Agenda item

The draft Kent and Medway Health and Social Care Sustainability and Transformation Plan (STP) was published on 23 November 2016. This report updates the Committee on the progress made since the last update presented to the Committee in December 2016.

A key next step is the publication of a clinical case for change alongside a public-facing summary of the document, which will provide a focus for discussions with the public and other stakeholders. It is anticipated that this will have been published by the date of Committee meeting.

Discussion

The Programme Director for the Kent and Medway Sustainability and Transformation Plan (STP) introduced an update on the Plan. Four themes of transformation were proposed by STP. These were care transformation, productivity and modelling, enablers and system leadership.

It was anticipated that the Case for Change document would be published by the end of March 2017 and it was proposed that this be presented to the Committee at the June 2017 meeting. It was also suggested that this update would include details of the service models being developed, particularly the Local Care Model. Local care provision was seen as being central to STP development. Eight proposed local care interventions had been set out in the STP document. To date, there had been a particular focus on elderly and frail patients. Work would now be undertaken to develop plans for other groups of patients. Two waves of consultation were expected, the first being in east Kent and the second in the remainder of Kent and Medway.

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

Closing of budgetary gap – A Member noted that the STP proposals aimed to close a significant budgetary gap. She was concerned that this would be at the expense of jobs or services and sought more detail on the financial controls to be put in place to deliver the STP. The Programme Director advised that the aggregate deficit for the end of 2015/16 was £110 million. The deficit was forecast to grow to 500 million by 2020/21 if no action was taken. The aim was to deliver approximately two thirds of savings from productivity and efficiency savings and one third from changing the way in which care was delivered. Further details would be provided to the Committee on financial control measures.

Public Engagement – A Member was concerned whether the composition of the STP oversight groups would facilitate effective public engagement. Details of events planned for Medway was requested. The Programme Director said that a number of listening events had already been held with further events due to take place. Healthwatch Medway was a Member of the Patient Participation Group as part of the engagement process. Further engagement and consultation would be required. The Medway NHS Clinical Commissioning Group (CCG) Accountable Officer advised that the CCG was planning engagement events and that a programme would be finalised by the end of April. The focus would be on presenting the work rather than on presenting a formal proposal for consultation at this stage. It was suggested that the Council could support the engagement process, particularly with regard to hard to reach groups.

The Healthwatch representative said that Healtwatch Medway was pleased to be part of the Patient Advisory Group and asked what further engagement activities were planned. The Committee was informed that this would include further listening events.

Patients in acute beds – In relation to the figure quoted of 32% (1,000 people) who were in an acute hospital bed without having a medical need to be there, it was confirmed that audit walks of hospital wards had been undertaken to confirm this figure.

General Practice Staffing – In response to Members who asked how many GP vacancies there were in Medway and how the challenges presented by an increased population were being met, the CCG Accountable Officer said that there was not a vacancy figure available for Medway. It was estimated that across Kent and Medway, there was a shortage of 245 GPs with there currently being 136 GP vacancies. A figure could be provided for Medway. There were not enough doctors available to meet this need, therefore it would be necessary to provide care in a different, multi-disciplinary way. A Member asked how many other medical professionals it would take to provide a service equivalent to that provided by a GP. The Accountable Officer said that it was not possible to provide a figure for the number of other medical professionals who would be needed to provide the equivalent service of a single GP as staff roles varied.

Adapting the model of care delivery would be necessary to meet the challenges presented by the increasing population. Two thirds of GP practices were single handed GPs. It would be increasingly important for smaller practices to collaborate to serve larger populations of between 30,000 and 50,000. Care Navigators would play an important role to direct people to the care professional best able to help them. The expansion of other non-GP roles was also being investigated, such as Advanced Nurse Practitioners and Paramedic Practitioners, with a view to reducing the pressure on GPs. There were an increasing number of future GPs going through training but it would take time before they were ready to enter practice.

Ensuring that GP practices had patient mobile numbers was also important. In Medway, 60% of patient mobile numbers were currently held by practices with 18 GP appointments a day being released as a result. It was anticipated that increasing the percentage of patient mobile numbers held to 90% would increase the number of daily appointments released to between 30 and 40.

The CCG had in the last year funded a number of practices to move to a universal web based operating system. It was anticipated that 45 of the 51 practices in Medway would be using the system by May 2017. Use of the system would enable practices to see details of patients registered with other practices.

Work had been undertaken with the Fire Service to undertake falls assessments within the home. This enabled direct referral to fall services which helped to reduce demand on primary and acute care provision. 

Rehabilitation Services – A range of rehabilitation services were required to meet patient need with the underlying philosophy being that the best bed for a patient to be in was their own bed. Appropriate support would be put in place to help facilitate this. Work was being undertaken to identify individuals at the most risk of being admitted to hospital in order to develop a plan that would enable them to be discharged from hospital once medically fit.

Decision

The Committee:

i)     Noted the update provided on the Kent and Medway Health and Social Care Sustainability and Transformation Plan and the Case for Change document and commented on the progress made.

ii)    Agreed that an update on the STP, including the Case for Change, would be presented to the June 2017 meeting of the Committee.