Agenda item

A presentation will be given on delivering the NHS Five Year Forward View, incorporating a briefing for the Committee on the purpose and development of the Kent and Medway Sustainability and Transformation Plan.

Discussion

Caroline Selkirk, Accountable Officer at Medway Clinical Commissioning Group (CCG), apologised that Glen Douglas, Chief Executive of the Maidstone and Tunbridge Wells NHS Trust had been unable to attend the Committee. The Accountable Officer introduced a presentation on the Kent and Medway Sustainability and Transformation Plan (STP). The Plan set out how health and social care would be transformed over the next five years. This would be against a backdrop of an aging population, an increasing population and an overspend of £100 million that had taken place in Kent and Medway in 2015/16.

The first priorities of the Plan would be to transform out of hospital care in order to meet increased demand, to improve care for all patients, especially the elderly and frail, to reduce health inequalities and to increase the amount of care delivered outside hospital.

It was anticipated that improvements to preventative services and mental healthcare would result in a reduction in demand for acute inpatient care beds, with evidence from east Kent suggesting that at any one time, up to 300 patients could be discharged from hospital if appropriate support was available elsewhere.

Development of out of hospital care was being led by the CCG, although it was important to note that a range of partners were involved in this work. Extended multi-disciplinary teams would be created to improve access to appropriate care. With regard to acute care, the possibility of creating specialist centres for elective surgery would be explored, the acute emergency medical pathway would be reviewed and explored and the reviews of stroke and vascular services would be concluded. Successful implementation of the Plan would improve efficiencies. These would be achieved through the sharing of services and working with local authorities to develop the business case for integrated infrastructure developments.

A draft of the STP had been submitted to NHS England and NHS Improvement on 30 June 2016. This had been followed by presentation to a variety of stakeholders on 25 July. A further submission, taking into account feedback received to date, would be made to NHS England in October. Positive feedback had been received and the aim was for consultation to commence before the end of 2016, with an integrated workshop scheduled to take place on 16 October.

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

·         Medway CCG Inadequate rating – Members raised concerns that the Medway Clinical Commissioning Group had been rated as inadequate by NHS England’s CCG Assurance Annual Assessment 2015/16 that had been published on 21 July 2016. The Accountable Officer advised that while Medway Clinical Commissioning Group had not been placed under special measures, it had received a headline rating of inadequate. There were five individual components of assurance behind the overall rating. ‘Performance’ and ‘Planning’ had each been rated as inadequate. ‘Well led’ had been rated as requires improvement, while ‘Delegated functions’ and ‘Finance’ had both been rated as good. Significant work had taken place over the last year to improve performance and service provision.

It had been acknowledged that a significant number of new staff were in place and that an understanding was being developed of the key challenges faced and how to hold providers to account. It was considered that there had previously been a lack of a clear strategy. This was being addressed through planning documents such as the Sustainability and Transformation Plan and the Annual Operating Plan. Members were not surprised at the inadequate rating received by the CCG and acknowledged that, although there were significant challenges still to be overcome, progress was being made. The CCG Accountable Officer advised that benchmarking data was being used in order to compare performance against other areas and to support the improvement journey.

·         Primary Care Provision - A Member felt that improvements could be encouraged through putting managers on the frontline of care provision so that they saw the issues first hand. Repeat prescriptions were considered to be a problem due to the relatively high cost of associated administration. In some cases, the drugs themselves were quite cheap in comparison to the administration cost. Members felt that the difficulty that some residents faced in getting a GP appointment could hold back improvement. The CCG Accountable Officer agreed that recruitment and retention of GPs and other primary care staff was an ongoing challenge. The close proximity of Medway to London also presented a problem in terms of recruitment and retention.

With regard to concerns about repeat prescriptions, the Accountable Officer acknowledged that this was an issue which needed to be looked at but the emphasis should be on improving the quality of care and not just about making savings. The decision to prescribe a particular drug was a matter for a GP but the CCG would look to support GPs with clinical evidence and data.

·         Mental Health care provision – It was suggested by a Member that an integrated mental health strategy was required to enable the provision of an effective service and to ensure that patients did not remain in hospital for longer than necessary. It was also suggested that CCG funding should be used for care in the community. The Accountable Officer acknowledged the need to find new, more joined up ways of working. It was noted that one aim of the Sustainability and Transformation Plan was to reallocate resources away from acute mental health provision. This would be achieved through improved prevention and by generally improving mental healthcare, including improving and extending treatment of mental health issues in the community rather than in a hospital setting.

·         Workforce - In response to Member concerns that not enough new staff were entering training for them to become part of the healthcare workforce by 2020, it was reiterated that recruitment was challenging but that work was being undertaken in this area. This would include looking at how to make the best use of resources. The recruitment of Occupational Therapists was not currently considered to be a significant problem, but recruitment to a number of specific care areas, including mental health, was more challenging. In house teams at the Council were receiving specific training to improve their skills with a number of services working together. Work was taking place at a regional level to put in place a training programme to help ensure a stream of new entrants to healthcare in Medway. There was a particular need to ensure that career paths were in place that would enable career progression so that they would attract young entrants. 

Decision:

The Committee noted the report and presentation provided and asked for a further progress report to be provided to the Committee in six months.