Minutes:
The Chair invited officers still in attendance from the previous item to make a presentation concerning the North-West London Sustainability and Transformation Plan (STP).
The focus of the first two years of the STP would be to:
· Develop the new proactive model of care across North West London
· Address the immediate demand and financial challenges
It was reemphasised that no changes would be made at Ealing Hospital until there was sufficient alternative capacity elsewhere, and no changes were planned to the Charing Cross A&E service currently being provided during this STP period.
The STP identified a set of nine priorities that would help in achieving its vision and fundamentally transform the system. These were:
To support people who were mainly healthy to stay mentally and physically well, enabling and empowering them to make healthy choices and look after themselves
· Improve children’s mental health and physical health and wellbeing
· Reduce health inequalities and disparity in outcomes for the top 3 killers: cancer, heart disease and respiratory illness
· Reduce social isolation
· Reducing unwarranted variation in the management of long term conditions – diabetes, cardio vascular disease and respiratory disease
· Ensure people access the right care in the right place at the right time
· Improve the overall quality of care for people in their last phase of life and enabling them to die in their place of choice
· Reduce the gap in life expectancy between adults with serious and long term mental health needs and the rest of the population
· Improve consistency in patient outcomes and experience regardless of the day of the week that services are accessed
These priorities would be delivered within five separate delivery areas:
· Improve your health and wellbeing
· Better care for people with long-term conditions
· Better care for older people
· Improving mental health services
· Safe, high quality sustainable services
Since the October 2016 submission of the NW London STP work had focussed around the establishment of Delivery Area boards, enabler groups and project groups that were fully representative and had the skills and expertise required to successfully deliver the STP outcomes. Statutory bodies for discussion of the STP were being supported and STP governance arrangements were being strengthened across the board.
As part of the discussions ahead of the JHOSC meeting, CCG officers had been asked to address a number of questions on implementation timelines, governance, transport strategies and the inclusion of community pharmacies within the reconfiguration strategy. A series of detailed answers to these questions had been included within the Agenda, beginning at p340 (http://bit.ly/2nH6RlQ - Item 6d).
Questions
The Chair then invited Committee Members to comment and ask questions.
In relation to community pharmacies, the Chair asked about suggestions that minor-ailments services were to be withdrawn from 1 April 2017. If this was true, would it bring further pressures to bear upon GP practices?
Officers were not aware of such a plan as NHS England retained control over pharmacies, therefore a response would be provided in writing.
Councillor Sheth asked that if the NW London collaboration of CCG’s were not to receive all the monies they requested, would they fund some elements themselves? It was advised that if it was something that could potentially save money, then it would still be considered regardless.
Councillor Sheth asked for more information on potential out of hospital hubs in the Wembley area, and asked if the STP had fully taken account of population increases.
It was advised that an indicative list of hubs was in place, officers would follow up with a list of probable services in the hubs. Detailed work had taken place on population projections, such as developments at Old Oak Common. Significant growth was expected and had been tested back with local planning departments.
Councillor Sheth then asked if any possibilities around devolution were being taken forward. It was advised that lots of conversations were ongoing considering possibilities around devolution of services, with officers being particularly open to conversation where the benefits would improve outcomes for residents.
Councillor Vaughan asked if inflation and other costs had been fully factored into the STP plans. He also expressed concern regarding staff modelling, with the cost of living and the exit for the European Union both potentially having a significant impact.
It was advised that risks around both costs and staffing had been fully taken into account. Inflation had been built into the financial numbers. A 15% contingency and a 25% optimism bias had been built in. There was a need to develop roles to bring strong staff into the service, offering clear and attractive career structures.
The Chair asked how local authorities would be built into the STP governance structure. He also asked how the Better Care Fund would be affected.
It was confirmed that the group overseeing the STP had local government representation on-board. The Better Care Fund was not being replaced by the STP in any way. Local Authorities were not expected to feel ‘worse off’ under the STP.
The Chair expressed concern that there was a perception that savings were being prioritised ahead of helping people in need. Officers strongly disagreed, stating that there was evidence that shorter bed stays actually aided the speed of health improvement in many cases.
The Chair then made reference to transport issues. A recent conference had taken place at Hammersmith which had brought good people together. Could results from the conference be circulated? And were they being brought into the strategy? Officers confirmed that they would circulated results, and that they had found it helpful and would form part of the work being done.
The Chair then expressed further concerns around the loss of bed capacity. Where were figures coming from to support these changes? It was advised that the plans had been fully tested. Clinical beds would not be reduced but it was expected that more capacity would be seen outside of the ‘traditional hospital setting’. It was not expected that care settings overall would be reduced.
The Chair then drew the item to a close, thanking all present for their attendance and contributions to the meeting.
Resolved: That
(i) the presentation on the Strategic Transformation Plan be received by the Committee;
(ii) feedback be provided on the removal of minor ailment services from pharmacies and the potential impact upon general practices;
(iii) a list of services expected to operate from out of hospital hubs be forwarded to the Committee; and
(iv) results arising from the recent transport conference in Hammersmith be forwarded to the Committee