Agenda item

Sarah Dugan explained that the intention had been to bring the full STP to the Board meeting, but NHS England had extended the national deadline so the document was still a work in progress. A summary of progress and draft proposals had been provided.

At the last meeting some details of financial allocation had been given but work on costings and how the investment money would be allocated was still being worked on and the position had become more challenging due to new control totals for providers.

The plan had four key priorities:

1.    Maximising efficiency and effectiveness of the core infrastructure and back office functions,

2.    Prevention and self-care, which was a golden thread which ran throughout the plan,

3.    Developing out of hospital care, which would be developed while at the same time supporting people into care when needed. Expanded multi-disciplinary teams and pro-active approaches for people with long term-conditions would be important,

4.    Clinically and financially sustainable services with streamlined, but minimised access points.

Mental health services was another golden thread throughout the plan. Maternity services and learning disability services were also important issues.

Key enablers included the workforce where it had been challenging to gain staff at all levels; and digital solutions which had received a multi-agency response.

The latest submission had been made on 21 October and feedback was now awaited from NHS England. Once NHS England had commented on the plan there would be public engagement. The STP, including all the financial details would then be discussed at the next public meeting of the HWB. Specific areas would be consulted on and would be discussed by the Health Overview and Scrutiny Committee.

In the following discussion various points were made:

·         Healthwatch had been pleased to be involved in STP discussions from the beginning but were disappointed that the finance details could not now be shared although it was understood that the pressure to keep details confidential was from the NHS England. They were satisfied with the work of the team STP team, but they would like more details to be made publicly available. There would be a public Healthwatch meeting on 11 November when the public could ask questions regarding the STP,

·         The County Council Chief Executive felt that the financial challenges had been discussed at the previous two HWB meetings and the process had now moved forward. The details of the delivery programme had not been available at the last meeting. She agreed that the process had been inclusive and felt that Worcestershire and Herefordshire were ahead of some areas in sharing details,

·         It was queried how the plan could be implemented with the current austerity. It was agreed that prevention was important but there was not enough investment and it was unrealistic to expect community services to pick up everything the NHS would not pay for,

·         It was suggested that priority 4 should be listed first, but it was explained that it could only be delivered by getting the first 3 priorities right first,

·         The fact that there may be changes to community hospitals but that they were not at risk of being closed should be more explicit in the plan. It was agreed that they play a vital role but the number of beds available may be reduced,

·         It was clarified that references to 'place based estate' referred to the public sector estate and whether the best use was being made of it,

·         A board member disagreed with a comment that Andrew Lansley's reforms had been a waste of time because they had allowed there to be more clinical involvement in decision making and the STP process was largely about clinical sustainability,

·         Simon Trickett felt there had not been any secrecy and there were no great surprises to come. The Telegraph report which had been quoted was aimed at other areas which were only just starting to look at centralising services unlike Worcestershire which had started its Future of Acute Hospitals programme 4 years ago. The numbers were known – there would be £1.327 billion to be spent in 2021 for the Hereford and Worcestershire footprint and it was known that increasing demand needed to be dealt with – he felt the STP was now a matter of how the spend would be allocated,

·         It was a challenging time but there was collective commitment by partners to working together to get the best outcome for the public.

Following an invitation from the Chairman for invitations from the public gallery there were two comments:

·         The document presented emphasised the positives so that it was difficult for individuals to judge the document and to say how it would affect them as individuals?

·         Another member of the public felt that overall processes were improving services for patients but people still felt excluded from the process. He urged the STP staff and Board members to engage more fully with the public.

In response it was confirmed that a lot of what was included in the STP had been spoken about already but there were plans to increase the public conversation. The STP was not just the acute trust moving forward in isolation – it brought various plans and services together and that would make it easier for the public to assess the improvements.

RESOLVED that the Health and Well-being Board:

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

b)    Discussed and commented on the draft priorities;

c)    Discussed and commented on potential approaches to engagement; and

d)    Agreed to receive a formal update at the next Board meeting following the receipt of feedback on the draft plan from NHS England.