Agenda item

(To receive a report from Simon Evans (Health Scrutiny Officer) which provides the Public Summary Document of the Lincolnshire Sustainability and Transformation Plan (STP) and invites the Committee to give initial consideration to the content of the STP and to consider a response to the engagement phase of the STP.  Andrew Morgan (Chief Executive, Lincolnshire Community Health Services NHS Trust), Gary James (Accountable Officer, Lincolnshire East Clinical Commissioning Group) and Sarah Furley (Programme Director, Lincolnshire Sustainability and Transformation Plan) will be in attendance for this item)

Consideration was given to a report by the Health Scrutiny Officer which provided the Committee with the Public Summary Document of the Lincolnshire Sustainability and Transformation Plan (STP) and invited initial consideration of the content of the STP with a view to providing a response to the engagement phase of the STP.

Andrew Morgan (Chief Executive, Lincolnshire Community Health Services NHS Trust), Gary James (Accountable Officer, Lincolnshire East CCG) and Sarah Furley (Programme Director, Lincolnshire Sustainability and Transformation Plan) were all in attendance for this item.

It was explained that each local NHS area was required to prepare a Sustainability and Transformation Plan (STP).  The Lincolnshire STP was published on 7 December 2016 together with a public summary document.  It was clarified that the STP was not a consultation document but a strategy document from which formal public consultations would be derived.  These were expected to take place from May 2017 onwards.

On 22 December 2015, Delivering the Forward View:  NHS Planning Guidance 2016/17 – 2020/21 was published by several national NHS organisations, including NHS England and NHS Improvement.  Included in the guidance was a key requirement for each local NHS area to prepare an STP, the aim of which was to find out how health and care organisations could improve the health and wellbeing of their resident population whilst increasing the clinical and financial sustainability of local health and social care services. 

In January 2016, 44 local STP 'footprints' were developed and the Lincolnshire STP covered Lincolnshire East, Lincolnshire West, South Lincolnshire and South West Lincolnshire Clinical Commissioning Group areas.  It was confirmed that North Lincolnshire and North East Lincolnshire Clinical Commissioning Groups were not included.

Draft STPs were submitted in June and September 2016 and an updated plan was submitted on 21 October 2016 for further review by NHS Improvement and NHS England.

Considerable progress had been made in the development of the Lincolnshire STP which had built upon the work already underway in the county to devise a new model for health and care, through the Lincolnshire Health and Care Programme (LHAC).  In addition, there had been discussion and input from Lincolnshire County Council officers, particularly in relation to how health and social care services could be better joined up; and how services in the community, which prevent ill health, could be improved.

A number of key stakeholders, including East Midlands Ambulance Service NHS Trust, Lincolnshire GPs, Lincolnshire pharmacies, key health providers outside Lincolnshire and local organisations from the public, private and voluntary sectors all contributed to the development of the plan.  Healthwatch Lincolnshire also participated on the Stakeholder Board.

Seven health organisations led the work on the development of the STP:-

·       Lincolnshire West Clinical Commissioning Group;

·       Lincolnshire East Clinical Commissioning Group;

·       South West Lincolnshire Clinical Commissioning Group;

·       South Lincolnshire Clinical Commissioning Group;

·       United Lincolnshire Hospitals NHS Trust;

·       Lincolnshire Community Health Services NHS Trust; and

·       Lincolnshire Partnership NHS Foundation Trust.

The Lincolnshire Health and Care (LHAC) programme was launched in 2013 as a result of organisations in Lincolnshire recognising that current services did not adequately meet the needs of residents.  Due to growing demands and financial pressures it was clear that a change of direction was necessary and, as a result, all health and social care organisations collaborated for the first time to design a new model for health and care in Lincolnshire.  This would then enable people to access the right services at the right time both now and in the future.

The announcement of the STP process delayed the public consultation on the LHAC programme, which was due at the end of 2015, as it was agreed that the LHAC work would become the clinical workstream of the STP programme.  The LHAC emerging model of joined up care closer to home was the foundation for how STP partners envisage clinical services developing in the county and was aligned to the Five Year Forward View for the NHS.  The scope of the STP, however, was broader and covered productivity and operational efficiencies including service procurement, best use of estates workforce development and technology innovation.

The vision of the Lincolnshire STP was based on a basic vision to achieve really good health for the people of Lincolnshire with support from an excellent and accessible health and care service delivered within the required financial allocation.  The vision included the key priorities for the STP, noted below:-

·       Spend more money on keeping people well and healthy;

·       Support people to take more responsibility for their care and increase the number of people who use personal health budgets for their health and care;

·       Reduce the number of people needing to be admitted to hospital and instead provide care in the community through joined up neighbourhood care teams;

·       Have a network of small community hospital facilities and urgent care centres to work with neighbourhood teams;

·       Have a small number of specialised mental health inpatient facilities to provide support to neighbourhood care teams and community hospitals;

·       Have a smaller acute hospital sector providing emergency and planned care with specialist services for things like heart attacks and strokes and maternity and children's services;

·       Have a consistent approach for which patients can be referred for treatment to hospital, based on evidence of what has the best results for patients; and

·       Improve the effectiveness and safety of services so patients have a better experience and we meet all national standards for care.

The LHAC Case for Change document was published in June 2016 and set out the reasons why services needed to be changed in Lincolnshire.  The document was developed with extensive engagement and discussion with staff and the public and an analysis of the evidence was done to ascertain how services were currently operating in the county.  The findings were stark and it was clear that services were not always delivered to meet national standards for safety and quality.

The age and health profile of services and the increasing cost of care was making services unsustainable in their current form and Lincolnshire struggled to recruit the relevant staff to enable all of its services to remain viable.  This year alone an additional £60m was spent on health services than the amount of funding received.

The Committee was guided to page 82 of the full STP document as this provided further details on service reconfiguration arrangements including a schedule of service redesign options on pages 83 and 84.

The STP was emphasised as a dynamic strategy document and not a consultation document.  The public consultation on service changes was due to commence in May 2017.

Statements and feedback on the Lincolnshire STP were welcomed and would be considered by the System Executive Team.  Should the Committee choose to make a statement on the Lincolnshire STP at this stage, input into the formal consultation would still be possible. 

Engaging Local People – A Guide for Local Areas Developing Sustainability and Transformation Plans stated that STPs should include engagement plans for both ongoing dialogue with stakeholders and for any formal public consultations required for major service changes.

The Chairman confirmed that the meeting of the County Council held on 16 December 2016 passed two motions in relation to this item:-

1.    It was unanimously resolved that the County Council could not support the STP in its current form; and confirmed that the Council was prepared to work with all local NHS organisations to encourage them to adhere to and act upon the views which emerged from the public consultation; and

2.    That the County Council confirmed that the Health Scrutiny Committee for Lincolnshire should scrutinise the likely impact of the proposals in the STP on different medical services in all parts of the county.  The County Council unanimously agreed to set up a working group to consider the likely financial, and other impacts, of the STP on County Council services.  This working group would then make recommendations to the County Council's Executive.

The Committee was invited to ask questions during which the following points were noted:-

·       NHS colleagues acknowledged the motions passed by the County Council, as noted above, and the risks involved in the delivery and implementation of the STP.  However, it was clear that Lincolnshire needed a clear plan to ensure that NHS services within the county remained sustainable.  All analysis undertaken to date had, regrettably, suggested that this would not be the case should services continue as it was currently;

·       The Committee reflected on the proportion of GDP in the UK which would be allocated to health care.  Any additional funding for health care would be welcomed by the NHS.  At present, there remained pressure on Trusts to manage with the funding available;

·       The Committee thought that the STP was too wordy and repetitive.  It was acknowledged that the document was large but it was further explained that the Full STP document had not been intended to be a public facing document and had been written to meet the requirements of NHS England;

·       Home First was included as an initiative within the STP and it was explained that Home First placed as an emphasis on discharging patients to their own home, with intermediate care used only, when it was absolutely necessary, but it was acknowledged that Home First would place more demands on social care;

·       Although not specifically mentioned within the document, NHS Colleagues had met with the Chief Executives of District Councils and it was confirmed that District Councils would be included in all discussions going forward;

·       The voluntary sector had also been consulted but it was acknowledged that this was not sufficiently documented within the STP document;

·       Although not always ideal for patients to opt to go out-of-county for hospital procedures it was acknowledged that in some cases this may be purely a geographical decision, based on how close the patients lived to the hospital;

·       Mention was made to the closure of all neurology services within the county and that all new neurology patients were required to have treatment out-of-county.  It was agreed that the provision of these types of services need to be available in-county;

·       It appeared that the inclusion of end of life and palliative care was minimal within the STP.  Although these services were incorporated elsewhere across the health community it was acknowledged that this could be made clearer, possibly by way of inclusion within a Frequently Asked Questions (FAQs) document;

·       Care in the community had been launched in 1979, of which a number of aspects were not as successful as first thought.  It was explained that a lot of the work in the community at that time was good work but that some could have been better.  It was also difficult to compare the services provided then to that proposed now due to the significant advances made, especially within home technology;

At 1.00pm, Dr B Wookey (Healthwatch Lincolnshire) left the meeting and did not return.

·       When asked the cost of producing the STP document, the Chairman reported that the cost incurred from the commencement of the LHAC to-date was £4.3m and that the cost of the PR to-date was £67k;

·       It was confirmed that partners of the integrated transport pilot strived to reduce inequalities within the public transport and infrastructure of the county.  It was hoped that, once mapped, school buses, NSL transport providers and on-demand buses could somehow amalgamate services as they currently used the same routes.

RESOLVED

1.    That the report and contents be noted;

2.    That the proposal for the Health Scrutiny Committee for Lincolnshire to provide a formal statement on the Lincolnshire Sustainability and Transformation Plan (STP) in advance of the formal public consultation be agreed;

3.    To further discuss the details of the Lincolnshire STP and to draft a formal statement, as agreed in resolution number two above, the Committee resolved to hold an extraordinary meeting of the Heath Scrutiny Committee for Lincolnshire on Thursday 12 January 2017; and

4.    That the draft statement of the Health Scrutiny Committee for Lincolnshire produced at the extraordinary meeting on 12 January 2017, as above, be tabled at the scheduled meeting of the Committee on Wednesday 18 January 2017 for approval.