Agenda item


To receive a presentation from Toby Sanders, Senior Responsible Officer for the Leicester, Leicestershire and Rutland Sustainability and Transformation Plan.


1.         STP Plan Overview


2.         STP Governance Arrangements


3.         STP Patient and Public engagement


Toby Sanders, Senior Responsible Officer for the Leicester, Leicestershire and Rutland Sustainability and Transformation Plan gave a presentation to update the Board on the progress with the STP since the last update to the Board at its meeting on 6 June 2016.  (Minute 10 refers)


The final Plan was expected to be submitted at the end of October 2016 to NHS England and when it had received approval it would be made available for public consultation. 


The key points to note from the presentation were:-


STP Update


a)     The Plan addressed local issues and implemented the NHS 5 year forward view to March 2021.  It made the case for national/external capital investment and access to non-recurrent transformation funding.


b)     It built upon the Better Care Together proposals and showed how sustainability would be achieved.  In developing the STP each area has to show how they were going to ensure sustainability in the following areas:-


·         Health and Wellbeing

(Lifestyle and Prevention, Outcome and Inequalities, Mental and Health Parity of Esteem).


·         Improving care and quality

(Emergency Care Pathway, General Practice variation and resilience and clinical workforce supply).


·         Ensuring financial sustainability (improving productivity and closing the financial gap)

(Provider systems and processes [internal efficiency], estates configuration and back office systems).


c)         By 2021 current spending across LLR would increase from the current expenditure of £1.6b to £1.8b.  However, the increased demand on       services and demographic growth, together with the cost of delivering services, was estimated to outstrip available resources by £450m across the NHS and £70m across local authorities.


d)        As a result of the STP process and a review of the ‘triple aim’ gaps (above), there would be focus upon the following five work strands:-

·           New models of care focusing upon prevention and moderating demand growth.

Ø  Urgent and emergency care.

Ø  Integrated locality teams.

Ø  Resilient primary medical care.

Ø  Planned care.


·           Service configuration to ensure clinical and financial sustainability.

Ø  Move acute hospital services to 2 sites (LRI and Glenfield)

Ø  Consolidate maternity services at the LRI.

Ø  Smaller overall reduction in acute hospital beds than originally planned.

Ø  Reduce the number of community hospital sites with impatient wards from 8-6.

Ø  Move Hinckley day case and diagnostic services from Mount Road to Sunnyside/health Centre.

Ø  Detailed proposals being developed for community services in Hinckley, Oakham and Lutterworth.

Ø  Changes subject to external capital investment (c£350m).

Ø  No decisions taken until after formal public consultation.


·           Redesign pathways to deliver improved outcomes for patients and deliver core access and quality.

Ø  Builds on the work carried out on the BCT work streams and key local access/quality issues involving prevention, long term conditions, cancer, mental health, learning disabilities and continuing healthcare and personalisation.


·           Operational efficiencies to reduce variation and waste.

Ø  Back office efficiencies/reducing corporate overheads.

Ø  Medicines optimisation – reviews, cost and waste.

Ø  Best value procurement.

Ø  Provider system/process efficiencies to reduce delay and duplication.

Ø  Rostering systems and job planning to reduce use of agency staff.

Ø  Estate utilisation across the wider public sector.


·           Getting the enablers right to create the conditions for success.

Ø  Patient and public involvement.

Ø  Clinical leadership.

Ø  Workforce.

Ø  IM&T (Local Digital Roadmaps).

Ø  Estates.

Ø  Integration between health and social care commissioning.

Ø  Organisational development/culture.


e)         Once the STP had received assurance from NHS England it would be made public in November.  Strengthened governance and delivery arrangements were also planned to be implemented in November.  The plan would then be translated into 2 year operational plans and the operational contracts put in place to support the management of services.


f)   Public consultation was expected to take place in January 2017.


STP Governance Arrangements


a)         New governance arrangements were being designed with a view to simplifying ownership and to increase clinical leaderships and public visibility.  It was intended to have dual ownership through both Health and Wellbeing Board and individual NHS Boards.


b)         A new System Leadership Team (SLT) was proposed with both clinical and executive membership with individual delegated authority to represent commissioners and providers of services.


c)         Greater stakeholder transparency was planned with public meetings and a quarterly forum.  Multi agency implementation teams would deliver the priorities with strong patient involvement.


d)         Draft proposals would be submitted during October.


STP Patient and Public engagement


a)         PPI groups and Healthwatch would be involved in shaping issues and priorities.


b)         Most proposals were already in the public domain through BCT and UHL’s 5 year plan; and there had already been summary presentations on the STP made in public. The full STP documents would be made available in November 2017.


c)         A new System Stakeholder Forum to start in November would provide wider on-going discussion.


d)         Communications and engagement would be issued by each partner organisation’s communication teams.


The Chair commented that, whilst there were no major surprises in the context of LLR, the various decisions would need very different methods of consideration, particularly in the political context.  He also commented that the issue of BCT branding should be reviewed as it now had negative images from the public resulting from long delays in making plans available for public consultation.  He also felt that the Health Needs Neighbourhood Centres would need to be examined in greater detail to assess their impact upon local government services and different areas of the city.


Members in discussing the presentation made the following comments and observations:-


a)         There was an apparent paradox as Health and Wellbeing Boards were expected to have system leadership on health issues in their areas but Boards would only receive the STP Plan after it had been given approval by NHS England.


b)         The Board should have key role in the process but the complexity of political accountability amongst constituent partners should be recognised and decision making should not be made by the ‘STP’ as such but by individual constituent partners.


c)         The Board was expected to have ownership of the STP and whilst there would be an opportunity to engage with the public and the plans might change as they advance through the process; the Board had not had full and complete details of the STP proposals prior to consultation.


d)         Healthwatch should be involved with the System Leadership Team (SLT) and members questioned how patients and public could be involved in the process.


e)         It would be helpful to have a diagram clearly setting out where decisions will be made and whether there will be any public involvement to make the process more transparent compared to the current opaque process.


f)          The proposed roles of the Boards in the process would need further clarity around the references to ‘ownership’ as these would be interpreted differently by different partners in the process.


g)         The frustration with the process of the STP delaying the consultation on the BCT was also shared by some health partners and providers.


In response the Senior Responsible Officer stated that:-


a)         Patients and public had an important part to play and this role would be discussed at a meeting later in the week.  There was a role for a forum to act as a sounding board on STP issues as they emerged.  Patients, carers and families were already closely involved in a number of work stream issues.


b)         The current draft STP could be shared with Board members in confidence at this stage if requested.


c)         The intention for the SLT was to have all members as full equal members with decision making authority.




1.         That the Senior Responsible Officer be thanked for the representation.


2.         That the Board recognises its need to play an important role in the governance arrangements for the STP.


3.         The Board should have a lead role around the primary care strand of STP.


4.         The Terms of Reference for the Board in the Governance arrangements should be submitted to the next meeting of the Board.