Agenda item

The Programme Director for Leicester, Leicestershire and Rutland Five Year Strategy to submit a report on the Directional Plan for Better Care Together Programme. There will be a presentation at the meeting on the Plan. 

 

A copy of the summary report is attached at Page 147 and the Better Care Together 5 Year Strategic Plan 2014-19 is attached at Page 159.

 

The Programme Director for Leicester, Leicestershire and Rutland Five Year Strategy submitted a report on the Directional Plan for the Better Care Together Programme.  A copy of the summary report and the Better Care Together 5 Year Strategic Plan 2014-2019 had previously been circulated to Members of the Board.

 

The Board received a presentation ‘A blueprint for Health and Social Care in LLR 2014-19 – Phase 2 – Discussion and Review Phase’ a copy of which is attached to these minutes.

 

During the presentation it was noted that:-

 

a)         The strategy was produced by a partnership of commissioners, providers, local authorities and Healthwatch.

 

b)         It was the biggest ever health and social care review locally.

 

c)         Whilst the review was being conducted against a backdrop of a financially challenged health economy, it was not purely a financially driven plan.

 

d)         The values and principles which underpinned the Plan together with its strategic aims and objectives were listed in the presentation.

 

e)         The Better Care Together programme was based around a ‘left shift’ in the settings and models of care moving care from the acute sector of hospital health care into the primary and community care services sector.  However this shift would not take place until the primary and community services necessary to support and achieve this new care model were in place.

 

f)          The Improvement Interventions for outcomes in 5 years’ time for the 8 pathways of Urgent Care, Frail Older People, Long Term Conditions, Planned Care, Maternity and Neonates, Children Young People and families, Mental Health and Learning Disabilities were set out in detail in the presentation.

 

g)         The current phase of ‘Discussion and Review’ would end in September 2014.  During this period further discussions would be held with partners and there would be further community and patient engagement during the summer.  Detailed options for change and a final strategy for approval would be presented for approval in September 2014.

 

h)        Phase 3 – ‘Implementation and Consultation’ would start in September and where formal public consultation was required, this would not take place until after the elections in May 2015.

 

Following questions from the public it was stated that:-

 

a)         The plan was evidence based and all the evidence used to underpin the plan had been published in its appendices. The directional plan was by its nature a high level plan and further more detailed business cases would be developed in the future. Any evidence to support those would also be made available.

 

b)         A Risk Register was currently being developed and would be submitted to the Better Care Together Board in due course.  The risk register was being prepared on the best practice guidance of the Office of Government Commerce and they had also been asked to provide an independent assessment of the governance and risk management elements of the programme.

 

c)         Although the Better Care Together Board did not currently meet in public this was being re-assessed as to whether it should in future.

 

d)         There had been extensive public involvement and engagement in the development of the programme which had involved public patient involvement groups and Healthwatch.  Further discussions were being held with these partnership groups to determine the appropriate method and level of consultation which would satisfy the patient involvement groups, Healthwatch and Local Authority Scrutiny requirements.

 

e)         The final plan will be submitted to the various provider and CCG Boards as well as all the Healthwatch, Health and Wellbeing Boards and Scrutiny Committees.

 

f)          Only those parts of the programme that do not require consultation will be implemented initially.  There would need to be a major consultation exercise on the proposal; to reconfigure the acute hospital service provision from 3 sites to 2 sites.  It was not know yet whether this would be a single consultation process or a number of consultations on each part of the scheme.

 

g)         Although the programme identified a reduction in capacity of 400 beds from the system, this should not necessarily be seen as a cause for concern.  Approximately half these beds could be reduced through improved productivity of acute hospital services.  Currently UHL did not undertake enough day case surgery operations as they did not have the dedicated facilities.  Consequently this increased the need for inpatient beds.  Investment was being provided to build dedicated facilities to allow this pressure to be removed.  These better clinical processes should account for half the proposed reduction in the number of beds.  The remainder of the reduction in beds would be achieved through the transfer of patients out of acute hospital care into community hospital or home based care as appropriate.  This was particularly relevant to the radical changes proposed for the care of elderly and frail patients to reduce their admissions to hospital unless it was essential for them to be there, by providing more intervention and support services in the community and at primary care level.

 

h)        Leicestershire Partnership Trust (LPT) confirmed that they would continue to support 250 community beds across the county but under the proposals there was likely to be an increase in the number of acute or sub-acute patients being admitted to them.  It was critical that integrated social care services were in place to support this proposed shift in care and that the level of investment was sufficient to support this.  The investment needed to work alongside the proposals to reduce admissions and to manage long term conditions differently in order to create the right flows through the system as a whole.  There were significant risks in delivering this element and all parts needed to be delivered efficiently to achieve the desired outcomes.

 

i)          The Board had a role in holding the whole system to account in delivering the Plan.  Social care services needed to be fully integrated into the Plan to ensure that people at risk were identified and intervention was provided at an early stage to prevent pressure on more acute services.

 

At 11.33am, Councillor Palmer entered the meeting and with his agreement Councillor Patel continued to Chair the meeting.

 

Councillor Palmer commented that:-

 

a)         It was imperative to secure the confidence of the public, patients and stakeholders and to demonstrate that everyone involved in the process was committed to making the process open and transparent and that decisions were made through the effective use of all available public forums.

 

b)         A great deal of effort and work had gone into getting the plan to this stage and the roles of Philip Parkinson as Chair of the Board and that of the Interim Programme Director should be acknowledged.

 

c)         The scale and magnitude of the plan required that high quality decisions were taken.

 

d)         It was crucial for public confidence that the delivery of the plan was seen to be credible.

 

e)         The Council would also be discussing the respective roles of the Health and Wellbeing Board and the Health and Wellbeing Scrutiny Commission in relation to the plan.  It was likely that the Board would oversee the strategic elements of the programme and the Commission would scrutinise the details of individual parts of the programme.

 

f)          The plan looked at an array of acute services but it was evident that it did not make any specific reference to the children’s cardiac heart services.  The plan should be an important vehicle to reflect the aspiration to retain this facility in Leicester.

 

In response, the Chief Executive of University Hospitals of Leicester NHS Trust stated that the plan contained a reference to investing in the children’s services which was complementary to the LLR Plan.  There were however, some complicated issues that still needed to be resolved and an operational appraisal was currently being undertaken to consider these.  Children’s services were currently split between Glenfield Hospital and Leicester Royal Infirmary.  It was not feasible to move children’s congenital heart surgery away from the adult heart surgery facilities and equally the paediatric services could not move from the Royal Infirmary as it needed to support the A&E services there.  Furthermore the new Emergency Floor scheme would have a specific Children’s A&E facility within it.  Although there was no obvious solution to providing all children’s service in one place, the Trust was still committed to providing a full range of children’s services.

 

During general discussion members of the Board also made the following observations:-

 

a)         The primary care sector needed to be developed further if it was to provide more care in the community, particularly in relation to GP services.

 

b)         Capacity and resources represented two of the largest risks in delivering the plan.  The primary care sector have been considering a number of national and local policy issues to understand what the new system should look like.  The Local Medical Committee was holding a solutions day the following week to map out the options for a re-configured primary care sector so that it was fit for purpose to meet the new challenges.

 

c)         Dr Prasad commented that 90% of NHS activity took place in the GP sector of primary care and it was important to get the reconfiguration of services right as it could have a huge impact on the Better Care Together Plan.  Investment in the primary care sector had reduced from 10% to 8% in recent years.  There was shortage of GPs in Leicester as it was not an attractive place to work.  There would shortly be a cohort of GPs retiring and recruitment was already difficult.

 

d)         Professor Farooqi also referred to the reduced numbers of students on training programmes and many newly qualified doctors opting to work overseas.

 

f)          It was recognised that part of the programme relied on making the most of GPs expertise and that patients needed to be directed to the right person to deliver their care such as practice nurses, pharmacists, health care assistants and other health practitioners.  However this was not easy to achieve as many patients wanted to see a GP and often complained if they were directed to other health professionals, even if other health professionals could provide the appropriate level of care for the patient.

 

g)         There needed to be a modal shift away from the patient being a consumer within the health service to recognising that they are part of a mutual society, otherwise commissioners, providers of services and patients would all suffer the consequences.  Embedding this ethos in everyone would not be without its challenges.  Until this cultural change took place, the public understood what other options were available to them and had the confidence to use them, then there was a huge risk to the plan succeeding.

 

h)        The Director (Leicestershire and Lincolnshire Area) NHS England commented that recruitment issues of GPs were common across the East Midlands area, and competing for limited numbers of GPs was not necessarily the focus to solve the issues involved.  Given the future aging population it was likely that the number of consultations with GPs would increase and the length of consultations would increase as the severity of the conditions increased.  The time was now right to rethink the model of primary care delivery, particularly in relation to small independent GP surgeries and to look to groups or federations of surgeries to provide the support that would be required in the future.  It was suggested that the Board should re-visit this issue at a future meeting to discuss the primary care strategy that was necessary to underpin this issue.

 

i)          It was recognised that the challenges facing the health economy required steps such as the Better Care Together initiative to be taken because maintaining the status quo was worse.  Any critique of the proposals should be focussed on challenging how well the changes can be delivered and not on challenging whether the changes are required or possible.

 

j)          There was now an opportunity to deliver things differently and better than they have been delivered before to reduce the burdens on the acute NHS services.  This included more preventative measures to stop people becoming ill and to prevent existing health conditions from deteriorating.

 

In conclusion it was noted that comments on the proposals could be made through the Better Care Together website, through Healthwatch or direct to the Interim Programme Director.

 

The Interim Programme Director also undertook to discuss with Healthwatch the best way to meet the challenge of communicating the proposals and consultations with those sectors of the community that don’t have access to the internet or do not speak English as a first language.

 

RESOLVED:-

 

1)    The report, presentation and the proposals for developing and approving the final Better Care Together Strategy be noted.

 

2)    That the Board receive further progress reports on the development of the Better Care Together Strategy prior to its formal approval.

 

3)    That the City Council reconciles the differing roles of the Health and Wellbeing Board and the Health and Wellbeing Scrutiny Commission in the future consideration of the Better Care Together Strategy and its implementation.