Agenda item

(To receive a report from the Lincolnshire Sustainability and Transformation Partnership, which provides the Committee with a quarterly update on the overall progress of the Lincolnshire Sustainability and Transformation Partnership.  John Turner, Senior Officer responsible for the Lincolnshire Sustainability and Transformation Partnership, will be in attendance for this item)

The Chairman welcomed to the meeting John Turner, Senior Responsible Officer, Lincolnshire Sustainability and Transformation Partnership (LSTP) and Sarah Furley, Programme Director, Lincolnshire Sustainability and Transformation Partnership.

In guiding the Committee through the report the Senior Responsible Officer (LSTP) made reference to the NHS Long Term Plan (LTP).  The Committee was advised that the Prime Minister had set out a funding settlement for the NHS in England for the next five years.  In return for this the NHS had been asked to set out a Long Term Plan for the future of the NHS service.  It was highlighted that work on the LTP was being co-ordinated nationally by NHS England and NHS Improvement (NHSI).  As part of the process NHS England and NHSI had been engaging with stakeholders and groups to develop policy proposals for inclusion in the plan.  The Committee was advised that the Secretary of State for Health and Social Care had stated that his three priorities were Workforce, IMT, and Prevention; and it was expected that these would feature strongly in the LTP, along with greater emphasis on integration and system working.  Details of the considered themes were shown on page 31 of the report.  Particular reference was made to the clinical priorities, which were Cancer; Cardiovascular and Respiratory Diseases; Mental Health including Learning Disability and Autism.

It was highlighted that publication of the LTP was the start of the next phase; as local systems would be required to engage with patients, the public, stakeholders and health and overview scrutiny committees in developing local strategic plans in line with the LTP.

A copy of a letter sent to Council Leaders, Health and Wellbeing Boards and Health Scrutiny Committees from NHS England and NHSI was attached to the report at Appendix A.  Appendix B provided the Committee with a copy of a letter from the NHS England Chief Executive and the NHSI Chief Executive which advised of their approach to planning. 

It was highlighted that nationally steps were being put in place to streamline working procedures between the NHS England and NHSI, to have one team of National and Regional Directors working together.  It was highlighted further that the new region had just been announced.  It was reported that there would now be seven regions across the country and that Lincolnshire would be part of the Midlands Region. 

The Committee was advised that planning for the content of the LTP as a system approach was already on-going.  Previously, there had been individual plans; but now for 2019/20 there would be a one system approach, with Clinical Commissioning Groups and NHS Trust working together as one team.  It was noted that the priorities that would be addressed were care in the local community where appropriate, diabetes and frailty.  There was an emphasis on supporting more care in the community.

The Committee noted that there would be one Accountable Officer for all the four CCG's; and a single leadership team.  The Committee noted further that there was a requirement for a 20% reduction in CCG running costs; and as a result there would need to be a different approach to how business was conducted going forward and a different approach to transforming services.  The Committee was advised that there would be a CCG joint committee making commissioning decisions on behalf of the four CCGs. 

The Committee noted that the Acute Services Review was currently going through the assurance process and that once concluded in 4 - 6 months' time, NHS England would then support the CCGs in going out for a full and public consultation.  It was highlighted that the consultation would be a full and open event to gather the thoughts of the public; and that it would involve a range of activities across the County.

The Committee noted further that once the LTP was published, there would be conversations with staff and the public concerning the plans for Lincolnshire.  It was noted that these conversations could not happen until all information was in the public domain and that this would be in advance of any formal consultation.  The publication of the NHS LTP had been expected in early December, but now there was some uncertainty over the publication date.

During discussion, the Committee raised the following issues:-

·         Page 54 - One member referred to the 3,000 comments received in response to the questionnaire and the need for the formal consultation to attract a higher number of responses;

·         The continued overnight closure of Grantham A & E remained a concern;

·         Some concern was expressed that the whole system could be slowed down by small consultations, as the STP could not be viewed as a variation of the LTP.  The Committee was advised that the new LTP would build on the old plans and address new issues.  Clarification was given that engagement was on-going with patients and stakeholders when there were minor changes to services.  However, where there was a significant material change proposed, a consultation exercise would take place;

·         One member expressed concern regarding the newly formed NHS England and NHS Improvement regions, with some hospitals continuing to be in a different region; and whether this would have implications for patients.  The Committee was advised that there were already good relationships with neighbouring health providers; and there was already joined up thinking.  It was highlighted that a quarter of the Lincolnshire population attended hospitals outside of Lincolnshire;

·         Some concern was expressed to the 20% reduction in CCG administration costs and how that would be achieved, particularly as there appeared to be some resistance to change in the NHS.  The Committee noted that this time it was different; as colleagues across the country had expressed views that the current system was not working; and that the changes proposed had come from the CCGs themselves rather than from central NHS management.  At the heart of any changes was the drive to ensure that a good service was provided for the residents of Lincolnshire.  The 20% reduction in administration costs was a hurdle and would be a shift in working practices, which would have to be maintained by the four CCGs.  It was noted that the system was up for the challenge;

·         The need to ensure that the work force issues were addressed, to ensure that improvements were achieved;

·         That prevention was a priority and as such needed to have adequate resources.  It was felt that it needed to be a priority for national and local government;

·         The impact of rurality and transport links in Lincolnshire had on service provision and the need to ensure that the County received adequate funding to compensate for these issues.  The Committee was advised that rurality and transport were a shared concern across all organisations in Lincolnshire, especially on the east coast where access was an issue.  It was highlighted that integrated community care provision across the County would help with this issue;

·         One member highlighted that Ophthalmology appeared to be struggling and confirmation was sort as to whether this was the case? The Committee was advised that there had been some challenges for the 100 day programme for Ophthalmology due to the loss of staff, and that services changes were being planned to make ophthalmology more sustainable; 

·         A question was asked relating to the proposed integrated community care model, did that mean that staff would be integrating into primary care and GPs.  Confirmation was given that staffing remained fragile; but getting the right staff was fundamental for the system to move forward.  The Committee noted that with regard to rurality, Lincolnshire was a member of the Rural Health and Care Centre; and that a report was due to be published concerning workforce in the early part of 2019;

·         Some Members welcomed the single CCG Joint Committee.  The Committee was advised that the Joint Committee would ensure that the right issues were highlighted and managed across the County.  Other members welcomed the working together of NHS England and NHS Improvement.  It was highlighted that the public perception was that the NHS was one single organisation, whereas in practice the NHS was still working in silo's; and the whole principle was to get one NHS working within its constraints;

·         One member enquired as to the newly appointed Regional Director for the Midlands; and also where the new single Accountable Officer would be recruited from.  The Committee was advised that the newly appointed Regional Director, Dale Bywater, had been appointed following a vigorous recruitment process and had expertise in the new roles he would be undertaking; he was also familiar with Lincolnshire and its challenges.  The Committee was advised further that the Accountable Officer position would be advertised nationally;

·         One member extended thanks to the officers for their optimistic report; and made reference to the fact that the budget for health services would need to increase year on year to address the needs of the older population; that a career in the health service needed to be promoted better in schools; and that more needed to be done to fund the 'hidden' Lincolnshire population.  The Committee was advised that the NHS offered a brilliant service; and that it needed to have ambition and hope; as there was a clear understanding of what needed to be done to address the issues in Lincolnshire.  Confirmation was given that work was on going with Lincolnshire schools; and that health colleagues were always learning what other areas were doing; seeing what was working and whether these could be replicated in Lincolnshire; and

·         Clarification was sought as to when engagement would commence for the LTP or the Acute Services Review.  The Committee was advised that once the LTP was published, things would move quickly; and at a best guess it was felt that the LTP would be published early in 2019.  As the Urgent Treatment Centres would be dealt with as a system, the consultation on them would be part of the overall consultation.

The Chairman extended thanks to the representatives.

RESOLVED

1.    That the NHS Long Term Plan – Impact on the Lincolnshire Sustainability and Transformation Partnership report presented be noted.

2.    That a further update report be received at the 23 January 2019 meeting to update the Committee with regard to the local planning, engagement and progress, alongside the response with regard to the future consultation plans for Grantham and District Hospital A & E Services, as requested by the Minister of State for Health.