Agenda item

The Senior Communications & Public Affairs Lead for Communications and Engagement team at NHS Leicester, Leicestershire and Rutland submits a report on the NHS Transformation.

The Executive Director for Integration and Transformation for Leicester, Leicestershire and Rutland (LLR) submitted two papers to outline where the NHS in LLR were at financially in terms of budget.

As part of the presentation, it was noted that:

• During the last financial year, the system worked together to deliver a challenging joint financial plan. Despite the difficulty, the system saved £150 million by improved efficiency of service delivery.
• Demand for health and care services continued to rise, increasing the pressure to deliver further savings. The total budget for LLR was £2 billion, with a further £190 million in savings required.
• National and local changes announced earlier this year had intensified pressures. These included organisational restructures that were impacting staff, with the ICB in LLR required to reduce its running costs by up to 33%. NHS Trusts had also been given targets to reduce workforce growth, particularly in non-clinical/non-patient-facing roles and there had been a pause on recruitment in these areas.
• Health and care partners across LLR were tackling these challenges head on. Everyone working in the system remained committed to delivering the high quality care our communities expected and deserved. They were focused on making every pound count but the scale of the challenge meant they would need to make difficult choices about how services were delivered or potentially stopped.
• They would continue to work closely with partners, including councils, voluntary sector organisations, patients and the public to become more efficient and make the changes needed to meet financial targets.

The 3 key areas of focus were:

·       Recruitment and staffing – Prioritising the most critical, patient-facing roles, and reducing bank and agency spend, whilst maintaining a strong focus on putting patient safety first.

·       Tackling inefficiencies – including inefficient processes to delivering care that doesn’t meet patients’ needs. We can all help by improving how we work and making sure we are delivering the right care in the right way.

·       Redesigning services – It was essential that budgets funded the services our population required most. That may mean changing or potentially stopping some established services and rethinking how to deliver better outcomes for patients.

As well as focusing on these areas, they were contributing to the development of the national 10-Year Health Plan, which aimed to transform healthcare delivery by emphasising prevention, enhancing community-based care, and embracing digital technologies. The local shorter-term operational plans would be developed alongside this to ensure we are aligned nationally while responding to local needs.

In discussions with members and officers, the following was noted:

• Assurance was given that, despite savings pressures, progress had been made on initiatives such as mental health cafés and health checks.
• It was acknowledged that system transformation was discussed each year, with questions raised around how savings targets were being met and measured.
• The potential to include year-end reporting on the work programme was suggested.
• Concern was raised regarding the impact of workforce reductions, particularly a 33% reduction in ICB staffing, and how staff morale and wellbeing were being supported.
• Support mechanisms such as weekly briefings, leadership visibility, and transparency with staff had been implemented.
• Recruitment was restricted to business-critical roles, emphasis was on avoiding duplication and sharing capacity across partner organisations.
• Concerns were raised about the impact of efficiency savings on patient care, especially within general practice, and the availability of GP appointments.
• It was noted that there was no official GP-to-patient ratio, but partnership working with practices was ongoing. There remained a national shortage of GPs.
• Bank staff continued to be used due to flexibility, but efforts were being made to reduce agency reliance and improve rostering.
• The system executive group had submitted an operational and efficiency plan, and there was an intention to bring this forward for future scrutiny.
• Members requested access to efficiency plans and the metrics used to monitor progress. Clarification was provided on ICB running costs, noting the organisation remained in the lowest 10 out of 42 nationally. With an offer to circulate monthly public broadcasts detailing how financial targets were being addressed.
• A request was made for data on GP appointments, including the breakdown between GP-led and alternative staff-led consultations. It was reported that 60% of appointments in the city were with GPs and 40% with other practice staff, though this did not always align with patient feedback.
• GP services were supported by Primary Care Networks, with some offering additional hours in evenings and weekends, but this varied across locations.
• Concerns were raised about the accuracy of appointment data and whether patients understood the new models of care. Clarification was given that the 33% workforce reduction would not affect patient-facing roles but would impact functions supporting delivery and scrutiny.
• Questions were raised about whether reductions in emergency care demand were being reflected in statistics, particularly around urgent care usage. Urgent care centres saw significant daily attendance, many patients could have been seen elsewhere, and the system was working to stream patients appropriately.
• There was recognition that reducing pressure on one part of the system could lead to increased demand elsewhere.
• Reassurance was sought around the safe transfer of safeguarding responsibilities from the ICB to provider organisations. A transition committee had been established to oversee these changes, and it was confirmed that no service would be moved without assurance of safety.
• The timeframe for delivery of transfer plans was set for December 2025, although further national information was still awaited.
• Concerns were raised about public communication regarding service changes, particularly in rural areas and for older populations.
• National communications were in place to reassure the public that their existing services would not change.
• Discussion took place on the underuse of urgent care and minor injury services in rural districts, and the associated cost implications.
• It was noted that services must be better utilised and more equitably accessed across geographies.
• There was a brief discussion on potential local government reorganisation and its potential implications for health and care planning, but no confirmed proposals were in place.
• It was confirmed that no changes would be made to services without clear evidence and assurance that it would be safe and appropriate to do so.

AGREED:

1.    That the reports were noted.

2.    That an item on primary care access and general practice models be added to the work programme.

3.    That an in-depth session on GP service provision across LLR, broken down by area, be added to the work programme or delivered via informal briefings.

4.    That figures on patients who presented at primary care and whether this is due to the increase of available GP appointments to be circulated to members.

5.    The Model ICB blueprint to be circulated to members.

6.    That a further update on ICB changes be scheduled for the November meeting.