Agenda item

To provide the Surrey Wellbeing and Health Scrutiny Board with an update on progress towards NHS Sustainability and Transformation Plans (STPs).

Witnesses:

 

Julia Ross, Chief Officer, NHS North West Surrey CCG & Surrey Heartlands STP lead

Giselle Rothwell, Head of Communications and Engagement, NHS North West Surrey CCG

Tina White, Frimley Health STP Programme Director

Amanda Fadero, Sussex and East Surrey STP Programme Executive Board Member

Cliff Bush, Chair, Surrey Coalition of Disabled People

Matthew Parris, Evidence and Insight Manager, Healthwatch Surrey

 

Graham Ellwood, Tim Hall and Ben Carasco were absent from the room for a brief time during this discussion.

 

Key Points raised during the discussion:

 

Surrey Heartlands STP

1.    The Chief Officer reported that at a recent Committees in Common on 20 October 2016, the Sustainability and Transformation Plan (STP) received good feedback overall, and that the focus now was very much on work-stream mobilisation and robust engagement activity to enable implementation to begin in 2017/2018.

 

2.    The Chief Officer explained that following the Committees in Common meeting on 20 October 2016, the plan had been amended, to take on board comments raised at the meeting.  These changes included clarification of governance arrangements of shared resources and the role of carers.  The plan would be published when the STP had received the latest feedback from NHS England.  The next stages of the plan were dependent on the widespread public, staff and patient engagement that was being undertaken.

 

3.    Members were informed that engagement thus far had identified that quality and speed of care was of greater importance to the public than location.  The next stage of engagement would entail a quantitative survey with 1500 randomly selected people from the community being invited to take part.

 

4.    It was acknowledged that the biggest challenge was primary care.  The Board noted that within 10 years, the population of over 85s would have increased by 36%, placing additional pressures on the health system with no additional resource.  Having not received investment for a long time, the workforce needed to evolve and the delivery model would need to change with it.  This was exemplified in the Epsom Health and Care model, where acute services were now working in partnership with community health and social services to meet demand in a different way.  Witnesses highlighted that this had led to a decrease of acute bed days by 25%.

 

5.    Members enquired whether there were plans to de-layer the governance structure within the STP.  The Chief Officer explained that this would be a challenge due to there being 11 organisations involved in the STP including three Clinical Commissioning Groups (CCGs).  The Board was informed that the CCGs deliver primary care at community level, therefore their contribution was vital. 

 

6.    The Board noted that the STP sought to balance individual requirements by consulting with a representative sample of the community.  It was highlighted that, traditionally, working-age adults had been the hardest group to engage with.  A number of engagement approaches would been undertaken to ensure this group was involved and that all care needs were identified.

 

7.    The Board noted that the Council had an important contribution to make towards the success of STPs;  by providing democratic political mandate, providing a link to the local population and supporting the NHS and local authorities achieve full integration within health and social care.

 

8.    A Member highlighted that information surrounding STPs at borough and district level was very scarce and it was difficult to inform and advise residents.  The Chief Officer recognised that things could have been done better in this regard; and the latest version of their plan was being circulated to boroughs and districts in order to allow Members to better engage with their residents.

 

Frimley Health STP

9.    The STP Programme Director explained that as one of the Country’s smallest STPs, initial discussions were had around the viability of the footprint area, however it was decided that it was credible and there was room to make a significant impact.

 

10.  The Board was informed that the basis of the Frimley STP was predominantly to build on existing work and to use the STP as a vehicle to take health services and patient experience to the next level.  Currently two years in to the Five Year Forward View (5YFV), it was vital to identify areas in need of traction; as well as recognising areas of success which could be developed at scale. 

 

11.  The STP Programme Director indicated that the embargo of sharing the full plan with the public was frustrating and detrimental.  There was a desire to engage and understand what the changes would feel like within the local population.  The plan was still work in progress and changes would be made in line with engagement findings.

 

12.  The Board was advised that Frimley’s STP priorities were underpinned by a programme of transformational enablers, one of which was developing the workforce.  The Board raised concerns around the need to strengthen the workforce, given that the right people needed to be in the right place in order for implementation to succeed.  The Programme Director acknowledged the Board’s concerns and explained that the design of a support workforce provided the opportunity for a joint recruitment strategy, enabling staff to be recruited to work in various roles across the STP and provide a mixture of acute, social and home-based care, therefore reinforcing the workforce.

 

13.  A representative from the Surrey Coalition of Disabled People raised concerns with the presentation, stating that there was no mention of carers; and that 45% of the plan would not work without the carer community being considered.  The Programme Director reassured the Board that while the patient and carer community had not yet been involved, a lot of this engagement was in the pipeline and that the communications work-stream were focusing on a plan to engage the wider community and gain feedback.

 

14.  The Board was informed that each work-stream had established steering groups, with patients, public and Healthwatch representatives forming the membership.  It was suggested that scrutiny groups could feature within the governance structure. 

 

15.  The Board was advised that the STP had also worked closely with neighbouring STP areas; namely Buckinghamshire, Oxfordshire and Berkshire, to reduce clinical variation of care and improve outcomes. 

 

Sussex and East Surrey STP

16.  The Programme Executive Board Member explained that their programme faced similar complexities to those of the other two STPs who had already presented, however, Sussex and East Surrey’s plan incorporated 27 different organisations and covered eight CCGs.  It was therefore necessary to break their STP down into three place-based plans; Coastal Care, Central Sussex and East Surrey Alliance (CSESA) and East Sussex Better Together (ESBT).  Furthermore, it was explained that each place-based plan had an executive appointed for leadership, forming a leadership system across the STP.

 

17.  The Board was informed that primary care and community-based care were the main areas of focus across the STP, however each of the place-based plans had their own set of priorities dependent on the demographic and the service provision within its own footprint.  The Coastal Care plan had been fully aligned with social care over the past two years.  The CSESA had only been in place since August 2016, however despite the alliance being new, the principles of the plan were not. 

 

18.  The Board were advised that the STP plan had not yet been shared publicly.  The ESBT plan was fully available to the public, while the Coastal Care and CSESA plans had, to date, only been shared in part.

 

19.  The Programme Executive Board Member pointed out that three key challenges for the STP had been identified; Health and Wellbeing, Care and Quality, and Finance and Efficiency.  Sussex and East Surrey faced higher than average pressures of the ageing population and higher rates of cancer. It also featured Brighton and Sussex University Hospitals NHS Trust that was currently in special measures having been rated as inadequate by the Care Quality Commission (CQC) and East Sussex Healthcare Trust was  also in financial special measures.

 

20.  The Board noted that similarly to the previous two STP presentations, doing nothing was not an option.  The do-nothing shortfall would amount to £865 million by 2020/21.  By sharing resources and working together across the STP, they would be in a £55m deficit after five years.  The witness stated that Sussex and East Surrey faced some financial challenges and that its recovery would be a long and slow journey.

 

21.  The Programme Executive Board Member advised that there was a public expectation of care from cradle to grave, however it was ultimately down to the individual to look after their own health and make the correct lifestyle choices whilst there was a duty for the NHS to focus of promoting prevention, and the return on investment in this field was much further down the line.

 

22.  The Board was informed that the STP had developed a separate winter plan, identifying the use of community hospital beds for patients no longer requiring acute care and increasing capacity of home care resulting in speedier discharge from hospital, in preparation for the tough winter ahead.   

 

Recommendations:

 

The Board thanks the respective witnesses for their contributions. It recognises the challenges posed by the STPs, in particular the financial and demand pressures faced across both social care and health providers.

The Board recommends:

1.    That each footprint provide the Board with an update on progress in delivery of the STPs, with a particular focus on how the Board may contribute to the plan success;

 

2.    That each STP define and share its governance arrangements as a matter of priority, with a particular emphasis on improving public understanding around how decisions are made within the STPs;

 

3.    That STPs seek to engage with the relevant district and borough councils in order to improve public awareness, and report back to the Board on planned and future activity in this respect;

 

Surrey Heartlands

4. That the Board receive a future updates on:

 

Frimley

5. That the STP seek to engage more widely with patient and carer participation forums, and provide a further briefing of how this activity has influenced the development and delivery of the plans

 

Sussex and East Surrey

6. That the STP share the place-based plan relevant to Surrey with the Board, when available for scrutiny.

 

 

 

The meeting adjourned at 12:30pm and resumed at 12:40pm