Agenda item

(To receive a report from John Turner, Chief Officer, South Lincolnshire Clinical Commissioning Group (for Lincolnshire CCGs), which provides an overview of the NHS Long Term Plans and asks the Board to review the commissioning intentions for 2019/20 against the priorities in the Joint Health and Wellbeing Strategy)

It was suggested that the NHS Healthy Conversation 2019 and NHS Long Term Plan and Lincolnshire's Planning/Intentions for 2019/20 items were considered as one as there would be overlapping information.

John Turner, Chief Officer, South and South West Lincolnshire Clinical Commissioning Group, presented reports to the Board and provided updates in relation to the NHS Healthy Conversation 2019 and NHS Long Term Plan and Lincolnshire's Planning/Intentions for 2019/20.

It was reported that in the three to four months leading up to 5 March 2019 (launch of the Healthy Conversation 2019) a number of conversations had been held with the Health Scrutiny Committee for Lincolnshire, this Board, County and District Council colleagues as well as other partners.  The NHS had been preparing to start an open conversation in very broad terms on the direction for the county.  Work had been taking place on this for a significant amount of time.  In early January 2019, the NHS Long Term Plan was launched.  Planning discussions had been taking place over the past year or so.  The Healthy Conversation 2019 had now started and was an open engagement exercise which was running across the county.  The approach being put forward included things that a lot of partners were already doing and it was highlighting a lot of good examples of changes.

Board members were encouraged to look at the website which had been set up as there was a large amount of information available which was presented in a user friendly way.

Health colleagues were starting to think about what the next stage of the engagement activity would look like, as there was a lot of information coming in, and it was planned to deal with it according to area as there would be different issues for different localities.  The Healthy Conversation 2019 was planned to run into the autumn.

It was expected that there would be more work around prevention and how to keep people as healthy as possible including work around self-care.  There would be a stronger emphasis on developing integrated community care services.  Acute hospital services should be there to provide specialised care that it was not possible to provide in the community.  There would be a push towards system working as the NHS was very fragmented, both in the services it provided and the way it worked with partners.  There would be work to move towards becoming an integrated care system and working more systematically with partners.  Partnership and collaboration would be much stronger going forward.

Health colleagues were required by NHS England and NHS Improvement to produce a local version of the Long Term Plan for the County.  This had to be informed by open discussions with people who used the services and partners and so it was timely that the Healthy Conversation had just commenced.

Members of the Board were provided with the opportunity to ask questions to the officers present in relation to the information contained within the report and some of the points raised during discussion included the following points:

·         Through collaboration between NHSE and Healthwatch England, there was a need to determine what was wanted by Lincolnshire from the Long Term Plan.  Healthwatch had had the most input from survey responses, and would be holding focus groups, as the general public did not yet know what they wanted.  The Healthy Conversation was welcomed.

·         In terms of urgent care centres, there were changes proposed to urgent treatment centres as opening times did not seem to be consistent and there was a need for uniformity across the county with opening and closing times.  It was queried whether there was an expectation that people should call 111 when during times when the centres were closed.  It was noted that the Health Scrutiny Committee for Lincolnshire had also expressed a wish to explore this issue with the CCG as well.  It was highlighted that Urgent Care treatment was for those who needed care, but it was not an emergency or life threatening situation.  There was national guidance on what services should be provided and that they should be open a minimum of 12 hours per day, 7 days per week.  It was envisaged that there would be a 24 hour centre at Pilgrim and Lincoln County Hospital.  Grantham was also expected to become an urgent care centre on a 24 hour basis, as well as Louth.   Stamford minor injury unit was open Monday – Friday from 9am – 5pm and it was envisaged that this would become an urgent care centre, but on a 12 hour/7 days per week basis.

·         Currently people were expected to call 111 during out of hours for urgent care centres, as this would enable people to get to the right place at the right time.  However, it was noted that not all services would be available at all times of the day, for example x-ray services.

·         It was noted that there was not a fixed position on whether these would be walk-in services or 111.  Louth and Skegness did have the opportunity to be walk-in services.

·         There was a need for clarity and a consistent message that could be promoted to residents.

·         There had been a lot of questions about the ambulance and the 111 service.

·         It was highlighted that a clear message was key and that having the conversation with the public was important in order to manage expectations.  The Board was advised that in terms of the conversation, this would involve being realistic about what could be delivered.

·         It was known that there was a struggle to recruit and retain staff, and accounted for 10% of the spend.  It was hoped that the healthy conversation would be an honest one but there was a need to be ambitious for the future of the health service, and it was thought that most of the public understood this, and people should not be prevented from expressing what they wanted.

·         It was noted that the events which had taken place had been well attended, and there was concern that the public were not hearing about some of the work which was already being done, such as neighbourhood working.

·         In terms of timescales, it was expected that the Healthy Conversation would run until the autumn of 2019.  It was acknowledged that this timescale was quite vague, but autumn was also referenced in the NHS Long Term Plan.  Health colleagues advised that they would like the Healthy Conversation to run for as long as it needed to.

·         Digitally enabled care, this depended on people being able to access it, rather than just age, and how it would work in different areas of the county.  There would be an issue of digital infrastructure.

·         There was a lot of material on the website about the things which were working well, as well as information on the changes which had taken place in the last 12 months and those that were planned for the 12 months ahead.

·         On the feedback forms, people were being asked if they would be prepared to receive care digitally, and how helpful it would be.  It was noted that this was currently working well in other parts of the country and the world.

·         It was acknowledged that the digital infrastructure was not as comprehensive as health colleagues would like it to be, but it was better that in some other parts of the country.

·         In terms of the condition of the NHS estate, it was noted that a collaborative approach through partnership working would be required in order to improve it.  It was highlighted that the blue light services were now under one roof at the new Headquarters building at South Park, Lincoln was a good example of how different services could work together.

·         There were concerns about accessibility to health services for people taken into custody in places such as Grantham, as they would generally be transported to Lincoln.  The Police and Crime Commissioner would like to work with NHS colleagues to tackle this.  There was a responsibility to use the money available to its best effect, and health colleagues had been alerted to the issues around custody suites in Grantham, and would be happy to work with the PCC and his team on this.

·         It was noted that there were over 10,000 calls to 111 each day.  However, there were some concerns around how it worked.  If a person had a concern and needed attention, they should call 111.  There was confidence in the 111 service to enable people to use it.

·         It was queried what was being done in terms of engaging with young people and it was reported that there was a group of  young people who were engaged with as well as engagement events for those with protected characteristics.

·         It was queried how health organisations were going to tackle the difficulty in retaining staff.  It was acknowledged that NHS England had a workforce crisis.  There were 100,000 vacant posts in England.  40,000 of these were nursing posts.  The rest were a whole range of health care professionals.  However, the issues were further exacerbated in Lincolnshire, particularly towards the east coast.  There were 850 vacancies in Lincolnshire.  It was noted that there was a huge amount of work taking place to try and tackle his, including a new medical school to be based in Lincoln, development of a health academy, and it was suggested that this work may be worthy of an independent discussion at a later date.

·         In terms of the estate, it was noted that a lot of it was quite run down and it would take a lot of money to change this.  It was acknowledged that the hospital estate left a lot to be desired, but a lot of the models that were hoped to take the service forward were those that brought health and social care partners together in one place.  It was noted that some of the buildings within the estate had covenants on them so they could only be used as hospital buildings.

Both reports were considered and discussed at the same time, however, each set of recommendations were considered separately as follows:

NHS Healthy Conversation 2019

RESOLVED

            That the Board note the launch of the Healthy Conversation 2019 listening and engagement exercise on 5 March 2019 and that feedback would be incorporated into the local 5 year long term plan which was required to be developed by autumn 2019.

NHS Long Term Plan and Lincolnshire's Planning/Intentions for 2019/20

RESOLVED

            That the Board note the detail in the report about the NHS Long Term Plan and the key priorities (system intentions) for 2019/20 as set out in the draft System Operating Plan.