Meeting documents

To receive this report.

The Committee received a report and presentation from the Sustainability and Transformation Plan (STP) Programme Director and the Strategic Lead – Communication and Engagement.

The presentation set out the shared vision for reforming health and social care to address the challenges of the rising needs of our population, changing demographics and increasingly stretched resources.  The presentation highlighted the strategic priorities identified by the Programme Executive Group and the proposals for engagement with stakeholders and the public.  This included: the STP vision and case for change; the priorities for closing the Health & Wellbeing, Quality and Financial gaps; the ‘One Plan’ approach for integrating care and pathways; identifying ‘quick win’ projects; establishing Design Groups to develop and implement solutions; addressing issues of sustainability and improving efficiency; and the three phases of the engagement and communication process.

The following points were raised during the discussion:

·        One of our biggest problems is that the NHs is enormous and parts of it are not accountable to the public.  How will you get each department to work together?

-        We can’t underestimate the challenge but there are incentives for this to work.  Individual organisations don’t have the resources and adequate funding so this encourages collaboration and co-operation.  There are national issues to address in Somerset. 

·        Have you thought about working with the emergency services?  We are all talking the same language and experiencing the same issues.  I would invite you to attend the South West Emergency Services Forum and explore avenues there.

-        We haven’t properly engaged with the emergency services and there is opportunity there.  Thank you for the insight.

·        I applaud the vision of this ambitious project but have concerns as we have been talking about this for years.  There is an emphasis on early intervention but there is a huge cohort already in the system that has missed early intervention so savings are a long way off. 

-        With prevention, longevity is the key in this area.  Some people who already have a problem can be helped e.g. those with hyper-tension.

·        Can community care be stepped up to the level that we require to make this work? Staffing in this area is already a challenge.  The STP will be seen to be driven by financial cuts and people will focus on this instead of the need to make clinical change.  I think the timescale to achieve this will be difficult to meet. 

-        I agree with a lot of what you say.  The key is to have something in place which has been tested to show the public and to reassure them of change.

·        I am concerned that the perception will be that the STP is a delivery model to achieve cuts.  The closure of community hospitals and beds is concerning.  The NHS needs more public money.  I don’t believe that we can achieve savings through efficiency alone.

-        There has been no discussion of closing community facilities as part of the STP yet but we do recognise that we have a finite pot of money no matter what plan we develop. 

·        How did you achieve the £8m saving in overspend?

-        This was achieved through savings and cost improvement plans, for example, reduced agency spend and reduced costs of delayed transfers of care.  There were lots of small things that added up to that saving. 

·        How will early intervention work?

-        These are being developed at the moment with clinicians.  At this stage we have identified this as an area to improve and the plan is yet to come. 

·        The language used in the report is not simple enough for the public to access it.

-        We agree with the need to use plain English and to explain things better.

·        With regards to housing, there is a huge challenge to get groups together.  How to get people back into their homes for care instead?  Volunteers are difficult to find especially in large built-up areas.

·        This is seen as a cost-saving exercise and the five year timeframe is not achievable.  The NHS is a bottom-less pit.  You could poor money into it forever.  There are huge staff shortages and they can’t be trained at the drop of a hat and there are not enough volunteers.  We are going to lose expertise and knowledge.

-        The workforce challenge is very real; only 4% of the workforce is under 24.  We are very supportive of a university for Somerset.  It’s important to remember that we are not coming from a standing-start.  We already have some good examples in Somerset and we are considering hwo we can widen this.

·        Village agents – we don’t have the in urban areas and Councillors don’t always know who they are.  I think that village agents are working well but they are not in every community.

-        This is being developed and grown.  We will have them in all areas in the future.  We could bring this to Scrutiny at a later stage once it has been developed.

·        I am hearing that there is consensus amongst NHS staff that the NHS needs reform but that there is huge disagreement about how it should be changed.  There is a conflict between strategic views and local views.  It requires a change of culture and the NHS needs to engage more. 

-        We will get local differences and may need to take account of these in our plans.

·        What percentage does the £600m overspend represent of the total budget?

-        It’s around 6-7% over that period.

·        That is very low compared with the savings that other public sectors have had to make.

·        Are you going to engage with the One Public Estate (OPE) process for sharing facilities?

-        We are engaged with OPE and have a representative on the Board.  We are having conversations about sharing facilities. 

·        With regards to the need to consult if significant service change is needed; what is the definition of ‘significant’?

-        There are very clear guidelines around this and we would be happy to circulate this.  We would expect to consult over significant changes to clinical services but it may not be required for some areas, for example, changes to back office systems.

·        I am concerned about recruitment and training of staff and I am not sure that this has been addressed in a meaningful way.  This is not a joined up approach in my view.

-        Recruitment and retention is key and there is a benefit to collaboration.  Historically, we have been competing with each other to recruit from the same pool of people.  There is work to do also around re-defining roles but it is a big challenge. There is a dedicated workstream looking at this.

·        I have heard that Musgrove Park Hospital is very consultant heavy and there is not enough theatre time to support them but that this is not being addressed.  There doesn’t seem to be a balance of responsibility.  Where do community hospitals fit into this?  What’s the plan for them?  You need to be upfront early on with the public over this. 

-        Community hospitals are only one piece of the strategy and shouldn’t be looked at in isolation.  There is the voluntary sector, complex care at home and bed-based care in the community.  We don’t yet have a plan for this so we are not at a stage to share it.  Somerset does have more community beds than other areas. 

·        It is critical to engage at a local level.  In South Petherton the village agent, volunteers and parish councillors are collaborating together and this is working very well. 

·        What does a local community care plan look like?  Who decides if someone is fit enough to go home?  Some people need an in-between service and historically this has been delivered by community hospitals.

·        We need to consider the issue of transport.  It makes more sense for staff to travel around the county rather than patients. 

·        A&E needs a stronger message that it is only for emergencies.  If someone presents several times, we are not addressing their problem.  GP’s used to filter patients and now patients just go direct to A&E because they can’t see their GP. 

-        People do present at A&E for reasons that are not emergencies.

·        I would like to give a Public Health perspective.  The STP is about what is right for the health of the population.  Need and demand is undoubtedly increasing and the NHS is becoming unsustainable.  I have been inspired by the Fire Service which used to be very reactive but has had a huge shift to prevention.  The NHS needs to achieve this flip to being more proactive in keeping people healthy to stop them needing to use services.

-        It all came back to education for the Fire Service.  One severe road incident costs the emergency services and NHS £1.6m so prevention is very worthwhile.

-        I agree but it is hard to back this up with evidence when you see the Government making so many cuts to preventative services. 

The Committee agreed with the priorities identified and was content with the direction of travel for consultation and engagement.  It noted the report and requested an update at the next Committee meeting.