Agenda item

At the last meeting of the Committee, Members asked to be informed and regularly updated on the NHS Medway CCG Five Year Strategy and commissioning intentions for 2016/17 (and annually thereafter) so that the Committee can plan the areas Members would like to scrutinise in more detail and liaise with the CCG about any forthcoming proposals for substantial development or variations to the health service. This report provides the Committee with a copy of the NHS Medway CCG Operating Plan for 2016/17. A presentation will be given at the meeting which will also cover the CCG Five Year Strategy 2016-2021.

Discussion

Caroline Selkirk, the Accountable Officer at Medway Clinical Commissioning Group introduced a presentation on Medway Clinical Commissioning Group’s (CCG) Five Year Strategy and Operating Plan. The Plan’s vision was for the CCG to move from being a reactive to a proactive person centred system. The aims of the plan were to improve health outcomes, improve patient experience, improve staff experience to deliver better services and to reduce costs. It was important to recognise the personal element of care delivery, but the quality of care provided was only likely to be good if staff were fully supportive of the aims of the Plan. Hospitals were trying not to admit patients by default, but rather to only admit them when absolutely necessary.

An explanation of the ‘House of Care’ model was provided. This was noted to be a systemic process to enable people living with one or more long term conditions and healthcare professionals to have more collaborative and productive conversations. The model saw healthcare professionals signposting patients to relevant activities and social services within a community.

The Committee was advised that 90% of all care delivered was primary care and that the number of primary care practices in Medway had reduced from 56 to 52. It was difficult for some of the smaller practices to provide a full range of services. This made collaborative working with other practices and the ability for practices to see patients from another practice particularly important. A local population of 100,000 was required in order to make provision of a full range of primary services sustainable. By specialising in particular services on behalf of other practices in the area, a practice would be able to meet this threshold. Providers were being asked to set out what services they could provide. Practices were currently being migrated to the EMIS health software, which would facilitate the sharing of information and co-ordination of appointments between practices. There were also plans to make more use of Healthy Living Centres.

A Local Digital Roadmap had been set out. This aligned with the Five Year Strategy and set out how technology could be used to improve care provision. This aimed to see increasing use of technology by patients at home. Work was being undertaken by the Medway and Swale Centre for Organisational Excellence (MASCOE) around quality improvement.

An event had already taken place at Priestfield Stadium in Gillingham. This had involved a range of healthcare professionals and had considered how to improve services. A further event would take place on 6 September.

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

·         Healthy Living – A Member congratulated the CCG on the work undertaken so far but was concerned that some people were not interested in living healthily and questioned how these people could be better supported. On the other hand, there were also patients who were desperate for surgery e.g. for cataracts, who could have to wait for a long period of time. The CCG Accountable Officer and the Council’s Director of Public Health agreed that helping the reluctant was a challenge and advised that supporting young people to be healthy was likely to translate to them being healthier adults. It was important to encourage people to be active. It had been established that undertaking around an hour of activity a day mitigated the health risks posed by a deskbound job. It was suggested that the need to live healthily should be raised and promoted in a constructive and non-threatening way and that the public should be supported to engage in healthy living. Targeted activity was taking place in more deprived areas. It was considered that GPs may be best placed to have a direct impact on morbidity rates in their local areas.

·         Impact on the elderly of service centralisation – Concerns were raised that the provision of shared services and service specialisation would have an adverse impact on elderly patients, particularly those unable to drive. Older people without cars tended not to travel outside their locality and their needs should be considered before they were forced to go to appointments in a range of locations, sometimes at times when public transport was unavailable or at times when their bus passes were not valid. Technology had a role to play, but it was important to consider the views of older people, many of whom did not use the internet. The Accountable Officer confirmed that the intention was not to force people to have to travel excessively in order to access services. She acknowledged the need to consider transport availability and bus routes and provided assurance that the needs of those who did not use technology would be taken into consideration. Constructive challenge from patient groups would be welcome.

·         GP registration and appointments - A Member said that some residents found it difficult to find a doctor who they could register with in the first place, let alone get an appointment. Another Member was concerned that persons who were unable to get a GP appointment would go to Accident and Emergency instead and asked what had happened in relation to the move of the Medway NHS Healthcare Centre from Canterbury Street in Gillingham to Balmoral Gardens. The Member wished to ascertain what was happening to the building in Canterbury Street.

The CCG Accountable Officer said that collaborative working between GP practices to enable them to see each other’s patients and use of new technologies would help to combat such issues. This technology would be of significant benefit to patients who were able to use it. Improvements would also be realised for patients not able to make use of the technology. Ian Sutherland, Inrterim Director of Children and Adult Services said that there were six hubs of social care. These enabled the co-location of occupational therapists and social care staff. It was noted that GP practices needed support from a variety of staff, including nurses, social workers and occupational therapists, amongst others. Services should be ‘wrapped around’ GPs. In relation to the move of the Healthcare Centre,the Accountable Officer confirmed that the move of the Centre to Balmoral Gardens had taken place the previous weekend and said that she would find out what the plans were for the Canterbury Street building.

·         Risk Registers - In response to a Member question, the CCG Accountable Officer said that extensive use had been made of risk registers in order to manage risk and to identify how to make a difference to patients. The Director of Children and Adult Services highlighted The Better Care Fund,  a programme aimed at improving the lives of some the most vulnerable people in society and placing them at the centre of their care and support. This would help risk to be shared and provision of social care to be protected.

·         Volunteer Opportunities – A Committee Member raised concerns that the local volunteer workforce was relatively small and required more training and mentoring opportunities to increase its effectiveness. It was also considered that not enough was done to publicise opportunities available. In response, the CCG Accountable Officer said that an evaluation of volunteer opportunities was being undertaken and that a system of ‘spice credits’ would enable people to gain recognition for volunteer work undertaken. Following concerns that the term ‘spice’ was also a slang term for a legal high, it was agreed that the name would be changed. In response to questions about how the less affluent would be encouraged to volunteer and how public engagement would be increased, it was suggested that work could be undertaken with the Economics Foundation. The Council’s previous support for green gyms was also noted.

Decision:

The Committee:

a)    Noted the content of the NHS Medway CCG Operating Plan 2016/17 and the presentation and provided comments to the CCG.

b)    Agreed that future updates on the Strategy and Operating Plan would be provided to the Committee with the CCG Accountable Officer and the Interim Director of Children and Adult Services to discuss the frequency and content of updates.

c)    Requested that briefing notes should be provided on specific items of interest, as agreed by the Committee.