Agenda item

The draft Kent and Medway Health and Social Care Sustainability and Transformation Plan (STP) was published on 23 November 2016.

An STP update was last presented to the Committee in August 2017. This report invites the Committee to consider the attached update provided by the Kent and Medway Sustainability and Transformation Partnership.

Discussion

The Project Director of the Kent and Medway Sustainability & Transformation Partnership introduced the update. A presentation was given to the Committee, the key points of which were as follows:

·         The Kent and Medway Sustainability and Transformation Plan (STP) was a five year plan that was being developed to cover the key aims of the NHS Five Year Forward View document. These were health and wellbeing, care and equality and finance and efficiency. A Case for Change had been developed with a refreshed version of this document due to be published in early 2018.

·         Transformation as part of the STP would be pursued around four key themes – Care Transformation, System Leadership, Productivity and Enablers.

·         Local Care was central to the delivery of the Kent and Medway STP. Local Care was a term to describe care provided out of hospital, including in primary care and adult social care. An overall model of care had been developed with specific plans now being developed for each part of Kent and Medway ahead of implementation.

·         The East Kent programme was focusing on acute provision and orthopaedics. A list of options had been developed, which included a primary option and a secondary option. It was possible that there would be a ‘new build’ offer close to the Canterbury hospital.

·         In relation to the Kent and Medway Hyper Acute and Acute Stroke Services review, an update had been presented to the Kent and Medway Joint Health Scrutiny Committee (JHOSC) on 12 December 2017. A further meeting of the JHOSC was due to take place on 22 January. This would review consultation options following approval by NHS England of the pre-consultation business case. The length of the public consultation had not yet been determined but would be for a maximum of 12 weeks.

·         Joint work had taken place across Kent and Medway in relation to planning for winter pressures.

·         Realising planned budget savings through productivity savings would be key to successfully delivering the STP. £190 million would need to be saved. The move to a strategic health commissioner for Kent and Medway would help to achieve this.

·         Accountable Care Partnerships would be established to bring together providers for local areas to facilitate collaborative working. GP practices would also be encouraged and supported to work collaboratively. Two potential geographical areas had been identified for the establishment of Accountable Care Partnerships within Kent and Medway, one in East Kent and one in Medway, North and West Kent. The latter would be led by the chief executive of KMPT.

A Member said that the STP work demonstrated some good innovation but was concerned that the STP was being presented primarily as a way of saving money rather than as a mechanism through which services could be improved. The Member was also concerned that health professionals had dominated the listening and engagement events held so far with relatively few members of the public or voluntary sector representatives having attended. The Member was also concerned that work to re-procure community health services could be delaying the progress of the STP and emphasised that this needed to consider whether the services currently provided were fit for purpose. The Member also felt that her personal experience suggested that clinicians in Medway tended not to be particularly well engaged in the preventative health agenda.

The Accountable Officer of NHS Medway Clinical Commissioning Group said that there was a legal obligation to re-procure services. The exercise was an opportunity to improve efficiency and to gain a thorough understanding of what each service needed to provide. Significant numbers of the general public had attended events held so far and further engagement events were planned, including on 10 January 2018, after which all the responses received at the engagement events would be analysed.

A Committee Member said that that it needed to be ensured that reconfigured stroke services also catered adequately for younger people and also asked what the ‘break glass’ policy was. The Accountable Officer said that she would feed back comments about stroke provision for younger people to those involved in the stroke review. She advised that the break glass policy related to the use of temporary staff in acute care whereby agreed levels of temporary staff would only be exceeded in certain circumstances. Another Committee Member commented that some young people had been involved in the engagement that had taken place in relation to stroke services.

In response to a Committee Member who asked whether there were sufficient resources available to the deliver service improvement, the Project Director said that there was evidence that improving quality would also save money. It was acknowledged that stroke services were currently poor. Changing from providing current services at seven sites to providing improved services, include hyper acute provision, at three sites would improve the service. The quality of local care would also improve, including enabling more people to access services closer to home rather than in an acute hospital. The STP set out a 5 year plan for improved quality and sustainability. Transformation was also required because there were not the staff available to provide services using existing models as the population increased.

The Director of Children and Adults Services informed the Committee that the only current pooled Adult Social Care budget with health was Better Care Fund funding of £17 million. Increased investment in social care was anticipated as part of the local care model.

The Project Director and the Accountable Officer highlighted that achievements so far had included productivity savings, reductions in the use of agency staff, significant reductions to hospital Delayed Transfers of Care (DToC) and the establishment of proactive clinics for the elderly frail, which were helping to reduce unnecessary A&E admissions. The benefits of much of the STP work would, however, only be realised in the longer term.

Decision

The Committee considered and commented on the update provided on the Kent and Medway Health and Social Care Sustainability and Transformation Plan and agreed that a subsequent update to Committee would be requested with the date of this to be determined in the New Year.