Agenda item

In attendance for this discussion were:

Worcestershire Clinical Commissioning Group (CCG):

-       Simon Trickett, Chief Operating Officer (Wyre Forest CCG, Redditch and Bromsgrove CCG)

-       Carl Ellson, Chief Clinical Officer (South Worcestershire CCG)

-       David Mehaffey, Director of Strategy (South Worcestershire CCG)

Worcestershire Health and Care NHS Trust - Sue Harris, Director of Strategy and Business Development (and STP Communications and Engagement Lead)

Worcestershire Acute Hospitals NHS Trust (WAHT) – Chris Tidman, Interim Chief Executive

Simon Trickett, Chief Operating Officer, gave a presentation to provide further information on Sustainable Transformation Plans (STPs) – the concept, focus, challenges, targets, next steps and plans for communication and engagement.

Following comprehensive spending reviews, STPs were long-term five year transformational and collective plans to look at available funding, and what changes were needed to sustain services. STPs were strategic planning footprints covering the whole of England, of which there were 44 nationally, with a range of populations. Herefordshire and Worcestershire was a relatively simple footprint with only two Health and Well Being Boards and one of the smaller areas in population. However it had one of the larger areas in terms of geography and one of the biggest financial challenges, particularly as both acute trusts were in special measures.

The STP required a single budget and approach, and had the triple aim of identifying how to close the gaps in health and well-being, whilst improving care and quality, within the financial allocations available.

A lot of work had taken place so far. Some of the key challenges were already known to commissioners, such as the gap between life expectancy and healthy life expectancy. The significant challenges for Herefordshire and Worcestershire STP were around finance, care and quality, including NHS constitutional standards for Urgent Care, Planned Care and Mental Health. The financial challenge was already well known.

There were lots of areas which the STP would seek to enable as part of the overall transformation priorities to:

·         maximise the efficiency and effectiveness of back office functions and infrastructure

·         prevention approach and supporting more self-care

·         out of hospital care – home not hospital

·         reviewing use of specialist services – how and when

Total spend across Herefordshire and Worcestershire would rise from £1.168billion, to £1.327billion by 2021, but if services stayed as they were now, an extra £250million would be needed. The presentation showed a summary table of funding areas and indicative funding share.

The full draft STP would be published on 22 November, available online and discussed at Board meetings of Redditch and Bromsgrove CCG and South Worcestershire CCG on 24 November. More detailed operational plans for 2017/18 and 2018/19 were also being developed – the majority of which would already be known to HOSC members, as priorities built on previous activity and engagement, although this would not be the same everywhere nationally.

Public engagement and discussion of the STP and Operational Plan would take place from January to March 2017, with implementation beginning in April.

Sue Harris, STP lead for communication and engagement explained that engagement on the principles and emerging themes of the STP had taken place throughout 2016 and would increase through the new website www.yourconversationhw.nhs.uk .

A lot of work on engagement and co-production was taking place, involving drop-in sessions via a mobile bus, events, forums and use of different communication channels. The Plan would be published on the CCG websites and on the designated STP website.

Feedback and key themes would be collated at the end of February, and formal consultation would take place on any changes required.

Main discussion points

·         It was clarified that although the concepts of the Plan were not new, the point of the STP was to bring all agencies together, not just commissioners - as part of a single plan, and collective direction of travel

·         The draft Plan published on 22 November would focus on priorities and principles. There would be areas of service change which would require specific consultation

·         When asked why HOSC members had not yet seen the Plan, the Chief Operating Officer advised that across the country, only a few Plans had been published (or leaked) and most would be published the following week

·         The Plan was still draft, was subject to input from the public and it would be a good while before the detail was finalised

·         When asked whether communications would include reasons and explanation rather than just principles, the CCG Chief Operating Officer highlighted the accessibility of the public-friendly version of the Plan.

·         It was confirmed that the aim was not to cut services, but to focus on available resources, outcomes and efficiency

·         Whilst supporting a self-care approach, a HOSC member pointed out that this was less easy for those who were old and sick. It was acknowledged that self-care covered a broad spectrum and that views on self-care varied amongst the STP partners. Signposting was important and more work was needed to map what worked well and how it could be embedded.

·         For some services, such as Stroke Services, collaboration with other areas would be necessary, and some providers would feature in more than one STP.

·         More certainty and structured planning would help staff recruitment and reduce the need for costly agency staff

·         Shared buying power would be important and STPs would also improve the health and social care interface

·         Several HOSC members spoke about their pride in the NHS, and why this made them concerned for health care in the future, and motivated their constructive criticism of plans

·         Contribution was invited from Cllr Johnson, a Worcester City Councillor present, who asked how confident were commissioners that the bid submitted for acute services as part of the Future of Acute Hospital Services in Worcestershire review, would be successful, and what was the plan otherwise? This was bearing in mind that the bid was central to the STP, and there were continued pressures from demand, year on year efficiency requirements, and the fact that all STPs would be competing for capital. Commissioners were confident of the bid's success, although nothing was guaranteed and the WAHT Interim Director acknowledged that 'Plan B' would be a 'nightmare scenario', and mean continuing with the temporary emergency changes already implemented. Investment was needed to ensure planned care, as well as emergency care and across the country the STP was being used as a mechanism for more strategic working

·         Comments were invited from the Healthwatch Worcestershire Chairman, who advised that Healthwatch, which was independent and not part of the NHS, met regularly with the Health officers present. He pointed out that it was NHS England which was responsible for plans not being made public earlier, although he agreed there was nothing new for Worcestershire – the operation and the detail would be interesting, and merit HOSC involvement

·         Healthwatch had recently held an open meeting, at which many of the issues raised today had been discussed – the weblink would be circulated.

The Chairman thanked everyone for a useful discussion, and a further update would be planned. HOSC members welcomed the information and looked forward to more involvement. Suggestions for groups to consult and locations for the consultation bus were also encouraged.