Agenda item

Sir Chris Ham, Independent Chair of Coventry and Warwickshire Health and Care Partnership (HCP) presented the five-year strategic plan for consideration and comment. Sir Chris summarised the key points of the draft plan and the work undertaken to date. Sustainability and Transformation Partnerships (STPs) and Integrated Care Systems (ICSs) were required to create five-year strategic plans, setting out how systems would deliver the commitments in the NHS Long Term Plan. There was an expectation that STPs/ICSs would bring together member organisations and wider partners as they developed and delivered the plans. A key principle was that the plans should be owned locally.

The draft plan was submitted and feedback was being sought prior to 15 November 2019, when the final plan would be submitted to accord with national timescales. The summary priorities of the draft plan were confirmed. Sir Chris referred to the process involved in developing the former STP and the different approach undertaken for this document, working with local Healthwatch organisations and building on the work of the two local health and wellbeing boards. The work on prevention and promoting health and wellbeing were referenced particularly and the plan sought to align with these aims. A priority was the aspiration to integrate health and care around patients and populations, with an asset-based approach to health and wellbeing, involving all sectors. There was an aging population who had complex needs that required joined up services. There was a wish to work differently and to engage more. Sir Chris outlined the three strategic priorities in the plan for the next five-year period being to promote healthy people, build stronger communities and develop effective services. He referred to the four ‘places’ across Coventry and Warwickshire and approximately 80% of the Plan’s ambitions would be delivered in place, rather than across the system. There would be local partnership arrangements for each of the places. For complex services, a system-wide approach would still be required. He highlighted the focus on urgent and emergency care and the pressures these services faced year-round, as well as mental health services, cancer care, stroke and maternity & young people services. Money was a further challenge and whilst additional government funds were being provided to the NHS, there was an increasing and aging population who required more services. The financial constraints for other organisations was a further driver for partnership working.

Sir Chris referred to staffing aspects and the shortages in some areas. Investing in the workforce, to recruit, retain and train staff was a further priority. He closed by reiterating the points on prevention and giving young people the best possible start in life. The aim was to have a more resilient urgent and emergency care, strengthened general practice, out of hospital care and social care. The draft plan was informed by a focused engagement exercise, details of which were provided. The understanding of population needs was drawn directly from the local joint strategic needs’ assessments (JSNA). The plan had been developed by the senior responsible officers for each of the workstreams, with involvement from stakeholders across the system. Clinicians had been engaged fully in developing the plan and the supporting clinical planning templates. Questions and comments were submitted, with responses provided as indicated:

• In the previous STP, it had identified a saving need of £267m. There was a need for increased funding to provide services for the area’s aging population. The reference to funding cuts in the STP was really about addressing a gap in funding between identified need and the resources available. There would be a continued growth in funding to the NHS locally, but this would not be sufficient to meet anticipated service demands. The local NHS spent about £1.4bn annually. It was perceived that efficiencies could be achieved to make better use of this money and the other assets available.

• Life expectancy had effectively stalled and it was suggested that the plan make reference to how this would be addressed. This point was broader than for the UK alone, affecting countries who were not experiencing austerity. It was against the backdrop of the significant improvements made previously. Perhaps the limit on life expectancy had been reached, unless there was further advancement of medical science.

• The place-based approach was welcomed as there were differences between Coventry and Warwickshire and within areas of Warwickshire itself. There would need to be further disaggregation to each local area. Sir Chris agreed that the plan did work at the micro level, being based on JSNA data.

• A view that JSNA boundaries did not align geographically with the boundaries of organisations or elected members’ areas.

• Reference to the finance assumptions and the underlying deficit of £101m. The eight finance principles were welcomed with further information being sought on the governance principles.

• Productivity and efficiency were raised. This showed an efficiency requirement of £119.4m and the need for a different approach to achieving savings. This was linked to the previous section on the approach to engagement and co-production. Previous documents had similarly referred to these aspirations, but they hadn’t materialised and further information was sought on how work with the voluntary and community sector (VCS) would be approached. Sir Chris acknowledged the financial gap and underlying deficit, whilst reminding of the partnership’s status and that financial accountability remained with the CCGs and trusts. NHS bodies were working hard themselves and with partners to address the financial aspects. There were opportunities for efficiency for example in medicine optimisation, collaboration and reducing duplication. In responding to the points on co-production, he made reference to the work with Healthwatch as a body that brought together many smaller groups, but acknowledged that the NHS could do more and learn from local authorities in working with the VCS.

• It was questioned how the system learned from feedback and could become more transparent and accountable. It would be helpful to see this referenced in the document. Some people were fearful of making complaints in case it impacted on the treatment they received. Sir Chris wished to reflect on this point, to provide a more reasoned response.

• Providing additional services at GP surgeries to reduce reliance on accident and emergency (A&E) and outpatient appointments. Coventry’s population comprised 33% of people of black and minority ethnicity (BME). It was noted that a higher proportion of the BME population attended A&E. There could be more cohesion. Sir Chris referred to the 18 PCNs being established, which were groupings of GP practices to address workforce challenges and meet the growing needs of the population. These organisations were still developing in the main, although some were better established.

• Reference to the difficulties caused by the 2016 STP document which led to rumours about the closure of maternity services and A&E at the George Eliot Hospital. Clarity was sought that there would be no such closures arising from this review. This also had an impact in recruiting and retaining staff.

• Some of the positives in the report were noted in regard to maternity services, notably the 23% reduction in still births and the 17% of women now having a single midwife throughout their maternity, which was valued – 5 – especially for those with difficult pregnancies. Sir Chris Ham confirmed there were no plans to close maternity units. The staffing challenges provided the rationale for working together, rather than in isolation. There was a major piece of work being led by CCGs on how to improve maternity services.

• Reference was made to the key risks and mitigation measures in relation to workforce. There were no plans to increase the workforce numbers, at the same time as reducing agency staff numbers. This implied that existing staff would be asked to do more and could impact on the quality of service provided. The implications of Brexit were raised. The detailed risk register would be welcomed and it was perceived that there was not sufficient funding within the system. Sir Chris agreed with the points on workforce and funding pressures. Staff were working hard to deliver the best services they could, but there was mounting evidence to show the impact this was having on frontline staff. This was why the workforce aspects were referred to extensively in the report. On agency staff there was a need to reduce reliance on them where possible, given the high costs of using agency staff.

Resolved

That the Joint Health OSC:

1) Notes the process for developing and engaging on the draft Plan; and

2) Considers and comments on the draft Plan ahead of final submission by 15 November 2019.