Agenda item

NHS Long Term Plan

(To receive a presentation from Glen Garrod, Executive Director Adult Care and Community Wellbeing in relation the NHS Long Term Plan)


The Committee received a presentation by the Executive Director for Adult Care and Community Wellbeing in relation to the NHS Long Term Plan which provided detailed information in relation to the following areas:

·         Some background: the Green Paper, the NHS plan and the Spending Review – it was anticipated that the Green Paper would either be released by the end of March or in May.  It would be a consultation document which would feed into the Spending Review.  There had been £20.5bn allocated to the NHS.  It was noted that the Plan had been produced following an intensive 12 week engagement period.

·         How the NHS Long Term Plan was developed – members were advised that this was a very engaging process, partly due to it being so intense.

·         Background – it was noted that the increase in funding of 3.4% per year was not what the NHS had asked for.  4.1% had been requested, which meant that the NHS was already working with less than it was thought was needed. The Prime Minister had also announced a number of conditions on which the £20.5bn would be dependent, including improved NHS efficiency and elimination of the NHS deficit.  The Long Term Plan's reference to 'integration' mostly referred to integration within the NHS rather than with adult social care, as the NHS  was currently very fragmented and there would be a need to re-integrate the NHS (for example in Lincolnshire there were 4 Clinical Commissioning Groups and 3 NHS provider trusts).  There was also an expectation to deliver significant improvements for patients.

·         What the NHS Long Term Plan will deliver for patients

·         Making sure everyone gets the best start in life

·         Delivering world-class care for major health problems…- it was noted that some respiratory conditions, such as asthma, were being exacerbated by cold, damp housing. There was also an increasing number of elderly people moving to the county to retire, who had pre-existing health conditions. 

·         Supporting people to age well… - this was the area of greatest interest for councils, as the NHS had historically invested more money on acute care than primary care. 

·         Delivering the ambitions of the NHS Long Term Plan:-

·         1. Doing things differently

·         2. Preventing illness and tackling health inequalities

·         3. Backing our workforce

·         4. Making better use of data and digital technology

·         5. Getting the most out of taxpayers' investment in the NHS

·         What this means for staff, patients and the public

·         How did the Association of Directors of Adult Social Services assess the Plan – ADASS had stated that the Green Paper and the NHS Long Term Plan should have been developed in parallel and a major opportunity had been missed; the absence of clarity and certainty about future social care funding represented a major risk to the ambitions of this NHS Plan.  However, ADASS had been positive about the proposed shift of resources to community and primary care; and the emphasis on personalisation and choice.

·         Reference was made in particular to paragraph 1.57 of the NHS Long Term Plan which stated:


            "Both the wellbeing of older people and the pressures on the NHS are also linked to how well social care is functioning.       When agreeing the NHS funding settlement the government             therefore committed to ensure that adult social care funding is           such that it does not impose any additional pressure on the NHS       over the coming five years.  That is the basis on which the       demand, activity and funding in this Long Term Plan have been        assessed."


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

·         A requirement for the funding was that the NHS must not have a deficit, and therefore much of the remainder of the funding would be taken up by this.

·         It was noted that 5200 clinical grades left the NHS every year but there were training places for 4,500 trainees.  The remainder would be filled by staff from overseas.  However, it was noted that India was developing its own primary care system which could impact on the numbers of staff coming to the UK to work.

·         It had been highlighted that there were staff recruitment and workforce challenges in Lincolnshire, and it was queried whether anything could be learned from the way that Children's Services had been recruiting.  It was noted that some things did have to be done differently, and the Care Providers Association (LINCA) had been a good strategic partner to the Council.  Members were informed that the Care Association employed over 20,000 care assistants.

·         It was commented that the current NHS structure could not deliver this Plan and if it did not change the way it did things then it would still be in deficit.  However, the direction of travel that the Plan laid out was good, but the local authority would need to deliver its part.  It was commented that a fundamental change in the approach to the management of the health service would be required for this Plan to be effective.

·         There was support for the idea that a fundamental change in approach was needed.

·         Concerns were raised regarding the attitudes around Type 2 diabetes, as in the majority of cases it was linked to lifestyle and was a preventable.  It was highlighted that the case of Tom Watson, a Labour MP, was a good example of how people could 'reverse' their type two diabetes by making health and lifestyle changes.  Treating type 2 diabetes used an enormous amount of resources, but it was something which was largely preventable.

·         Members were informed that there was a national diabetes prevention programme and it was starting to look at aspects of health and lifestyle.  Nine out of ten new cases of diabetes were Type 2, and 90% of these cases were preventable. 

·         The Integrated Lifestyle Support Service was due to launch in July 2019 and would involve work to change behaviours over a 12 month period.  People with Type 2 Diabetes would be one of the priority groups.

·         Public Health was still a priority area, and a Green Paper on Prevention was expected which would bring together the NHS, social care and Public Health.

·         In terms of the digital platform, it was noted that a design was being worked on for the website.

·         As part of the Integrated Lifestyle Support Service, an individual would meet with someone on a regular basis to ensure they continued to follow the guidance.

·         It was queried whether there would be an opportunity on the new website to promote self-help options. 

·         The Connect to Support website was separate to the Council website at present but would be integrated in due course, and would give information on how individuals and communities could help to support themselves without going to the council.

·         The local NHS would shortly be launching its own engagement plan, which would include self-help and the role of community pharmacies.  There was an opportunity over the next year to pull a lot of this together so there could be one common approach.

·         It was queried how the message could be communicated to people who wanted to help themselves.  It was suggested whether the Committee should have a 'deep dive' of these issues another time.

·         It was commented that cultural change took a long time, but it was something that needed to be done.  For example, obesity often started in childhood due to not having the right diet, and there was a need to address this early on.

·         In terms of reducing childhood obesity there was a need to work much better with schools and children's centres.

·         It was important to note that you could not make people change their lifestyle if they did not want to.  There was a real opportunity when people had a baby as that often prompted them to make that change.

·         Concerns around the ability of the NHS to deliver on this Plan were supported and there was not the same degree of accountability that local authorities had.  It was highlighted that one of the biggest impacts on health care was substance misuse.  Members were advised that a substance misuse service was currently commissioned to provide this service.  Substance misuse was often wrapped up in lots of other issues, in particular mental health, as well as housing and chaotic lifestyles.

·         The number of people diagnosed with autism was now as high as the numbers with dementia.  Members were advised that there were a lot of people who had not previously been known to the SEND team who were now coming to adult services needing help.  These were adults who had been in mainstream education and college but not previously needed support.  Officers were carrying out a piece of work to understand why this was now happening. 

·         The headline figures were that 12.3 children per 1000 pupils in Lincolnshire were diagnosed on the autistic spectrum, compared to 11 in the East Midlands and just under 11 nationally.  Less than 5% of adults with autism received support from Adult Social Care.  The prevalence did match that of dementia, but different resources were required.  There was a pathway for children and young people into work following school.

·         In terms of home learning, by law, the authority could only go into the home once per year for school age children.  There was no requirement for parents to get a tutor for their children and could teach them themselves.

·         It was queried whether the authority was rigorous with GP's in terms of antibiotic resistance and opioid addiction through prescription.  Antibiotics over prescription were one of the priorities for the Chief Medical Officer.  This was about the impacts on health rather than money.  This also included antibiotic use in farming and other industries.  It had improved but work needed to continue.

·         There was an increasing number of people with addiction to prescription drugs and would be seen through the substance misuse service.  This was not a national priority at the moment so more work was needed to push this forward.  An integrated pain management approach was required and a new service was being developed which would help people to deal with pain without substances for support.

·         In terms of the increase in demand for autism services, it was queried whether other parts of the country were experiencing the same sort of increase, or historically whether the authority had not had the resources to pick up the extra cases.  Members were advised that there were a lot of young people that had a statement with a diagnosis of autism but did not need any additional services.  It was also noted that autism had such a wide spectrum of needs.




            That the presentation and comments made be noted.



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