Agenda item

Attending for this Item were:

Frances Howie, Director of Public Health, Worcestershire County Council

Sue Harris, STP Communications and Engagement Lead, Worcestershire Health and Care NHS Trust

Ruth Lemiech, Director of Strategy, Worcestershire Clinical Commissioning Groups

A presentation was given which outlined the national and local background to STPs, highlighting that the NHS Five Year Forward View set out plans to improve health and well-being, improve quality of services and narrow the funding gap.  After consultation and engagement during 2016/17, the Herefordshire and Worcestershire Sustainability and Transformation Plan was published in Summer 2017 and the 'P' for Plan was changed to Partnership to reflect the joint working required in the implementation phase.

Structurally, a Partnership Board had been formed, which had an Independent Chairman.  Its remit was to oversee the delivery of the Plan through various sub groups.  Membership was drawn from clinicians, managers and leaders from across all programme areas and both Counties.

Triple Aims were often referred to and for the STP, these were:

·         Health and Well Being (improving Health Outcomes)

·         Care and Quality (improving Care and Quality)

·         Finance and Efficiency (delivering Financial Sustainability).

The STP vision was described as 'local people will live well in a supportive community with joined up care underpinned by specialist expertise and delivered in the best place by the most appropriate people'.  Within Worcestershire, there were already good examples of health economy partners working together to achieve better outcomes for residents.

The Presentation also explored Accountable Care Systems (ACS), where the NHS England definition was 'An ACS is an evolved STP through which local organisations take collective responsibility for the performance of their system'.

Nationally, it was hoped that STPs would evolve to become Accountable Care Systems, where NHS organisations (both commissioners and providers), in partnership with local authorities, choose to take collective responsibility for system resources and the population's health, providing joined up, better co-ordinated care, acting and behaving as one single system even though in law there are a number of distinct entities with distinct duties.

Nationally, in time, as ACSs demonstrate their ability to act collectively as a system, greater control and freedoms may be given.

Further developments were cited in relation to the ways in which working across organisations was already occurring, such as winter planning, a system wide focus on frailty and diabetes and extended access to Primary Care.

Next Steps included strategic discussions at all partners' Boards, including the County Council, to agree a set of principles which would guide the work towards accountable care.

In the ensuing discussion, the following main points were raised:

·         Members noted the shift from Sustainability and Transformation 'Plan' to 'Partnership', but agreed that the language used was not clear and the concept continued to be confusing

·         The Committee noted that some partners had statutory duties to fulfil and these would have to be taken into account when looking at future services, unless there was a move to change legislation.  Despite the desire to work collaboratively, it was felt that residents would still want to know 'who' was accountable for their care

·         One Member queried the definition of Social Prescribing, an area which was tackled well across different organisations.  In response it was described as a standard NHS term, whereby GPs may refer patients to non-clinical services, such as those provided by the community or voluntary sector

·         Community Hospitals were seen as the 'jewel in the crown' and an asset to be utilised.  With the concept of care closer to home their use would be stronger than ever, with examples given whereby extended GP access could see the sites being used as physical bases.  Previously, it had been reported that beds could close as part of the STP programme and it was clarified that some future modelling work was being undertaken.  Everyone acknowledged that the public was concerned and at an appropriate time in the future, an Item would be brought to HOSC

·         The Director of Public Health reported that Prevention was a strong theme across the programme and it was felt that success in this area could improve service efficiency in the future

·         The role of Independent Chairman was filled following a national advert and comprehensive recruitment process and it was clarified that future decisions would be made by a combination of clinicians and managers

·         When asked whether the workforce was in place to support new structures, it was said that this was not the case and had to be addressed urgently

·         The Committee understood that it was difficult to define the role of Community Hospitals and Minor Injury Units, but urged Representatives to improve communication to residents to ensure a clearer pathway to available services

·         Members felt that Integrated Care was much clearer than Accountable Care and hoped that nationally there may be a shift to clearer language.