although the Plan was bringing together existing work rather than working from scratch;

·         Board members felt it was important that public expectations were managed given that some of the solutions may be quite radical;

·         It was good that the Local Authority and other partners were involved in preparing the plan. However this was balanced against the fact that although the footprint was one of the smallest in the Country, proportionately Hereford and Worcestershire were the 3^rd most challenged area out of 44 STP areas, with 2 acute providers who were in financial deficit and in CQC special measures;

·         It was clarified that although the two counties were working together on the STP the resources within each county would stay within the individual county. Of the total, Worcestershire was responsible for around 75% and Herefordshire around 25% of resources, although the greater proportion of financial challenge was in Herefordshire;

·         NHS England clarified that the plans would be sent to Simon Stevens and Jeremy Hunt who would decide if the plans were robust enough to proceed to public consultation in local areas.

·         In response to a question from the public gallery Sarah Dugan said the plan was a 5 year plan but timelines may vary in different areas and it was important that a robust job was done. Following an opportunity for HWB Members to comment on the draft submission, greater details would be available at the November HWB meeting.

RESOLVED that the Health and Well-being Board:

a)    Noted the progress on development of the Herefordshire and Worcestershire Sustainability and Transformation Plan (STP),

b)    Noted the Programme Budgeting approach being taken to allocate spend in healthcare and the implication of this on service transformation through to 2020/21, and

c)    Agreed that the draft plan would be emailed around HWB members for comment on 14 October prior to its submission to NHS England on the 21 October.