Agenda item

Allan Kitt, the Chief Commissioning Officer for the South West Lincolnshire Clinical Commissioning Group will talk to the Council about the Lincolnshire Health and Care Sustainability Plan.

The summary of the document is attached for contextual reading ahead of the presentation from the guest speaker                                                                                        (Enclosure)

The full version of the Sustainability and Transformation Plan can be viewed via the following link: http://lincolnshirehealthandcare.org/wp-content/uploads/2016/12/STP-full-plan-20161212-web.pdf. Any Member who would like a hard copy of the document should contact the Democratic Services Team.

14:15 – Councillor Manterfield left the meeting having disclosed a pecuniary interest in the following item of business.

The Chairman proposed the suspension of article 4.11.5 of the Council’s Constitution for this agenda item only; the suspension would enable members to speak more than once on the item. The proposition was seconded and carried when put to the vote.

The Chairman welcomed Allan Kitt, who was the Chief Commissioning Officer for the South West Lincolnshire Clinical Commissioning Group. Mr Kitt had been invited to attend the meeting and give a presentation of the Lincolnshire Health and Care Sustainability and Transformation Plan.

Mr Kitt began his presentation by providing some contextual information about the STP; it was a mandatory national programme required by NHS England and the Department of Health. The aims of the STP programme were two-fold: firstly to address national concerns about quality and safety in health care and address three gaps with current provision – the health gap, the care and quality gap and the financial gap. He added that the STP was not a consultation document on definite solutions; instead it contained a number of scenarios that had been modelled to test whether the health economy could balance financially. This would form the starting point for a dialogue to shape the final picture which would include politicians and the people of Lincolnshire.

The expected budget for health services in Lincolnshire in 2021 was expected to be £1.4bn. To deliver quality services within this budget, providers would have to establish governance arrangements that would facilitate different branches of the NHS, mental health services and social care working together. The need to improve prevention was also highlighted as early intervention was recognised as being more effective.

In June 2016, Mr Kitt explained that a case for change document was launched, which had received a positive response with people recognising the issues that were faced. At this point he referred to the overnight closure of the A&E department in Grantham, which had resulted from concerns over staffing.

While Mr. Kitt recognised that the bulk of care in Lincolnshire was good or outstanding and there were excellent staff who were dedicated, he outlined a number of challenges. Some of the services provided in the county did not meet national standards. He gave an example that people in Stamford were more likely to get cancer treatment within the national standards than people who lived in Grantham. Demand for health care was growing, with an increased and ageing population. He also highlighted seasonal challenges that put pressure on health services that could lead to the cancellation of procedures.

Mr Kitt then made comments about work to recruit doctors to Lincolnshire, the lack of continuity provided by locum doctors and the financial impact of reliance on locums.

One of the most significant developments included in the STP related to providing treatment within neighbourhoods. He stated that there were a number of procedures that could be provided through GP surgeries, which would enable patients to access treatment nearer home and outside hospital. This model was working particularly effectively at a practice elsewhere in Lincolnshire, but there was no similar provision in South Kesteven, which meant that patients were reliant on hospitals.

There was recognition that partnerships needed to be developed outside the county, to provide greater access to services in a joined-up way.

Mr. Kitt drew Members’ attention to the financial challenges and highlighted the potential savings that could be made by changing the care model, organising services better, making systems more efficient, smarter working with regard to staff (e.g. using permanent staff) and ensuring that the county had the correct care and commissioning priorities. The Government had offered a financial incentive of £52m at the end of the plan period if it had been successfully delivered.

The aim that accompanied the potential savings was providing a consistent, quality service for the county. He added that a lot of patients presented to A&E departments because they were unable to get appointments with their GP. Options around hospital configuration were being worked through. Mr. Kitt added that the outcome had to be a health service that was fit for the future.

Mr Kitt stated that dialogue was underway with clinicians, public groups and campaign groups. During the week commencing 23 January 2017, clinicians would decide which of the options in the STP should go forward to public consultation. The proposals would then be reviewed by the clinical service prior to the submission of a full business case to NHS England. Consultation could not begin until after the elections on 4 May 2017. Mr. Kitt informed members that delivery time for the plan was likely to be ten years, citing the transformation experience of the NHS Trust in Northumberland, which was now rated as outstanding.

After the presentation, Members of the Council were given the opportunity to ask questions, a summary of those questions and comments is provided below:

·         One member challenged the figures given by Mr. Kitt in relation to the number of admissions following presentations at Grantham Hospital A&E and overnight demand. Mr Kitt explained that daily monitoring was undertaken. The number of patients presenting in Grantham A&E had not exceeded more than 70 a day. He added that there had not been a full A&E service in Grantham for 10-15 years

·         Whether the Trust would listen if public feedback from the consultation exercise was that they wanted Grantham A&E to remain open

·         A suggestion was made that the scheduling of operations could be built around troughs in seasonal demand to try and prevent cancellations. While profile work was undertaken to alleviate pressure as far as possible, the national standard was for patients to have operations within 18 weeks of referral, which meant a rolling surgery timetable was required through the year and peaks could not always be avoided

·         The importance of joined-up care was highlighted by one Member who gave an account of her recent personal experience. She also highlighted that if the patient’s family was caring for them, they needed support and training

·         Members were keen that consultation should be extensive with mail-outs to all households in the county. Mr Kitt explained that while consultation would be extensive it had to be delivered within a budget. The consultation methodology would be scrutinised to ensure that it was robust with solutions in place to help reach different groups

·         The proposals talked about standardisation in Lincolnshire but there was no requirement for standardisation nationally

·         How proposals would impact GP surgeries given current levels of demand. Work was underway to attract more doctors to general practice, including participation in a national project to recruit international GPs

·         Waiting times for transferring patients from ambulances to A&E had led to the payment of penalties to East Midlands Ambulance Service totalling £1.7m

·         Ensuring members of the public have a clear understanding about the service that is most appropriate to address their needs to alleviate pressure points, e.g. patients presenting at A&E because they are unable to get an appointment with their GP

·         Opportunities to turn GP practices into a contemporary form of cottage hospital

·         Integration of the NHS, which was free at the point of use with social care, where access was restricted and based on an individual’s financial situation. Opportunities existed through joint assessments and there were effective examples of joined up working for people with learning disabilities however wider discussion and resolution was still required

·         Getting care planning right and giving patients choice on the implementation of their plan through personal budgets

·         Comments within the STP about “managing pay” related to an assumption of a 1% pay increase for NHS staff per annum. If a decision was taken nationally that the increase should exceed 1%, then there would be a financial gap.

·         A programme was underway across the CCG that made it easier for doctors to set patients on the right care path and ensuring that tests were done in the appropriate order. When a GP entered what they suspected a patient’s condition might be, the computer system would bring up the appropriate pathway and supply the appropriate referral forms.

·         Detailed business plans would be drawn up for all proposals that would be taken forward; these would be subject to scrutiny by NHS England prior to public consultation. Consultation would not begin until the plans had been signed-off.

The Chairman thanked Mr. Kitt for attending the meeting and answering Members’ questions.

15:58 to 16:18 – the meeting adjourned.