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Councillors and committees

Agenda item

Outcome of STP Engagement Exercise

Item attached. Mark Adams Joint Lead for Combined Cumbria and NE STP and Caroline Latta, North East Commissioning Support will provide the Joint Health STP OSC with a presentation on the above.

 

 

Minutes:

The Joint Committee was advised that the draft STP was published in November 2017 and a twelve week engagement programme on the draft was carried out.

 

 

The North East is one of the highest performing regions in the country and the aim is to have high quality hospital and specialist care and address the gaps in the Five Year Forward View.

 

The draft STP had identified gaps relating to the need to scale up existing health prevention work and the need to work collaboratively to improve the quality of care.

In particular there was a need to focus on out of hospital care and provide care closer to home. The need to close the financial gap was also identified as a key priority.

 

The Joint Committee was advised that the feedback received showed strong support for work to tackle health inequalities and queries had been received on how public health could be funded to progress this.

 

A major theme emerging from the engagement exercise related to workforce and centred around the issue of the ageing GP workforce and shortages of mid - grade doctors and the impact on nursing burseries and the need to retain staff. There had been questions around how these issues could be tackled and in relation to seven day working and how this might impact on the role of carers.

 

Another key theme related to access to services particularly in rural areas such as Durham and Northumberland and a strong theme in Durham had been around the fact that it was split across two differing STPs.

 

In addition, it was highlighted that the STP was very focused on health rather than social care issues and there were issues raised as to how local authorities were going to be involved in the plan and how the financial costings outlined in the plan were going to be achieved. A major theme in the feedback was around how the financial gap would be achieved.

 

Feedback from the engagement exercise also highlighted that there had been the expectation that there would be a significantly greater level of detail in the plan than is currently there, particularly around how the needs of certain groups would be looked at /met.

 

There was also feedback from some parties who felt that they should have been involved in drawing up the plan.

 

The Joint Committee was advised that when the STP goes out for formal consultation liaison will take place with local authorities to ensure the formal consultation is as wide as possible.

 

Councillor Mendelson highlighted that she was aware that the Ambulance Service and Pharmacy Services had raised concerns that they had not been involved in drawing up the STP and the proposed delivery method. Concerns had also been raised around accountability and the structure for delivering this and it was considered that this needed to be spelt out more clearly.

 

The Joint Committee was advised that the plan is currently at a very high level and there is a need to provide a significant amount of detail for each area going forwards.

 

Councillor Mendelson was asked who it was she had spoken to from Pharmacy Services and she advised that it was a representative from the local Pharmacy Committee in Newcastle.

 

The Joint Committee was advised that Pharmacy Services will be involved in the development of the STP and that different people from different organisations will be involved at differing levels.

 

Councillor Mendelson advised that the Chief Executive of the Ambulance Service had also raised this as they are involved in delivering care at the front end.

 

Mark Adams stated that this was really helpful feedback to receive.

 

Councillor Caffrey advised that she was aware that locally representatives from the voluntary sector generally and also from Healthwatch Gateshead would have liked to have been more involved in the engagement exercise and there appeared to have been confusion amongst some as to whether the exercise was a formal consultation exercise as opposed to an engagement exercise.

 

Councillor Caffrey highlighted that within the report there was no overall analysis and there appeared to be less than 800 parties involved in the engagement exercise. Given the size of the area the STP was covering, Councillor Caffrey considered that it was no wonder that a number of people, were quite rightly unhappy at what they saw as the CCG and STP getting on with business in the usual way and making plans. As a result, there were concerns that health colleagues would be rubber stamping the plans and Councillor Caffrey asked that these views be taken on board when health colleagues moved on to the next phase in the process.

 

Caroline Latta advised that this was also really helpful feedback. Caroline indicated that she had already met with the Chairs and Chief Officers from Healthwatch across the patch and they had expressed their concerns and there would be ongoing dialogue with Healthwatch going forwards. 

 

Caroline advised that it was felt that there had been a good quality response to the engagement exercise as they had invited responses from those with knowledge of health and social care issues. However, Caroline acknowledged that the exercise had not really focused on responses from the general public. Caroline stated that NECS would work with this Joint Committee to look at how they developed plans for future engagement and consultation.

 

Caroline indicated that there were opportunities for the Joint Committee to do some work with the Consultation Institute if that was felt to be helpful.

 

The Chair advised that it was not elected members who didn’t understand the difference between the engagement exercise and consultation, it was the voluntary sector who had not felt engaged. The Chair indicated that it was appreciated that health colleagues had carried out an engagement exercise prior to a formal consultation. However, the key point was that there were some organisations who felt that they should have been involved in that engagement exercise.

 

Councillor Caffrey also highlighted that this had not been helped by the fact that it had almost been a year since the engagement exercise was carried out and there appeared to have been very little progress since then.

 

Councillor Hetherington noted that South Tyneside Council was currently involved in a consultation on major service changes to the acute trust and it was clear from that process that it was very important that there is ongoing consultation with staff. Councillor Hetherington considered that this was an important consideration for any consultation on the STP.

 

Councillor ? noted that Professor Pollack had previously raised concerns that the STP was being used not just as a savings exercise but a means of making cuts and closing hospitals. It was queried what was known about the organisations who would be expected to provide new care models and whether these would be Accountable Care Organisations (ACOs).

 

Alan Foster advised that the aim was to create an accountable care system across the North East and Cumbria so that the NHS and local authorities and other partners can support each other at the right level. Alan stated that health and social care are inextricably linked and face immense funding challenges so within the system they will need accountable care organisations that can work at a local level. Alan stated that the way they hoped to achieve these aims was to adopt a place based approach and build on the work of local Health and Wellbeing Boards to assist in strengthening primary care and community services. Alan stated that investment was needed in primary care and community services and it was hoped that some additional funding would be forthcoming in the budget.

 

Councillor Heron noted that the consultation on the proposed changes to services in South Tyneside had highlighted issues around lack of consultation with staff and major concerns around the ambulance service not being funded at the right level and he considered that this was something that really needed to be looked at further.

 

Caroline indicated that NECS had taken on board the concerns raised regarding consultation with staff as part of the consultation on changes to services in South Tyneside and there will be a presentation to the South Tyneside and Sunderland Joint Committee outlining proposals for a full year of pre – engagement where staff will be brought into options development.

 

Caroline stated that NECS also wanted to learn lessons from the STP engagement process.

 

Mark highlighted that funding for the ambulance service was high on their agenda. There were a number of difficult issues such as availability of funding and workforce and these would play into different workstreams within the STP.

 

Councillor Taylor noted that there had been no reference within the emerging themes to Brexit and its impact. There has been a 90% drop in the number of nurses applying to work in the UK and there are huge issues in terms of GP shortages. Appropriate levels of staff and training are needed but this will all take time and Councillor Taylor considered that this was not achievable within the timeframes given. In addition Councillor Taylor noted that funding was also needed to invest in new services to ensure that they worked effectively. In light of this, Councillor Taylor stated that she had serious concerns that the STP was not achievable.

 

Mark stated that the financial situation was hugely difficult for all the NHS. However, as a region this was one of the best places to be starting this work as it was the highest performing NHS area nationally so the region has as good a chance as any of achieving the desired outcomes. Workforce is one of the reasons why planning is taking place across this footprint as there is no sense in one hospital in the area doing well and another doing badly.

 

John Whalley Co – ordinator for Keep the NHS Public noted that there were representatives from a number of health campaign groups from across the patch at the meeting and he asked to raise a number of points relevant to all groups.

 

The first related to rationing of services. John considered that reductions in funding could lead to rationalisation of services and this was fundamentally at odds with equity and universalism.

 

The second point was that STPs were leading to increased privatisation. However, national contracts which have gone out to private businesses have then had to be handed back to the NHS as these organisations have not been able to cope.

 

Thirdly, STPs were based on unrealistic collaborations between private organisations and NHS providers.

 

Finally, STPs centre around an underfunded NHS and whilst it was acknowledged that there is scope for improvements, it was considered that this underfunding was driving the development of the STP.

 

Mark stated that in terms of the comments made regarding rationing, the health service is continuously looking at services and whether they are being delivered effectively and efficiently and new services are coming into being as a result of technical innovations. It is therefore not a case of rationing. Rather it is a case of ensuring that organisationally the health service has the ability to continue to deliver the services which are needed. In order to ensure a strong sustainable health service into the future it is therefore necessary to transform services and deliver them in a different way.

 

On the issue of underfunding, Mark acknowledged that there has been a significant amount in the press regarding this and Simon Stephens has raised this. However, Mark indicated that it was necessary to work within the funding allocated to the region and make best use of this.

 

Alan stated that there had not been a funding cut. However, the region was not being allocated as much of an increase in funding as in previous years. Alan stated that as a result it was necessary to make this funding allocation ie the place £ go as far as possible and it was important to lobby government for increased levels of funding.

 

Alan stated that the STP was not about privatisation. The aim was to keep NHS funding in the NE and localities as far as possible rather than pass this to the private sector. Alan acknowledged that the NHS has had to deal with the private sector in terms of PFI initiatives but stated that going forwards what was needed was collaboration and previous models for tendering services needed to be rethought as a model which encouraged competition between trusts was not necessarily the most economic model.

 

? highlighted that within this sub regional footprint there were three maternity units and it was clear that there were going to have to be less. Furthermore the prevention agenda can’t be achieved without investment and the money to achieve this is not forthcoming. It was also noted that the BMA does not support the STP.

 

Councillor Caffrey noted that there were a range of different perspectives on funding for health and care provision and it was important to move beyond this.

 

The Chair stated that it was up to everyone to lobby for fairer funding for the NHS.

 

Supporting documents:

 

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