Alan Foster and Mark Adams, Joint Leads for Combined Cumbria and NE STP will provide the Joint Health STP OSC with a presentation on the above.
Minutes:
The Joint Committee was informed that when the STP plan / vision was put together this was done in a technical way. Consideration was given to three areas; how the health and wellbeing of patients can be improved; the quality of services and available funding. Within the STP footprint there is still a considerable amount of deprivation issues in terms of public and patient health and the aim is to narrow the gap. However there is an identified £641m funding gap by 2021. However, there is potential for this gap to be even higher as the demand for health services keeps rising and funding for these services is staying relatively flat.
The Joint Committee was advised that the plan predominantly sets out the work which is already taking place across the STP footprint which in general terms falls under three headings. The first is around how we can scale up prevention work and help people to have healthier lifestyles and become fitter. The second is around out of hospital collaborations to develop different services such as the Vanguard Care Homes Initiative in Gateshead. The third area is focused on how we get NHS staff in hospitals to work together in different ways. Previously trusts have been set up to work as competitive organisations. This approach has not been helpful in relation to funding issues. The aim now is to encourage trusts to look at how they can work together instead.
There is a focus on these three areas across the STP with different variations and work is taking place across prevention, urgent care, cancer, pathology and workforce which is one of the biggest.
The Joint Committee was advised that there is a really good track record of joint working in the North East and this has meant that some of the workstreams across the STP areas have been in place for some time eg Digital and Urgent Care.
The STP added other workstreams such as how the big Foundation trusts are working together to tackle issues such as workforce, pathology and prevention. Other workstreams have been put in place to take things forward on a task and finish basis so that learning can be disseminated to all CCG areas and to look at how it is possible to deliver more in terms of support services for patients.
The Joint Committee was advised that in terms of decision making across the region, governance arrangements are in their infancy and there is a need to understand how the three STPs will work together as all three STPs will need to work across the fourteen different workstreams. Draft proposals are being considered in relation to an Accountable Care Partnership and local delivery partnership / models linked closely to local Health and Wellbeing Boards.
Alan stated that the key point was around a changing emphasis away from competition to collaboration with Foundation Trusts working more together and developing networks of clinicians working across the patch so that they can support services and keep them as local as possible. Alan stated that he was not saying that there won’t be some changes arising from the work being carried out. However, the aim is to keep services as local as possible.
Alan also noted that workforce needed to be considered across the regional footprint as there is a need to address staff shortages in primary care and train up staff. Alan stated that as a result a medical school is planned to be developed and supported in Sunderland. It was important to achieve equity of access in the future.
The Chair queried who set the priorities for the workstreams and was informed that these needed to be clinically led. The workstreams would then make recommendations which be fed through to NHS and local authority managers and then to Health and Wellbeing Boards and OSCs if there is to be an impact in a particular area. The OSC was informed that the legal requirements for consultation on service changes would be adhered to.
Councillor Caffrey noted that every year the Health and Wellbeing Board in Gateshead would look to set its priorities for the year. However, when this process takes place most of the priorities have to relate to national or regional targets which have to be delivered before consideration can be given to putting forward one or two local targets. Councillor Caffrey stated that she would like to be convinced that this system is different as it is being driven clinically. However, Councillor Caffrey stated that looking at the diagram the same mechanisms / individuals appeared to be involved. Councillor Caffrey considered that it was important that a top down process was avoided and that work is carried out to understand the position on the ground and the services that people need in localities.
Mark stated that this was a good point although inevitably there would always be a need to address certain national targets. However, Mark stated that they were trying to make the process as bottom up as possible based on what is happening in each local area, having regard to the views of patients and the public and feeding this into the workstreams and then through local NHS / LA mechanisms and local Health and Wellbeing Boards?
Alan stated that they are trying to develop a bottom up approach and valued the help of the Joint Committee in this regard.
Councillor Mendelson stated that local delivery vehicles would be at the heart of this process and there was a need to have a greater understanding as to what these are and how they would work. Councillor Mendelson noted that she was aware of that recently there had been the threat of losing GP practices in Newcastle based on market issues rather than patient need. Therefore Councillor Mendelson considered that it was important to understand what local delivery vehicles were in place and how they were accountable locally moving forwards.
Councillor Robinson stated that he was delighted that a bottom up approach was being proposed as this was not the approach which had been adopted in North Durham where patients in Seaham are now having to travel to Sunderland. He was also aware of concerns being raised from other smaller parts of the region where there were concerns that local views would be lost in the STP process.
Councillor Robinson also highlighted concerns that there was no reference to NEAS and transport in any of the references to the workstreams. Councillor Robinson stated that he would have liked to have seen even one sentence confirming that every workstream would deal with transport. Councillor Robinson advised that Durham was very concerned about transport as NEAS is unable to fulfil its current targets in that locality and only achieves 36% of emergency 1 calls. Councillor Robinson asked that the issue of transport is addressed as it is a key priority for the public.
Alan acknowledged that this was a fair point and reassured Councillor Robinson that transport was part of the agenda and he agreed that it was right that this was made more explicit. Alan stated that they have established a paediatric intensive service outside of Newcastle where every hospital in the North East will get specialist transport for very ill babies. Alan stated that consideration now needed to be given to adult critical care transport.
Councillor Flynn noted that South Tyneside had lost its Stroke unit to Sunderland temporarily due to a shortage of clinicians and he queried whether work across the STP was being driven by a shortage of clinicians.
Mark advised that there are issues around the availability of clinicians and certain areas where there are specific problems. Caroline advised that there is a national shortage of stroke clinicians and this has already resulted in changes to Stroke Services across Newcastle and Gateshead as well as in South Tyneside. The issue is being considered by the workforce workstream and an update on this area of work will be brought back to a future meeting of this Joint Committee.
Councillor Hall welcomed the involvement of clinicians in the workstreams but considered that it was also important to balance this with input from patients.
Mark stated that this was a good point and once clinicians had made their recommendations work would take place around how discussions could take place with patients and the public regarding their needs.
Councillor Taylor noted that different workstreams were at different stages and queried whether it was possible for progress updates to be brought to this Joint Committee on the workstreams which were further ahead in their work. It was queried whether it would be possible to look at the Prevention workstream and as part of that update look at what is happening in the area of smoking prevention.
The Joint Committee was advised that there had been some good progress in this area and it would be useful to bring this to the next meeting of the Joint Committee.
It was also suggested that it would be helpful for the Joint Committee to receive a progress update on the Urgent Care workstream at a future meeting.
Councillor Schofield expressed concern that the STPs were more person - based than geographic and queried how this would be funded and patients would not be excluded.
Mark explained that the STP would involve the same levels and standards of service across the patch and much of the work of the workstreams would be around standards and outcomes.
Councillor Schofield asked Mark to confirm that the STP was not about people not being eligible for funded services.
Mark confirmed this was not the case.
Councillor Caffrey queried whether the workstreams were going across all areas and Mark confirmed that this was the case. Mark stated that when good practice was identified in one area it would then be shared across the patch.