Agenda item

The draft Kent and Medway Health and Social Care Sustainability and Transformation Plan (STP) was publically published on 23 November 2016. This report brings the draft plan to the Board for information. Work is ongoing regarding the STP programme and a more detailed case for change will be published for public consultation in 2017.

Discussion

The Senior Responsible Officer for the Kent and Medway Health and Social Care Sustainability and Transformation Plan (STP) introduced an update on it. He was supported by the Programme Director.

The close working and co-operation of all Kent and Medway health providers and local authorities was considered to be a significant achievement of the STP to date. The strategic direction of the Plan would be developed over the next few months. It was noted that Medway and Kent were currently facing difficulties in coping with the pressures that winter was putting on the health system and that a mechanism would need to be developed in order to ensure that the system was better able to cope next winter. The sharing of good practice across Medway and Kent would be key to this.

The three key aims of the STP were to reduce inequality, raise quality performance and address financial challenges. In order to achieve this, interventions would be targeted in four key areas, which were Care Transformation, Productivity, Enablers and System Leadership.

The STP submission made to NHS England and NHS Improvement on 21 October 2016 had represented more of a Strategic Direction of Travel than a detailed plan. A submission of more detailed proposals was required by the end of the financial year, with the aim being to launch a public Case for Change during March. This would set out why change was required.

Development of the STP was challenging as the majority of professionals working on it were also doing full time day-to-day jobs. Resources would be required in order to make the development and delivery of STPs sustainable in the long term and to help reduce the dependency on consultants.

The Committee raised a number of points and questions as follows:

Treatment Specialisms: A Board Member asked about plans for hospitals to specialise in providing particular treatments and the consequences if some hospitals may no longer provide particular treatments. The Member emphasised that there was a need for effective communication and engagement in the event that there was a future proposal to relocate services away from Medway Foundation Trust to other acute hospitals. Another Board Member said that they would want to be taken to the location that gave them the best chance of survival rather than to the place that was closest.

The Senior Responsible Officer considered that there was a cultural problem in terms of the high expectations of some people and a reluctance to take responsibility for managing their own health. This culture was contributing to the pressure on limited resources. There was a large population in the area surrounding Medway Maritime Hospital. Therefore, the case for Medway retaining services was perhaps stronger than it was in some other parts of Kent.

It was considered unlikely that there would be closures of whole hospitals, but changes in the services provided at certain hospitals was likely. There was already some specialism of services provided by acute hospitals. One example of this was that patients with major head trauma would be taken directly to Kings College Hospital rather than to a local hospital in Medway or Kent. There was an increasing need to separate between the provision of elective and acute services. This was due to beds being taken by acute patients, with the result that elective procedures were being routinely delayed.

There were currently seven acute stroke units in Kent and Medway. This was not able to deliver the highest quality of care achievable and thus, work was being undertaken to look at centralising services at fewer sites. It was considered that this would result in improved care quality with better outcomes for patients. Full consultation would be undertaken ahead of any changes.

The so-called ‘industrialisation’ of preventative measures was about the promotion of ongoing good health on an ‘industrial scale’, rather simply supporting and dealing with ill health. Development of this area was a responsibility of all health partners.

The Chief Executive of Medway Foundation Trust considered that the STP was at a pivotal stage of development. The challenges faced included introducing new ways of working, overcoming geographical challenges and the need to join up services in order to consider the holistic needs of the individual. There were currently minimal levels of elective surgery being undertaken at Medway Hospital due to the demand for acute services, with there having been a 19% increase in the number of patients accessing acute services between November and December 2016. In relation to the provision of stroke services, staffing the current seven units in Kent and Medway was challenging as there was not a sufficient supply of workforce available locally. It was suggested that establishment of centres of excellence and a medical school in Kent and Medway to attract those entering the health and allied professions to work in the area could help to overcome this.

STP Engagement: The Healthwatch representative highlighted that Healthwatch England had been impressed by the level of local authority involvement in the development of STPs and questioned how engagement would take place with frontline staff. The Senior Responsible Officer acknowledged the need to engage with frontline staff as well as there being a need to engage with the general public. There had previously been a lack of public information sharing in relation to the STP due to national policy and it was hoped that this would change in the future.

Promotion of good health and involvement of voluntary groups: A Member asked how the transition would be made towards delivering proactive care and ensuring that support focused on improving and promoting health and wellbeing, rather than care and support that was solely reactive to ill health and disease. The Member was also concerned at the apparent lack of STP related consultation that was being undertaken with voluntary groups. In response, the Programme Director emphasised that while the ambition was to increase the focus on prevention, health services also had a duty to treat ill health. There was a need to support changed behaviours that would lead to better general health of the population and to develop alternatives to hospital admission, including the redesign of packages of care. It was noted that in Kent and Medway, there were around 1000 people in hospital at any one time who did not have a medical need to be in an acute care hospital bed and who would be better in another setting, including the patient’s own home

With regards to the voluntary sector, the programme of engagement being developed would include meeting voluntary sector representatives.

Progress of the STP to date: A Board Member congratulated those involved in the STP process on the progress made to date and hoped that it would continue and result in better health provision in Kent and Medway. A considerable shift in thinking was required, particularly to encourage people to, where possible, to look after themselves.

The Chairman of the Board thanked the Senior Responsible Officer and the Programme Director for their attendance and the update provided. He stated that the STP process had brought together a wide variety of groups already and that the Case for Change would need to be disseminated to the local community to enable people to have their say. The key message was that the STP was being developed in order to facilitate delivery of the best possible outcomes and services across Kent and Medway.

Decision

The Board:

i)             Noted the draft Kent and Medway Health and Social Care Sustainability and Transformation Plan, the progress made to date and provided comments on the Plan.

ii)            Committed to supporting the continued development of the Plan.