Agenda item

The Programme Director Leicester, Leicestershire and Rutland Five Year Strategy to submit a report on the 5 Year Strategic Plan required to be submitted to NHS England.

The recently appointed Programme Director for Leicester, Leicestershire and Rutland Five Year Strategy submitted a report on the 5 Year Strategic Plan required to be submitted to NHS England.

The Leicester, Leicestershire and Rutland (LLR) Better Care Together Board held a Health and Social Care partner summit in January 2014 at which a shared vision for all partners was agreed together with the key actions required to support its successful delivery.

Five priority clinical work streams based on local needs assessments had been agreed for immediate review.  These were cancer, cardiovascular disease, respiratory disease, dementia and mental health and substance abuse.

The Leicester, Leicestershire and Rutland health economy had been identified as one of the 11 distressed health economies that would be offered support from April 2104 by NHS England, the Trust Development Authority and Monitor to develop the 5 Year Strategic Plan.  Ernst and Young had been commissioned nationally to help with producing the 5 Year Plan in the 11 distressed health economies by the end of June.  The framework document for the 5 Year Plan would be submitted on the following day and would form the basis for developing the details of the 5 Year Plan with Ernst and Young.

The Programme Director had met approximately 60 partners in health and social care including Healthwatch and the voluntary sector to review the current position in relation the governance of the programme.  It is being proposed that the programme will be streamlined to become more effective and focused. The Programme Board would also be extended to include the 3 Chairs of the LLR Health and Wellbeing Boards and the 3 Chairs of the LLR Healthwatches to make the Board more balanced.  Reference groups have also been introduced to provide a reference point for the Board as the strategy develops and is implemented.  The Public and Patient reference group would be co-ordinated by the 3 Healthwatch Chairs.  The other two reference groups would be drawn from clinical and political representatives.  The Political Group would help the Board to understand how to take the recommendations forward through the various political structures within Leicester, Leicestershire and Rutland.

The five clinical work streams were being developed and work was being prioritised along 3 key criteria areas of quality (improve outcomes and patient experience), scaleability (opportunity to scale up to have the maximum impact in the quickest time) and achievability.

The four key next steps were:-

a)    A LLR Health and Social Care Partnership Group had been established to develop the 5 Year Strategy with the external consultants.

b)    A cross partnership programme governance structure was being put in place to ensure an effective and timely approval and implementation of the Plan and to demonstrate that there is a clear governance structure.

c)    Developing an Integrated Health and Social Care Communication & Engagement Programme. A further summit was planned for the 6 May 2014.

d)    Philip Parkinson had agreed to be the Interim Chair of LLR Board over the next few months and to lead on recruiting the substantive Chair of the Board.      

The Chair expressed concern at the appointment of external consultants for the 11 areas chosen for additional support and the cost to the health economy for this and questioned the value that it would add to the process.  What assurance could be given that they would be working to a local health agenda and not a national government agenda and how would the structure execute decisions within the existing democratic structures it the health system?

In response the Programme Director stated that there were insufficient resources within the organisation involved in place at the moment to provide the work by the timescales required without any detrimental effect on the day to day work and service provision.   The Programme Director and the Chief Executive of University Hospitals of Leicester NHS Trust had met with the consultants yesterday and there was a clear understanding about the different relationships and how they would work and all parties were committed to undertaking a piece of work that was owned and developed by the Board.  As part of the process the Board had to demonstrate clear evidence and give an assurance that there was the ability, commitment and structure in place to deliver the Plan and the consultants would be a valuable means of giving that assurance to a number of other bodies, including the Health and Wellbeing Board. 

The Director of Operations and Delivery, Leicestershire and Lincolnshire Area, NHS England, stated that the engagement of external consultants was to strengthen the decision making and governance areas around the Better Care Together Programme, particularly as sufficient progress had not been made to date.  Also, given the current financial situation of the local health economy and the provider issues in relation to their deficit and the very difficult current commissioning round, the appointment of consultants was necessary to take the process forward and the governance arrangements were particularly strengthened by having that external support. 

Following a further question from the Chair, it was stated that external consultants had been commissioned nationally and not left to local to commissioning arrangements by NHS England, the Trust Development Agency and Monitor because they wished to have oversight of the process and to co-ordinate the external support to ensure that resources were targeted to where they were required.  It was also unlikely, that given the current £40m deficit in the local health economy, such decisions would be taken locally and not nationally.

After further questions from members of the Board it was stated that:-

a)    The Better Care Together Board would sign off the 5 Year Plan initially and then each constituent body would be required to fulfil its objectives in the Plan by submitting their own 5 Year Strategies.

b)    Each Health and Wellbeing Board would be expected to receive the Plan as well.

c)    There was no formal report expected from the external consultants, the only report from the process with the consultants would be the 5 Year Plan to be presented to the Better Care Together Board and others.

d)    That in relation to keeping the vision clear and simple to understand, it was accepted that the strategic vision needed to be seen with the objectives behind it for it to become clearer as they were more action orientated.  This point would be taken back to the Better Care Together Board for further consideration.

e)    The feedback from the previous engagement and consultation events had been taken on board and any draft reports and information to be discussed at the 6 May event would be circulated in advance so these could be considered by participants beforehand.

f)     Councillor Palmer would be representing the Board on the Political Reference Group and work would start soon on developing the terms of reference for the group.     

The Chair stated that he had already suggested that the Political Reference Group should also include the 3 chairs of the health scrutiny committees/commissions for each authority as this would strengthen the political input by including both executive and scrutiny members.  He hoped that this would be accepted by the Better Together Care Board.

It was noted that the programme was essentially designed to provide good care and at an early stage so that fewer things could go wrong and there would be less people in hospital when they didn’t need to be, which was good for both individuals and the future sustainability of the health economy.  However, this was dependent upon the right plans being developed and being able to be implemented at pace.  The governance arrangements were also important to reinforce the local ownership and control of the programme and it was encouraging that these had been strengthened in recent weeks.  The Programme Director was also thanked for the progress made since his appointment. 

Following a question from a member of the public the Programme Director indicated that the base evidence used to reengineer the local health economy through this process would be shared with the public.   

RESOLVED:-

that the progress made in the last 12 weeks be4 noted together with the proposed key steps to be taken during the period in April-June.