Agenda item

Update for Healthy Conversation 2019, the NHS Long Term Plan and NHS Estates

(To receive a report from the Lincolnshire Sustainability and Transformation Partnership, which provides the Committee with feedback from Healthy Conversation 2019, an update on the national timetable and local plans to deliver a Long Term Plan for Lincolnshire; and the position of NHS estate. Senior representatives from the Lincolnshire Sustainability and Transformation Partnership will be in attendance for this item)


The Committee gave consideration to a report from the Lincolnshire Sustainability and Transformation Partnership (STP), which provided feedback from the Healthy Conversation 2019; advised of the national timetable and local plans to deliver a Long Term Plan for Lincolnshire and provided an update on the position of NHS estate.


The Chairman welcomed to the meeting Sarah Furley, Sustainability and Transformation Partnership Programme Director.


The Committee were reminded of the background behind Healthy Conversation 2019; the number engagement events held, details of which were shown on page 30 of the report. 


It was reported that the online survey for the Acute Services Review had closed on 31 August 2019, to enable all data received to be analysed; and that locality road shows were continuing, as were locality workshops.  It was reported further that the Healthy Conversation 2019 campaign would be ceasing at the end of October 2019, so that all the information gathered could be used to develop the Long Term Plan for Lincolnshire.  Detailed at Appendix A to the report was a copy of Engagement Event Poster Distribution list; and Appendix B provided the Committee with information relating to engagement for Wave 2 and 3 of the Healthy Conversation 2019.


The Committee noted that there were other activities taking place, which comprised of the recruitment of a Citizen's Panel to help with virtual engagement with a representative sample of Lincolnshire's population; that work was continuing with Lincolnshire County Council to collectively address some of the public's concerns regarding transport; and that a local awareness campaign to promote NHS 111 would be starting in October 2019 to support winter resilience.


The Committee were reminded that the NHS Long Term Plan Implementation Framework, published in June had set out the requirements on sustainability and transformation partnerships and integrated care systems to create their five-year strategic plans.  It was noted that the framework expected local systems to meet the end goals set out in the Long Term Plan, but also allowed the substantial freedom to respond to local needs and priorities.  The expected principles of the system five-year plans were shown on page 32 of the report.  


It was highlighted that NHS England had asked each local Healthwatch to support public engagement on the long term plan; and to contribute to the development of a local plan in each area.  The report highlighted that Healthwatch Lincolnshire had asked people 'What Would You Do?' to improve local services in Lincolnshire.  The Committee noted that 400 people had responded and the common messages received were shown at the bottom of page 32 of the report.


It was reported that Lincolnshire's Long Term Plan would be underpinned by the feedback from Healthwatch and from the public and stakeholders.  The plan would also include the work that had been undertaken on integrated community care and the recent development of Primary Care Networks, as well as plans for Mental Health Services; and prevention and reducing inequalities; and the work of the STP.  It was highlighted Lincolnshire's Long Term Plan provided the opportunity to bring everything together in one vision. The Committee noted that the national timescale to produce a draft of the Long Term Plan was 27 September 2019, with the final version being submitted to NHS England on 15 November 2019.  The Committee noted further that NHS England would then produce a composite report form all the local plans before Christmas, when it was hoped the Lincolnshire Long Term Plan would be published.


The report also highlighted that there were some outstanding services in Lincolnshire, delivered from well-designed buildings.  There were also services that required improvement, in buildings not fit for purpose.  It was hoped that the new approach to planning NHS estate in Lincolnshire would unlock innovation and new ways of working.  The Committee was advised that feedback on the NHS Lincolnshire Estates Strategy which had been submitted to NHS England was anticipated in October 2019.


The Committee was advised that to deliver a Critical Energy Infrastructure and deliver Urgent Treatment Centre ambitions, a total of £102 million was required.  Less the £21 million for the A & E Department at Pilgrim Hospital, Boston announced by the Prime Minister, still left a total of £81 million to find. 


It was also highlighted that the back log of maintenance across the hospital sites was £236 million and was rising year on year.  It was highlighted further that the backlog maintenance costs of £236million would not achieve all 'new' building standards.


In conclusion, it was highlighted that in order to obtain the necessary capital funding to deliver buildings fit for future health care, significant support was required across the system.


During discussion, the Committee raised the following points:-


·         Some concern was expressed that there was a low number of people attending engagement events; and as a result the views obtained might not be representative of the wider population.  Reassurance was given that although there had been small numbers attending some of the Healthy Conversation 2019 events, there was evidence that engagement was reaching a wider audience.  The Committee was advised that there had been 40,000 hits on the website alone.  Reassurance was also given that the petition on Grantham and District A&E had been received and would be included as part of the Healthy Conversation 2019; and that the petition had also been passed to the South West Lincolnshire Clinical Commissioning Group.  One member advised that he had found attending a Healthy Conversation Event very interesting and worthwhile; and encouraged other members to attend an event in their area if they had not already done so.  It was further highlighted that there needed to be better publicity of future events.  The Committee noted that some of the events planned were going to be held in markets, supermarkets and other ad hoc places to ensure that everyone had the opportunity to have some input; and that meetings had been planned with voluntary organisations and other groups and stakeholders.  One member also highlighted that there was a need to engage with the elderly population;

·         The availability of a maintenance plan for NHS Estates.  Confirmation was given that a maintenance plan did exist.  It was highlighted to the Committee that the investment in building repairs and maintenance had declined, as a result of a lack of overall available funding to the NHS, with priority being on direct patient services rather than buildings.  Some concerns were expressed regarding the funding required to recover the back log in maintenance, estimated at £236 million.  It was highlighted that the £236 million would not achieve all 'new' building standards.  The Committee was advised that an estimate £102 million was required to change some of the buildings, as part of the transformation project.  The Committee was reminded that a lot of NHS buildings were over 100 years old.  Reassurance was given that every building deemed not to be at a suitable standard was risk assessed; and that risk assessments were conducted on a building by building basis.  It was highlighted that estimated maintenance costs were as a result of two decades of under investment in the maintenance budget.  It was highlighted further that the solution was this would be addressed by the whole system;

·         Joint transport working.  The Committee was advised that joint transport work was in progress between the NHS and Lincolnshire County Council to try and address the public's concerns relating to transport.  The Committee was advised further that an integrated transport strategy was expected by the end of the year;

·         One member enquired how the effectiveness of the 111 system might be solved.  The Committee was advised that there was a need to increase public perception; awareness and level of confidence in the service.  The Committee noted that awareness would be raised through education campaigns with the public; through the NHS communication plan, and as part of the preparation for winter resilience.  The Committee noted further that the communication plan was currently being re-written. Confirmation was also given that further engagement event dates would be shared with the Committee once finalised; as would the local awareness campaign on NHS 111;

·         Further suggestions made by the Committee for Appendix B was the inclusion of the Health Scrutiny Committee for Lincolnshire; and Bishop Grosseteste University;

·         One member enquired whether there was awareness as to which sites would be reduced (page 33 of the report).  A further question asked was whether the Long Term Plan supported a new hospital building for Grantham.  Confirmation was given that a new Grantham Hospital was part of feasibility activity, and the Committee noted that as yet no decision has been made with regard to a new Grantham Hospital;

·         Citizen's Panel – The Committee was advised that a third party would be recruiting the Citizen's Panel once the Healthy Conversation 2019 had ceased.  It was noted that the purpose of the panel was to allow for further engagement with hard to reach groups to occur.  It was noted further that between 3,000 and 5,000 people were to be recruited to the panel; and that members of the panel would be approached two or three times a year to engage in the co-design of services moving forward.  Confirmation was also given that the panel would be comprised of a mix of skills;

·         A question was asked whether a general election would affect the Healthy Conversation process.  The Committee was advised that the final report was due to be published at the end of the year; and that it was understood that publication of the report on the engagement exercise would not be affected by the pre-election period.  It was however highlighted that no consultation would commence during this period;

·         One member asked what the £21 million capital announced for Pilgrim Hospital, Boston would be used for.  The Committee was advised that the £21 million would be used to refurbish the A & E; up-grade the resuscitation room; and further support for Primary Care Streaming;

·         A question was asked if the £81 million required was not available for capital expenditure, whether this would delay the consultation.  It was highlighted that £50 million of the £81 million was required to support proposals in the Acute Services Review.  It was therefore understood that consultation could be undertaken on those services, where capital funding had been identified, or where no capital funding was required;

·         Emerging options from the Healthy Conversation 2019.  Confirmation was given that no emerging options had been changed or refined, in the light of comments.  The Committee noted that feedback would be reviewed at the end of Healthy Conversation 2019; and then feedback would be presented back to the Health Scrutiny Committee for Lincolnshire to consider; and

·         One member asked as to how much involvement the local authority had with regard to the creation of the local plan.  The Committee was advised that dialogue was happening between the NHS and Lincolnshire County Council; and for the system to work there needed to be partnership working.


The Chairman extended thanks on behalf of the Committee to the Programme Director, STP for her update.




That the Chairman on behalf of the Committee be authorised to provide feedback on the Healthy Conversation 2019, the NHS Long Term Plan and NHS Estates; and that a further update be received at either the December 2019 or January 2020 meeting.

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