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 2019/20: Local Care, Outpatient Transformation and the development of Primary Care Networks, Integrated Care Partnerships and Integrated Care Systems.
The Health and Adult Social Care Overview and Scrutiny Committee considered the operating plan on 18 June 2019. The comments of this Committee are set out in section 3 of the report.
The Deputy Managing Director, NHS Medway Clinical Commissioning Group (CCG) acknowledged that there were a significant number of acronyms and technical terms included within the Operating Plan ‘the Plan’ and undertook to consider this when producing future Plans.
It was explained that as well as Medway, the Plan also covered the areas of Dartford, Swale and West Kent. There were three core areas within the Plan which were particularly relevant to Medway, including:
1. System changes: The Plan provided information on the introduction of Primary Care Networks (PCNs). There were 7 PCNs emerging in Medway which covered populations of between 30,000 to 50,000 people. These PCNs were similar to Local Care Hubs established under the Local Care Model except Strood had been split to reflect probable developments on the Peninsula. The PCNs were aligned to existing Healthy Living Centres.
With respect to the Healthy Living Centres, it was explained that 4 had already been established and another 3 were needed. The Plan also reflected the work being undertaken with partners and providers across Medway and Swale to develop the Integrated Care Partnership (ICP) which covered this footprint.
2. Outpatient transformation: In line with the Medway Model, the Plan anticipated that some services would be relocated to enable them to be provided at community level, closer to the home of patients. The Plan aimed to improve care pathways and increase the number of ways patients could access clinical advice and clinicians.
3. Progressing Local Care: The Plan also set out proposals to: embed extended access to GPs, increasing the number of appointments available to patients; embed care home support; and complete integrated local reviews.
Other areas detailed within the Plan included: developing the 111 Service to ensure clinicians such as GPs and mental health nurses were available to consult with patients calling the service; reducing waiting times for planned care; and strengthening mental health provision which included increasing physical health checks for patients with serious mental illness and loearning disabilities.
A Board Member commented that as this was an annual plan, it was out of context with other NHS Plans such as the Long Term Plan, the Five Year Plan and the Sustainability and Transformation Plan. It was suggested that the Operating Plan should include narrative on how it interacts with the priorities of other NHS Plans and include timescales for implementation, budget, workforce requirements etc. Without this context it was difficult for Members to fully understand the Operating Plan.
In response to this and questions regarding the complexity of the Plan, it was explained that the Long Term Plan was published in January 2019 and was the basis for the Operating Plan. The Plan was constructed to meet the requirements and priorities mandated by NHS England, which was the target audience. A shorter, more user friendly, public facing version was being created. A Member asked that going forward the Health and Wellbeing Board and relevant Overview and Scrutiny Committee receive an informative presentation on the Plan ahead of it being discussed at the Board/Committee.
Board Members expressed concern in relation to the pace at which the Healthy Living Centres were being delivered, in addition to access to future hubs, particularly in rural areas. In response, the Deputy Managing Director, NHS Medway CCG advised that work was ongoing with the Council to find a suitable location and with NHS England and the Treasury to obtain the funding required to deliver the three outstanding Centres. It was added that rural needs around access had been assessed and the CCG was keen to locate a Healthy Living Centre on the Peninsula. Discussions in this regard had been undertaken in line with the new Local Plan. Referencing his experience on Medway’s Planning Committee, a Board Member said that there was an opportunity for the CCG to take more advantage of S106 process and seek contributions from upcoming developments.
A Member raised a concern that the Plan encouraged the use of Personal Health Budgets (PHBs) but then also discouraged self-referrals. In response, the Board was advised that the expansion of PHBs was borne from a drive to ensure that patients had more control over the treatment and care they received, increasing the choice and availability of services for patients. On the other hand, work had also been undertaken to consolidate secondary care pathways. Through utilising the private sector, this had reduced waiting lists for Medway. It was noted that one provider has recently been lost and it was recognised that there was a need to ensure the Medway Hospital retained its elective portfolio and was increasingly a choice for patients going forward.
It was recognised that there was a national shortage of doctors, nurses and professionals across the wider health service. Feedback from GPs in Medway indicated that some practices had struggled to recruit doctors. However, there had been 100% sign up by GPs to work in clinics to support the extended access programme which delivered an extra 900 appointments. On this basis, in some regards Medway was doing well, although more needed to be done.
In response to questions concerning attracting health professionals to live and work in Medway, it was expected that establishing the new Medical School and developing new housing would be an attraction. The Director of Communications, Medway NHS Foundation Trust (MFT) advised that the research offer at MFT had also been a draw for clinicians and the Managing Director, Medway Community Healthcare (MCH) explained that MCH had worked with local schools and colleges to encourage young people to consider a health profession as an option. It was also explained that in moving toward ICPs, there would be a focus on delivering care in different way, especially in light of a reduced workforce pool.
There was an emphasis on promoting Medway as a place and having a more holistic approach to promoting Medway. It was recognised that providers, commissioners and the Council needed to promote a shared narrative. The Director of Communications, MFT, explained that the Council’s place branding had been promoted. It was recognised that many doctors lived in the areas surrounding Medway but chose to work in the area. In order to encourage health professionals to move to Medway, as a Director of Medway Development Company Limited (MDC), a Board Member encouraged the CCG to explore opportunities with MDC for key worker housing in upcoming Council developments. A Board Member hoped that proceeds from the sale of St Bartholomew’s Hospital, Rochester, by NHS Property Services would be utilised in Medway to provide additional medical facilities and encourage people to move to the area. The Deputy Managing Director, NHS Medway CCG confirmed discussions were ongoing with MHS Property Services. A Board Member indicated that the property had been sold.
Whilst welcoming proposals for urgent and crisis care set out on page 114 of the Plan, a Board Member expressed serious concerns in relation to the lack of a section 136 facility in Medway, noting that the nearest facilities were located in Maidstone or Dartford. It was explained that the Kent Police and Crime Commissioner had taken responsibility for strategic planning around this area of work.
With respect to the national target to reduce suicides by 10%, a Board Member commented that the target should be zero and suggested that the Plan had been poorly worded in this regard. The CCG representative agreed with the sentiment and undertook to consider this when producing future plans.
The Health and Wellbeing Board:
a) noted the comments of the Health and Adult Social Care Overview and Scrutiny Committee set out at section 3 of the report;
b) commented, as set out within the minute, on the Plan set out in this report and Appendix 1; and
c) requested that a presentation be given to the Health and Wellbeing Board and relevant Overview and Scrutiny Committee on such plans ahead of discussion at the relevant meeting(s).