Agenda item

To receive a presentation from Geoff Rowbotham, Interim Programme Director, Better Care Together, and Sue Lock, Managing Director, Leicester City Clinical Commissioning Group on the Better Care Together Programme.

Note: The following documents have been made available since the agenda was originally published.

a)         Article in the Leicester Mercury dated 21 January 2015 – Appendix C (Page)

b)         Briefing Note on Better Care Together issued by the Interim Head of Communications and Engagement, Better Care Together on 21 January 2015. Appendix C1 (Page )

c)         Copy of the presentation notes.  Appendix C2 (Page)

Geoff Rowbotham, Interim Programme Director, Better Care Together, and Sue Lock, Managing Director, Leicester City Clinical Commissioning Group gave a presentation on the Better Care Together Programme. A copy of the presentation had been circulated to Members prior to meeting and had been published with the agenda together with the following:-

a)         An article in the Leicester Mercury dated 21 January 2015

b)         A briefing note on Better Care Together issued by the Interim Head of Communications and Engagement, Better Care Together on 21 January 2015.

In addition to the statements in the presentation notes the following comments were noted:-

a)         The vision and proposals for change in the Programme had been the result of considerable discussions between 8 partner organisations as the preferred way forward to address the challenges faced by health and social care services in meeting the requirements of the programme.

b)         There was a potential financial gap of £400m if 5 years’ time if nothing was change to the way health and social care services were delivered.  This could potentially be £1.2m if the projected cumulative financial shortfalls were taken into account.

c)         The programme could only be delivered through partnership working and all 8 partner organisations delivering health and social care services in Leicester, Leicestershire and Rutland.

d)         The proposals for the clinical and social care case for change had been derived from a number of stakeholder events in January/February 2014 attended by approximately 200 stakeholders.

e)         The left shift in delivering patient care from the secondary health sector to the primary care health sector across the 8 work-streams was aimed at increasing efficiencies and increasing the overall provision of care as a result.

f)          The development of the 8 clinical pathway work-streams had been developed by a cross section of clinicians, patients and carers groups and local authority representatives to identify the intervention necessary to transform for the existing service delivery model to achieve the outcomes required in 5 years’ time.   The urgent care, frail older people and long term conditions work-streams had been tested against the Kings’ Fund Ten components of care to frame the service transformation.

g)         The programme and supporting documents were now in the public domain and had been subject to external reviews by Health and Wellbeing Boards, Clinical Senates, NHS England and the Office of Government Commerce.  Although the programme was still being reviewed it was already delivering early patient experience benefits.

h)        Examples of improved patient pathways were shown in the presentation.  One revised pathway for patients with eye problems estimated that attendances at A&E could be reduced by 2,000 visits per year by improved training and treatment by GPs and Optometrists.

i)          Service reconfiguration was progressing and De Montfort, Leicester and Loughborough universities were involved in discussions to integrate their work to support workforce development and service delivery.

j)          Patient and public involvement and communication and engagement workshops had fed views back on the proposals in December and wider public consultation would start on 16 February 2015.  A number of specific engagement events to consult hard to reach groups were planned and mobile units would travel through Leicester, Leicestershire and Rutland in February and March.  There would be a widespread public media campaign including local radio services for BME communities etc.  Full details of the consultation process were contained in the presentation.

k)         Parts of the programme would require statutory consultation and this would begin after the elections in May and continue through the year.

In response to members questions it was noted that:-

a)         The Better Care Together Programme’s remit did not include proposals to make structural changes in the administration of the NHS such as reducing the number of CCGs for Leicester, Leicestershire or Rutland.

b)         Personal Medical Services was 1 of 3 contracts that GPs could hold.  There was a mismatch of funding as the core funding did not reflect the health needs covered by an individual practice.  Reductions made in payments in core contracts, stayed within the health economy and would be focused back into GP practices where the health need was greater.  The CCG would work with the practice to provide additional support to help them build improvements in patient services.

c)         One of the principles of the programme was to include an element of double running costs by supporting tandem services.  This was estimated at £250m.  Services would not be closed down in one sector until replacement services in another sector were shown to demonstrate the desire benefits in service delivery.

d)         The programme had been driven by clinicians with input from the public and patients and it was felt that this would give the programme a better chance of providing the envisaged benefits.

e)         The programme would be subject to continued scrutiny and the Project Board would be considering different methods of scrutiny , particularly where specialist advice was required.

With the consent of the Chair, Sally Ruane asked the following questions:-

a)         Is the plan going to lead to a restructured workforce which, overall, is of a lower skill mix than is currently the case?

b)         Does the expenditure of £800m to achieve a gain of £17m represent a good use of public money?

c)         What dangers are posed to the public through the closure of 427 beds in the context of rising need and a chronic current bed shortage?

d)         Given that the tables and figures shown in the plan and strategic outline case terminate at the end of the five or seven year period, what will the picture be, financially and in terms of beds and workforce, for the five, ten, fifteen or twenty years after the end of the plan?

e)         Why has there been no serious exploration of alternative options?

f)          The evidence shows that community initiatives only selectively and in a limited way lead to a reduction in unplanned hospital admissions and there is no evidence to show that they will lead to a cheaper model of care. So how feasible is it to have a plan which depends upon both of these features? And have other risks inherent in the project been adequately assessed and addressed?

It was agreed that the Interim Programme Director would provide a written response to the questions and that copies of the response would be sent to members of the Commissions at a later date.

RESOLVED:

That the presentation be received and noted and that the Interim Programme Director provide a written response to the questions submitted by a member of the public and that copies of the response be circulated to members at a later date.