The Committee is asked to receive a report from the West Leicester Clinical Commissioning Group that aims to provide an update on Better Care Together (the Sustainability and Transformation Partnership for Leicester, Leicestershire and Rutland), and the work being undertaken by partners to improve the health and wellbeing of people locally. An additional report entitled ‘Next steps to better care in Leicester, Leicestershire and Rutland’ is also attached. The Committee is asked to:
· Note this update and the work of the Better Care Together partners
· Note the publication of the Next Steps document
· Note the on-going work to co-ordinate business cases for acute and maternity reconfiguration, which will be subject to formal public consultation once capital funding is identified
· Note the on-going work of BCT work streams, and engagement and consultation activities.
The Committee received a report that provided an update on Better Care Together (BCT); the Sustainability and Transformation Partnership (STP) for Leicester, Leicestershire and Rutland (LLR). The Chair provided a background in relation to the scrutiny that had taken place relating to the BCT (formerly known as the STP). The meeting heard that the draft STP came out in 2016 and was brought to the LLR in December 2016. A refreshed STP was expected but never came and during the last few months, it became known that there would be a BCT Next Steps document instead. This document had just been published.
The Chair said that scrutiny needed to be clear as to what it wanted to focus on. She was aware that some dissatisfaction had been expressed relating to the way both scrutiny and NHS bosses had approached public consultation and reports to scrutiny. However, her research showed that scrutiny had carried out a lot of work on the STP; this just needed to be consolidated and a clear way forward agreed.
Toby Sanders, Managing Director of West Leicester CCG and STP lead for LLR, Richard Morris, Director of Operations, Leicester City CCG and Sarah Prema, Director of Strategy and Planning (Leicester City CCG) introduced themselves to the committee. Mr Sanders presented the report and explained that BCT was a partnership that came together across all health care organisations. The Next Steps document set out the important things that had been done and would be done for local people.
The Chair stated that the committee needed a clear idea as to what would be presented to Members in the future and she suggested that it would be useful to discuss this in an informal meeting. The Chair expressed a view that rather than looking at issues they would have little power to influence, it would be most useful for the committee to focus on what service improvements there would be for patients, and public engagement and consultation.
During the ensuing discussion, comments and queries were raised which included the following:
· A Member commented that she thought from the earlier debate in the meeting, officers from the NHS would understand the importance the public placed on consultation. Comments had previously been made that the NHS could not consult without the confirmation of funding, but she said it was still possible to communicate with the public. The Member said that they wanted to avoid the situation that had occurred in relation to the consolidation of the ICU. The Chair added that formal consultation could be about detailed proposals and consultation and engagement exercises on principles rather than details, could still be carried out.
· Further concerns were raised about the lack of information about the STP during the course of the process. Comments were made that the STP was linked to the consolidation of the ICU and the public had not had the opportunity to engage with the process. A Member said that local authorities had a duty to consult on the local plan, but much engagement took place before the consultation, which then informed the proposals, and she did not understand why the NHS could not do the same.
· Concerns were expressed that local authorities no longer had sufficient funding for adult social care and people would not be taken into hospital in the same way. There would be more reliance on voluntary care, but local volunteer groups were having their funding cut as well.
· It was questioned whether the digital team would be able to deliver what was required. A request was made for a written response to this question.
· A member commented that there were issues and inaccuracies relating to geographical boundaries in the report; for example, people in Market Harborough might go to Northampton hospitals and this needed to be taken into account.
· A comment was made that the document referred to hubs and urgent care centres but people did not know what hubs were and where hubs and urgent care centres were located. Concerns were also expressed that people in Hinckley had said that they were not kept informed.
· A Member referred to sickness levels and stated that it appeared that action was being taken to reduce sickness, but absences were still high. She questioned what action was being taken and asked whether those absences were long term.
· A concern was expressed that the Next Steps document looked like a stealthy back door STP with hidden information. An example was given that it did not mention the close of the Melton Maternity Unit which had been included in the original STP. The Member asked how much the process had cost as it had been going back and forth for some time.
· A Member asked how much it had cost to produce the Next Steps document. She referred to a diagram on page 38 which illustrated how the various organisational parts of the current health system came together and said that each organisation had different aims and she had concerns as to whether it was workable.
Mr Sanders and Mr Morris responded to the questions raised and made the following points:
· In relation to the cost, Mr Sanders explained that this was the mainstream work of the NHS and local partner organisations, and the diagram on page 38 was the reality of the NHS and partners. They endeavoured to work better across the CCGs, providers and partners and he believed that this was being achieved.
· Mr Sanders said that in relation to financial information and the sharing of such information, the efficiency savings as detailed in the document, were the savings across the partnership. Those savings had already been identified by the partners and made public so the financial details in the Next Steps was information that was already in the public domain.
· Further to the question about geographical borders, Mr Sanders said that whilst the document focussed on the LLR, they worked with colleagues in other counties, but that information was not as visible in the document as it could be. In relation to Hinckley, two applications for funding to support community services had been submitted but turned down. A team was working on a further funding bid and an update would be given on this when more information became available.
· In response to the comments about consultation, Mr Morris stated that he had been working on the BCT / STP for about ten years and a considerable amount of time and effort had been spent on going out and talking to people about the principles as discussed. Several thousand patients in the LLR had engaged in that process and thousands of comments had been received. He accepted that there had been ‘radio silence’ during the last 6 – 12 months but part of this Next Steps document being discussed now was to create the framework in order that those informal conversations about the proposals could continue. There could not be a legal consultation until the guarantee of funding had been received, but they would continue to go out to have those conversations in the meantime.
· Dr Underwood, Healthwatch Rutland said that she was interested in the development of the STP. She expressed concerns that a number of people in Rutland had sent in letters but had not received a reply. Dr Underwood expressed further concerns that the Next Steps document had been overlooked in Rutland.
Mr Sanders responded that he was aware of the letters and after they had been received, he and Richard Morris had attended a meeting involving Healthwatch in Rutland, where they had given a general response to the letters. Part of that feedback had been included in the Next Steps. He apologised if people felt they had not been responded to.
Mr Sanders acknowledged that the document did not answer everything however. The Rutland Memorial, Oakham and other community sites were included in the STP but not in the Next Steps document because some areas were still a work in progress. He understood that this was frustrating and created anxiety but as a partnership, it was thought it was preferable to include information on those areas where it was clear about what was happening. Dr Underwood responded that she was not convinced and said that people in Rutland needed to know what was happening.
· Councillor Conde commented that he thought there were too many people coming from different angles which made it difficult to get proper answers. However, he looked forward to working with Healthwatch Rutland in the future.
The Chair drew the discussion to a close and asked for responses in writing to the questions about hubs and urgent care centres and staff sickness levels.
1) that Members be invited to submit further questions; these to be consolidated and emailed round before sending to officers for responses;
2) for the Chair to agree a timeline for questions and responses; and
3) that it be noted that Toby Sanders is leaving, and the committee thank him for his work on the STP over the past few years.