Agenda item

South Yorkshire and Bassetlaw Sustainability and Transformation Plan

Chief Executives of Rotherham Clinical Commissioning Group, RDaSH, Rotherham Council and the Rotherham Foundation Trust to present

Minutes:

Chris Edwards (Chief Officer, Rotherham Clinical Commissioning Group), Louise Barnett (Chief Executive, The Rotherham Foundation Trust) and Sharon Kemp (Chief Executive) gave the following powerpoint presentation:-

 

Our Ambition:-

“We want everyone in South Yorkshire and Bassetlaw to have a great start in life, supporting them to stay healthy and live longer”

 

Why we need to change

-          People are living longer – and their needs are changing

-          New treatments are emerging

-          Quality, experience and outcomes are variable

-          Health and care services are not joined up

-          Preventable illness is widespread

-          Shortage of clinical staff in some areas

-          We have inequalities, unhealthy lifestyles and high levels of deprivation in South Yorkshire and Bassetlaw

-          There are significant financial pressures on health and care services with an estimated gap of £571M in the next 4 years

 

Health in its wider context

-          Being healthy is about more than just health services

-          80% of health problems could be prevented

-          60% are caused by other factors:

Socio-economic status

Employment

Housing

‘non-decent’ homes

Access to green space

Social relationships/communities

-          Public service reform

Personalised support to get people into work

Support young people facing issues

Develop wraparound services

Structure ourselves better

Make money work better to achieve outcomes

 

Reforming our services

-          We have a history of strong partnership working

-          We want to work together in new ways

-          Key to our success will be:

Developing accountable models of care

Building on the work of the Working Together Partnership Acute Care Vanguard

Joint CCG Committee

Local Authorities working together

 

Developing and Delivering the Plan

-          £3.9Bn total Health and Social Care budget

-          1.5M population

-          72,000 staff across Health and Social Care

-          37,000 non-medical staff

-          3,200 medical staff

-          835 GPs/208 practices

-          6 Acute Hospital and Community Trusts

-          5 Local Authorities

-          5 Clinical Commissioning Groups

-          4 Care/Mental Health Trusts

 

Developing the Plan

-          Built from 5 ‘place’ based plans – Barnsley, Bassetlaw, Doncaster, Rotherham and Sheffield

-          8 workstream plans (now our priorities)

-          Chief Executive and Chief Officer led

 

Our Priorities

-     Healthy lives, living well and prevention

-     Primary and Community Care

-     Mental Health and Learning Disabilities

-     Urgent and Emergency Care

-     Elective and Diagnostic Services

-     Children’s and Maternity Services

-     Cancer

-     Spreading best practice and collaborating on support office functions

 

Shadow Governance – Strategic Oversight Group

-          Collaborative Partnership Board – membership includes

5 Clinical Commissioning Groups

5 Local Authorities

5 Foundation Trusts

4 Mental Health Trusts

NHS England

Voluntary Sector

Healthwatch

-          Executive Partnership Board

-          Joint Committee CCGs

-          Provider Trust Federation

-          STP Delivery Unit

 

Reshaping and rethinking Health and Care

Our focus will be

-          Putting prevention at the heart of what we do

-          Reshaping and rethinking primary and community-based care

-          Standardising hospital care

 

Putting prevention at the heart

-          Drive a step change in employment and employability

-          Help people to manage their health in their community with joined up services

-          Invest in a region-wide Healthy Lives programme – focussing on smoking cessation, weight loss and alcohol interventions

 

Reshaping Primary and Community Care

-          Improving self-care and long term conditions management

-          Social Prescribing

-          Early detection and intervention

-          Urgent care intervention and treatment closer to home

-          Care co-ordination

 

Standardising hospital care

-          Reshaping services

-          Managing referrals

-          Managing follow-up appointments

-          Diagnostics and treatment

-          Reviewing local and out-of-area placement in Mental Health Services

-          Specialised services

 

Early Implementation

-          Spreading best practice and collaborating on support office functions

-          Children’s surgery and anaesthesia

-          Hyper Acute Stroke Services

-          Acute gastrointestinal bleeds

-          Radiology

-          Smaller medical and surgical specialties

 

Financial Challenge

-          We currently invest £3.9Bn on Health and Social Care in South Yorkshire and Bassetlaw

-          If we do nothing we estimate a £571M gap by 2020/21:

£464M Health gap

£107M Social Care gap

 

Putting the Plan into action - Our Objectives

We will:-

-          Reduce inequalities

-          Join up Health and Care Services

-          Invest and grow Primary and Community Care

-          Treat the whole person, mental and physical

-          Standardise Acute Hospital care

-          Simplify Urgent and Emergency Care

-          Develop our workforce

-          Use the best technology

-          Create financial sustainability

-          Work with patients and the public

 

Engagement

We will:

-          Connect and talk with our communities

-          Connect and talk with our staff

-          Foundation is in place with:

Partners’ communications and engagement group already set up

Strategy in development

Local conversations in ‘place’ already happening

 

Our Timeline

-          Collaborating on support office functions – 2016-2019

-          Develop network approach to services – 2016-2021

-          Review Hospital Services and resources – 2016-2017

-          Develop accountable care systems – 2016-2020

-          Implement GP Forward View – 2016-2020

-          Improve self-care and long term management of conditions – 2016-2021

-          Focus on employment and Health – 2017-2020

-          Invest in Primary Care and Social Prescribing – 2017-2020

-          Develop and invest in Healthy Lives Programme 2017-2021

-          New model of Hyper Acute Stroke Services – 2016-2019

-          New model of Children’s Surgery and Anaesthesia Services – 2016-2019

-          New model of Vascular Services – 2016-2019

-          New model of specialist Mental Health Services – 2017-2020

-          New model of Chemotherapy Services – 2016-2018

 

Discussion ensued with the following issues raised/clarified:-

 

-          There had been a lot of the concern regarding the decision by NHS England to keep the STPs confidential.  Some other areas had gone against NHSE advice and published their STPs early.  Would it have been better for South Yorkshire and Bassetlaw if it had been published early?  All Plans would be available in the public domain by Christmas; Rotherham’s had been published in November.  Everything going forward would be in the public domain.  With hindsight it was a misjudgement to have kept it private.

 

-          What was the aim of the consultation or was it an information sharing exercise?  The Plan contained a set of aspirations.  Working together across South Yorkshire was something everyone would want with increased prevention, joined up services and integration across Health and Social Care.  However, the devil would be in the detail as during the course of the next 4 years when the business cases that underpinned the Plan were submitted there would be deeper discussions.

 

-          Would the consultation change anything?  The Plan was an aspiration and if people thought the aspiration was wrong then it needed to be known.  It was an evolving document.

 

-          Was the “80% of health problems could be prevented” a snapshot of South Yorkshire and Bassetlaw or a national figure?  It was a national statistic.

 

-          With regard to governance, Sir Andrew Cash had recently stated to all the Chairs of Yorkshire Health and Wellbeing Boards that there would be an Accountability and Commissioning Board where any resources, be it staff or otherwise, would go.  The Board would be Chaired by him and it would make decisions as to where the funding would go.  The model set up did not take into account the key accountability of Members of any Council who were accountable to the electorate for any resources they spent.  Currently there was very little information being communicated with regard to the key accountability of Members and that was a real concern – The only governance the 3 Chief Officers were aware of was that contained within the presentation i.e. the Collaborative Partnership Board whose membership included the 4 Chief Executives who were very clear that they had no mandate to make any actions/decisions through the Board and that they had to go through each of their organisation’s decision making processes.  That feedback had been consistent.  The 4 Chief Executives needed to be part of the Partnership Board to influence and ensure key local issues were taken into account and make sure that whatever came out of the STP delivered the Rotherham Place Plan as that was what would make a difference to Rotherham residents.

 

The Cabinet Member would receive briefings.  However, there was a need to get complete clarity with regard to the governance and where the decision making rested.  The 3 Chief Officers were firmly of the view that the Partnership Board was an officer working group that would feed back into the respective decision making processes.

 

-          Children’s and Maternity Services had been included as 1 of the Plan’s priorities and mentioned how a particular challenge was staffing it 24/7.  Was this solely down to the lack of workforce and if so what had led to that shortage?  Was it national or just a challenge for Rotherham and South Yorkshire? There were a number of factors for The Foundation Trust but workforce was always a significant challenge and there were national workforce challenges.   You also had to be cognisant of the size of services, the level of demand and complexity of need.   As an organisation, the Trust was very clear and committed to the delivery of high quality Children’s and Maternity Services.  They were provided 24/7 and consideration was being given as to how to better provide those services going forward. 

 

A key part of the Place Plan would start developing around Children and working with all the partners across Rotherham to work through how to meet their needs well.  From that basis the Trust would then be contributing into the STP to ensure that where the Trust may need collaboration with other acute organisations to perhaps improve on clinical input which could be delivered to support services for Rotherham, this would be secured to deliver the Place Plan.

 

Staff shortages were not particular to Rotherham.  Like many organisations, the Trust struggled to recruit and was trying very hard currently to ensure that it created an environment where it could retain the staff it had and reduce turnover whilst at the same time creating an attractive place to work for other colleagues.  The Trust had recently recruited some quite exceptional individuals to help lead elements of those but continued to have vacancies in some areas.

 

-          Rotherham should not dilute the great services it had to its detriment for the wellbeing of other places – If done correctly, the STP should be a huge opportunity for Rotherham.  The Foundation Trust was very self-aware but there were several specialities that needed collaboration to be sustainable.  Hopefully the process would allow hospitals to collaborate with Rotherham patients treated in Rotherham unless there were good reasons, clinical or financial.  The default position was work behind the scenes to manage the workforce and the patient being offered treatment on the same site.  The majority of services should be provided from the same site.

 

-          The interim governance arrangements would remain in place until April 2017 during which time a review would take place.  What was currently operating?  Where was the review and what was it moving to?  What we have now was the arrangement on the slide with the 17 organisations having met once as the Collaborative Partnership Board. The review was to take place by April, 2017.  It would be the expectation that the Collaborative Partnership Board would receive the review.  The questions posed would be raised at the Partnership Board.

 

-          Had work taken place on the specialist areas possibly being brought together with regard to patients’ families travelling to visit and the associated costs?  Work was commencing on the 8 workstreams and would result in business cases and proposals for change.  If there were major changes it would have to go to full consultation and mapping of the impact for patients and family but had not reached that stage as yet.

 

-          In the recent Autumn budget the Chancellor had stated that there was no monies for prevention.  How was it intended to be able to deliver the standards desired and to meet the challenges when there was no extra funding?  Realistically there was no funding and making prevention part of everyone’s day job was essential.  Making Every Contact Count should not cost anything; if every health professional made a smoker aware of the Smoking Cessation Services on offer that intervention could make a big difference.  The Healthy Lives Programme, focusing on the “big three” of smoking cessation, weight loss and alcohol, and trying to measure how all Rotherham professionals could communicate that and ensure that the Rotherham population had the best access and made informed choices. Rotherham partners were trying to ensure that prevention would be one of the early workstreams.

 

 

-          Would the increase in GP budgets be for increased Health Checks?  In the plan there were 2 areas that received investment – GP and Mental Health Services.  In terms of GP Services it was 2-3% investment which would tackle the management of patients with Long Term Conditions and access to GP services.  However, there were not as many GPs so Primary Care would be looked at to provide, for instance, a pharmacist in the practice or more trained nurses to allow the GPs to spend more time with those patients with complex needs.  Prevention would be core to everything they did.

 

-          Are you looking at providing more training for staff who worked in GP  surgeries?  It was expected that every professional who came into contact with a patient to train them in the priorities.

 

-          If members of the public will be able to speak to other professionals at GP surgeries would anyone be refused to see a GP?  Every practice worked differently but patients would always be directed to someone who could meet their need.  The practice would judge that – it may be the pharmacist, physiotherapist etc.  If patients, after seeing those professionals, were not getting what they needed, they would need to see the GP.  It was about trying to get the maximum benefit from the GP appointment and saving people’s time.

 

-          How confident are you that GPs with the pressures that were on them and other clinicians for timescales and the time spent with patients that they could Make Every Contact Count?  GPs were a tiny portion of MECC.  It was hoped that people would get the message 2/3 times every time they came into contact with a health professional, Council Officer etc.

 

-          There was a complexity with the partnership working within and outside the South Yorkshire and Bassetlaw footprint.  The Transforming Care Plan for Learning Disability and Autism included 3 of the 4 South Yorkshire CCGs and North Lincolnshire.  Was there some train of thought as to how it would be tackled and how the Select Commission would be able to scrutinise it or would it be done on a singular basis?  The rationale for North Lincolnshire being in the cluster for learning disability clients was that RDaSH provided services there.  The 2 areas that you would normally see partnership with were North Derbyshire and Wakefield because of patient flow.  Although there was the STP boundary there would have to be partnership work with a number of STPs. 

 

The Chairman thanked Chris, Louise and Sharon for the presentation.

 

Resolved:-  (1)  That the presentation be noted.

 

(2)  That Rotherham Clinical Commissioning Group discuss with Public Health the possibility of providing local statistics regarding health problems.

 

(3)  That the Chief Executive of Rotherham Foundation Trust would raise the issues regarding the formal governance process with Sir Andrew Cash.

 

(4) That the Rotherham Foundation Trust submit their action plan to the quarterly briefing.

 

(5)  That consideration be given as to how the Transforming Care Plan for Learning Disability and Autism would be monitored/scrutinised.

 

(6)  That it be noted that reports would be submitted to the Select Commission on a regular basis with regard to STP priorities reaching decision phase.

 

(7)  That if Members had any further questions on the presentation these should be forwarded to be raised at the next Health and Wellbeing Board.

 

(8) That the comments made at the Select Commission be communicated to the Health and Wellbeing Board for inclusion in the formal consultation feedback.

Supporting documents: