As a Medway, North and West Kent footprint system, we have developed a single operating plan for 2019/20. This has helped deliver the consistency in planning aspired to in the Medway, North and West Kent (MNWK) Planning Approach (submitted to February 2019 Governing Body at Medway CCG).
The attached document has been adjusted to reflect local feedback from across Kent and Medway and national feedback from regulatory partners. Formal feedback is still to be received following 4 April 2019 submission and thus in-year amendment may be required. The plan documents the key developments for 19/20: Local Care, Outpatient Transformation and the development of Primary Care Networks, Integrated Care Partnerships and Integrated Care Systems.
The NHS Medway Clinical Commissioning Group (CCG) representatives acknowledged that there were a significant number of acronyms that had been used without explanation in the Operating Plan and undertook that consideration would be given to this when producing future plans. In response to a Member question, they also undertook to establish why the Operating Plan had not been presented to the Committee in draft form.
The Operating Plan covered all services provided by the CCG. The Plan covered four CCG areas, including Medway. It was anticipated that this would help to ensure consistency of approach across CCGs as they moved towards an integrated care system and a single strategic commissioner. The Plan had been submitted to NHS England on 4 April 2019 with no formal feedback having yet been received. The contents of the Plan were now being communicated to ensure that CCG staff and health providers were aware of its contents. Monitoring was being undertaken against the commitments included in the Plan and delivery plans developed where these were not already in place. There was a focus on developing a local five year response to the NHS Long Term Plan. This was due to be submitted to NHS England in the Autumn. The outcomes of the Operating Plan would be factored into these longer term plans.
A Member asked whether the pseudonymization [a process by which personally identifiable information is replaced by one or more artificial identifiers] described within the Operating Plan would lead to data no longer being useful. The Member was also concerned that there appeared to be fewer actions in the Plan specific to Medway than to West Kent, in view of the level of health inequality in Medway. The Member also voiced concern about existing priorities being consumed by the development of a five year plan and asked about the development of Care Navigators in Medway.
The CCG representatives advised that 2019/20 was the first year of a five year plan and that all priorities contained in the Operating Plan were still valid. It was considered that the pseudonymization being used had not made the data meaningless. It had not been the intention for the Plan to any way suggest that there was less need for services in Medway than in other areas. They agreed further work was needed in relation to tackling health inequalities, given that some inequalities were increasing locally. It was envisaged that the development of the local Five Year Plan and work with Public Health, would be catalysts to addressing this. It was considered that Care Navigators would have significant impact on the local health system and patient access to services. The Assistant Director – Adult Social Care, said that the Council was working jointly with the CCG to procure community care navigation services. Care Navigators were currently based at Medway Maritime hospital and also worked in the local community. The Navigators would support people to be connected to other services in the local community. EU funding had been obtained, through Public Health, to deliver social prescribing services with a network of local practitioners being developed. This workforce would be based within Medway Council and would work collaboratively with the existing care navigators.
A Committee Member said that planning by the CCG had previously been found to be a weakness by inspectors. Acknowledging that there had not been a recent inspection, the Member asked whether planning was now considered to be more of a strength. The Members remained concerned that the Operating Plan did not sufficiently highlight the need for services in Medway and considered that this could contribute to services moving away from Medway.
The CCG representatives considered that planning had improved and agreed that in some ways, service provision in Medway did warrant particular attention. In response to a Member concern that health planning appeared to be focusing on elderly and frail patients rather than on deprived areas, the Committee was advised that Medway had a younger population than the England average that had higher levels of morbidity. The term elderly and frail was misleading as frailty could also affect younger people. Frailty could be considered in the planning process in a way that does not lead to a reduced focus on deprivation.
In response to a Member question, the Committee was provided a brief explanation of the Medway Model. This set out how care services were arranged in Medway with the principle being to base services in geographical localities surrounding GP hubs in three localities and 7 sub-hubs in Medway.
The Committee considered and commented on the Operating Plan, as set out in this report and Appendix 1 and requested that a written update be provided on the development of the Healthy Living Centres.