Agenda item

To consider the Cheshire and Merseyside Sustainability and Transformation Plan.

Jon Develing, Senior Responsible Officer, Cheshire and Wirral Local Delivery System, attended the meeting and presented the Cheshire and Merseyside Sustainability and Transformation Plan (STP).

Partners across Cheshire and Merseyside had been working together over the past four months to develop further the blueprint set out in June to accelerate the implementation of the Five Year Forward View for  communities. They had come together to address the challenges: that people are living longer, but not always healthier, lives; that care was not always joined up for patients in their local community, especially for the frail elderly and those with complex needs; that there was, as a result, an over-reliance on acute hospital services that often did not provide the best setting for patients; that there was a need to support children, young people and adults more effectively with their mental health challenges. At the same time, there were enormous pressures on health and social care budgets. It was clear that these issues required much more radical thinking about how best to address the problems faced, in order to support the needs of communities into the future. The Plan summarised the plans developed to-date to address these challenges across all the different communities in Cheshire and Merseyside, which fell into four common themes:-

·       Support for people to live better quality lives by actively promoting the things we know have a really positive effect on health and wellbeing;

·       Working together with partners in local government and the voluntary sector to develop more joined up models of care, outside of traditional acute hospitals, to give people the support they really need in the most appropriate setting;

·       Designing an acute care system for our communities that meets current modern standards and reduces variation in quality;

·       Making ourselves more efficient by joining up non front-line functions and using the latest technology to support people in their own homes.

Much of this work was already underway at local level, but there was still much to do. The role of the STP for Cheshire and Merseyside was to co-ordinate efforts, ensuring that the best ideas and expertise were promoted to provide for the needs of the whole region in the future. It would be necessary to consider more efficient ways of working and also to look at a governance and decision making framework for the STP. 

It was noted that the STP contained a series of scenarios and this was not necessarily what would happen and that the various options would need to be tested. It was proposed to hold a series of consultation events and workshops in the future in order to engage with people as definitive plans were developed.

Following the presentation, members of the Board raised a number of comments and questions:-

·       The Chairman thanked Mr Develing for his presentation and welcomed his comments. She referred to Section 2, at page 7 of the Plan, “Our Cheshire and Merseyside Strategy”, which highlighted that often good strategies were developed, with clear benefits, but were not ultimately achieved and the need for a detailed plan to oversee real delivery, which would be monitored through its various stages. She reported that her Leaders’ Board had scoped how they could work together on this matter.        

·       Concern was expressed concerning the potential impact of the “top down” approach of the Plan.

·       Reference was made to the Kings Fund Report that summarised the approach used in the United States and their development of Accountable Care Organisations (ACO), the basic concept of an ACO being that a group of providers agreed to take responsibility for providing all care for a given population, for a defined period of time under a contractual arrangement with a commissioner. Providers were held accountable for achieving a set of pre-agreed quality outcomes within a given budget or expenditure target.

·       It was felt that the Plan contained a lot of platitudes and required more detail and that this should be addressed in any rewrite of the Plan.

·       The clear statement from North Mersey in respect of the Royal Liverpool and Aintree merger, at page 17 of the Plan, was welcomed.

·       Examples of where Acute Trusts worked together were provided, but it was queried whether there would be a mechanism to compel them to do so. It was noted that there were a series of scenarios in the STP and that they would be held to account. However, the governance arrangements had not yet been identified and it would be necessary to agree on a decision making process. It was also noted that there were patient flows across Cheshire and Wirral and from outside the area and this would have an impact on acute care systems.

·       Reference was made to the fact that social care was not factored in as part of the STP. It was noted that there would need to be a programmed approach in respect of social care and an attempt was being made to bring social care and adult care together. It would be helpful to have a Cheshire and Wirral approach to this and to consider the challenges that would have to be faced.

·       With reference to funding, it was queried as to whether, if one Local Delivery System overspent, the other LDS’s would have to bail it out. It was noted that the governance around this had not yet been developed, however if there was to be a Cheshire and Merseyside STP ‘control total’ there ought to be the ability to move funding?

·       It was suggested that the focus of the Health and Wellbeing Board should be on connecting together and on how the Local Authority and other partners should work together to bring about change and to implement and deliver this.

·       It was noted that the Alcohol, Hypertension and Anti-Microbial Resistance work-streams provided a good example of where there had been a successful Cheshire and Merseyside approach.

·       It was commented that although the STP was a public document, it was not currently a public facing document. A public facing document would need to be developed to meet the challenges and would need to contain more detail.

·       Further comments were made concerning the need to look at the different levels of planning which were currently in existence, including the CCGs, which had delegated responsibilities. It was felt that there was also an opportunity for community pharmacies to play a part.

·       It was suggested that, if the STP process was to be taken forward, it would be necessary to get the Comms right and that there should be a Comms Strategy, as part of the process.

·       It was noted that the STP only covered clinical issues and did not refer to issues such as mental health. It was considered that it should look at the wider issues.

·       It was thought vital to consider the provision of a framework for the commissioning of  voluntary/third sector services. It was suggested that this issue should be discussed at the joint meeting of the three Health and Wellbeing Boards in Cheshire and Wirral, to take place on 14 February.

·       It was considered important to look at the wider preventative strategies, for example on alcohol, and not to lose sight of the large piece of work being carried out through the NHS on prevention.

RESOLVED

1.       That the Cheshire and Merseyside Sustainability and Transformation Plan and, in particular the Local Delivery Plan for Cheshire and Wirral be received and the comments made be noted.

2.       That the Health and Wellbeing Board provide oversight and local accountability for the development and implementation of the Plan as it relates to Cheshire East, to ensure the proposals and impacts meet the needs of the Borough’s residents.

3.       That the Board calls for a full engagement and consultation strategy to be developed by NHS partners, to ensure that the proposed changes are shaped by service users, residents and wider stakeholders.

4.       That the Sustainability and Transformation Plan be a standing item on future agendas.