Agenda item

This report provides an update from H&F CCG about their response to the NHS Long Term Plan, published on 7 January 2019.

Juliet Brown briefly outlined that the response to the NHS Long Term Plan (LTP) took a collective approach that was structured to ensure both a strong PCN and a local focus.  The LTP included how the NHS was working towards improving mental health services and access to local care for long term conditions such as diabetes.

 This was a strategic response to the LTP setting out where the CCGs were currently, how they intended to work together and engage locally.  The response deadline was 15 November 2019 and it was explained that they had working on preparing a draft for some time, aiming for it to be available by the end of September. It was explained that the H&F integrated care partnership (ICP) offered the delivery of borough based local services.  It was noted that a joint meeting of council leaders, led by Sean Harris, Chief Executive of the London Borough of Harrow, was arranged for 24September 2019.

Lisa Redfern expressed concern that she had not received any formal communication about the work being undertaken by the care partnership board (which comprised of the North West London local authorities but did not include H&F and Ealing) or been consulted about the response to the LTP. The only communication received had been regarding workforce strategy.  Lisa Redfern explained that she had also not been contacted in her statutory capacity as Director of Social Care or been asked to contribute to the formulation of the draft response, which she had requested sight of several times earlier in the year.

The Council’s Better Care Fund had been drafted in the absence of any information about the LTP response.

Juliet Brown said that ‘system boards’ had been established and it was recognised that H&F did not currently form part of this.  Lisa Redfern reiterated that the lack of engagement was very disappointing.

Councillor Coleman reported that Mark Easton had previously given assurances that the Council would be fully involved and engaged. It was noted that this would be rectified at the earliest opportunity. The Council would have wished to have been included at the start of the process in producing the draft response, working jointly with NHS and local authority colleagues. In terms of governance, Councillor Coleman pointed out that Sean Harris was not a democratically elected representative or a director of social care and that he would raise the issue with members of the WLA.

Lesley Watts offered an assurance that the Council would be fully engaged going forward and confirmed that a timetable of engagement and joint working will be provided, commencing with a formal invitation to attend the meeting taking place on 24 September.

ACTION: NWL Collaboration of CCGs to provide a timetable for engagement regarding the preparation and submission of their response to the NHS LTP

Councillor Lloyd-Harris referred to page 22 of the Agenda pack and commented that H&F had a great deal of knowledge and expertise on undertaking local engagement and asked how the CCGs expected to engage with the Council and stakeholders. Councillor Caleb-Landy also enquired about the groups that the CCG had consulted with and whether they were H&F residents.  Juliet Brown confirmed that they had consulted with Healthwatch and conducted engagement events within each borough and offered to share further details about the events and the findings. 

ACTION:  Details about the engagement work undertaken to be shared with the Committee

Councillor Caleb-Landy highlighted also concerns about the lack of engagement with hard to reach groups such as those with learning disabilities.  It was explained that the NWL response to for example diabetes care, was in line with the LTP in terms of the engagement undertaken.  Dr Tim Spicer, former Chair of H&F CCG, had led a patient and carers group which looked at how care for older people was shaped and delivered with improved accessibility.  It was pointed out that the LTP outlined a priority to engage with hard to reach groups.  Juliet Brown indicated her agreement with this approach combined with the need to continue to develop cohesive plans with such groups. 

Jim Grealy commented on the growing local population which contained enormous local demographic differences within North West London, and which would require the careful calibration of contract, commissioning and governance arrangements.  It was pointed out that while there was information available about stroke and diabetes care, there was little clarity about the hierarchy of the CCG, how they co-existed and how they incorporated the local patient voice when commissioning services.

Greater complexity within the NHS meant that it became harder to hear the “local voice” and it would be helpful to understand how the PCN and CCG linked together. In considering local, place-based care, Lesley Watts commented that London had benefitted greatly with the boroughs benefitting from, for example, the reforms in stroke care.

Lesley Watts provided a brief overview of the what the LTP hoped to achieve nationally.  The integrated care system would exist as an overarching structure, covering the same geographical footprint of the Sustainability and Transformation Partnership. It was explained that the system had not yet been secured and will need to identify its own lead clinicians.  Beneath this would be the CCG, with collaboratively work between CCG commissioners and providers.  It was observed that within NWL, this was more refined and better established largely because of the commitment of the chief executives of the provider organisations to improving the health of residents.

Lesley Watts offered to provide the Committee with details about the prospective governance arrangements once these were completed. Jim Grealy responded that that there had been little time to consider the proposals and that this was difficult to do without a governance map in place. Lesley Watts took the view that treatment services had progressed and that they were committed to communicating more clearly, responding to the need for greater levels of scrutiny.

Lisa Redfern reiterated that the draft response had been requested repeatedly since the publication in January 2019 of the LTP.  The timetable for this required a local systems response and it was unclear why it had taken this length of time to reach this stage.  Juliet Brown explained that the technical guidance for the response was published in the last week of August.

Prior to this, it was explained that CCG colleagues had met to consider the initial shape and format of the response and how it could be structured.  Juliet Brown recognised and accepted the view that this had been a protracted process particularly given its transformational nature, however the technical guidance was prescriptive with a short timetable for a document response that covered a period of five years. 

There followed a brief discussion about the timetable and when the draft would be provided to the Council, with time to incorporate any comments by the submission deadline of 15 November 2019.  Lisa Redfern emphasised that it was critical for the Council to review the draft at the earliest opportunity with a structured approach to engagement.  It was accepted that a timetable for engagement with the Council would be agreed as soon as possible.

RESOLVED

1.      That the CCG prepares and communicates its timetable for engagement on the draft LTP response and that the Council was given time to review and input into the draft the response; and

2.      That the report was noted.