Council and councillors

To receive Report No. 116/2018 from the STP Lead for Leicester, Leicestershire and Rutland.

Report No. 116/2018 was received from Mr Toby Sanders, the Sustainability and Transformation Partnership (STP) Lead for Leicester, Leicestershire and Rutland and the Managing Director of West Leicestershire Clinical Commissioning Group.

The purpose of the report was to provide an update on the STP for Leicester, Leicestershire and Rutland and the work being undertaken by partners to improve the health and wellbeing of people locally. The programme was known locally as Better Care Together (BCT).

During discussion the following points were noted:

·         Two years ago partners had started talking about STP plans in order to improve health outcomes, improve the patient experience and address the issue of resources. Draft proposals received a very varied mix of feedback so the view was taken to move forward with the items that residents wanted progressed such as the 111 service and the non-emergency transport service.

·         Before changes were made to the large pieces of work there needed to be an understanding of what the service changes would be. The East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) had been looking at commissioning services and the intention had been to publish a final plan but the closer they got to doing that the more obvious it was that the NHS was not performing within budgets. Because of the budget situation it was felt that it was not the time to produce new blueprints and instead the case should be made for additional NHS funding. The STP would wait until the autumn to see what difference the new £20 billion of funding that had been announced would make.

·         The focus had therefore been moved from producing a grand plan to focusing on what could be improved practicably and in particular this meant looking at community work.

·         In tandem however, work had been progressing, with some success, to gain additional capital funding for acute hospitals.

·         Last summer £40 million had been secured to invest in a mix of critical services and children and young people’s eating disorders.

·         Over the last 15 months there had not been enough communication about the situation but this would be improved with the publication of a next steps document.

·         Members commented that they felt that the NHS was overly bureaucratic and management structures should be reviewed before any additional monies were spent. Officers responded that organisation and management was needed in order to free up clinicians time and in comparison to healthcare systems internationally, the NHS was not over managed. There was however, always work that could be done to be more efficient.

·         A recent positive for Rutland had been the Better Care Fund (a joint social care and health fund) which had the best outcomes for patients in the country of any Council.

·         The word ‘plan’ was used too frequently and instead STP partners should talk about giving information.

·         It was generally felt that most people would be happy if services that were already out there worked, if they could get through on the phone and if they could access services locally. By building on these basics and doing the simple things in the right way then larger joint project work could be developed.

·         Members felt that the district nurse service was too fragmented and that there needed to be much more proactive working between the GP surgeries, community nurses and social services. Problems occurred as GP’s did not have any way of contacting the community nurses and additionally the nurses when they arrived at the patient’s home, often did not know what they specifically needed to do. It was demoralising for the nurse if they were ill-equipped and under trained to perform the duties that the patients required.

·         Although Members knew about, and were impressed, with the clinical changes that were happening behind the scenes with the 111 service, there needed to be better promotion of what the service covered and what to expect from it. Members’ personal experience was that they were kept waiting for too long, that operators did not know the local area and referred them too far away and that on reflection it was just easier to go straight to Accidents and Emergency (A & E).

·         Officers agreed that the 111 service had not got off to a flying start but its recent drop off rate had indicated that it was improving. They recognised that it needed to be a consistent service so that people would learn to trust it.

·         Healthwatch Rutland had conducted a poll on the 111 service in January of this year and would revisit this data and take another snapshot poll if needed.

·         The Capital prioritisation process run by the NHS meant that the CCG did not get monies directly but had to bid into a national process. Before formal consultation could start the CCG had to be sure that funding was available so that public expectations were not raised unnecessarily. With regard to maternity services at Melton, work had taken place at the engagement stage and there would be formal consultation when the funding was secured.

·         Capital submissions would continue to be progressed.

·         Members asked why when such a large part of the NHS budget was spent on preventative measures, the UK was currently only 17^th in the world for bowel cancer survival rates and obesity levels were rising.

·         The NHS was world class in many areas but did lag behind in cancer survival rates. Early detection was the key and new tests for eg. rectal cancer were being introduced. GPs also needed to be upskilled.

·         The PRISM IT system was a central repository of information that supported GPs, enabling them to look up any issues and check referral pathways.

·         GPs had to do 50 hours of update work each year to keep their knowledge current.

·         The overall NHS budget had been rising at 0.1% per annum, but as health inflation ran closer to 6%, the difference needed to be found through local efficiency drives within the NHS.

·         The budget for prevention work had been cut year on year so at a time when prevention was critical its budget was being cut significantly.

·         In light of this situation it was important that every contact with patients was maximized; ‘making every contact count’. CCGs worked with GPs using their intelligence to drive commissioning. Frailty was the current preventative focus and GPs needed to promote active ageing.

·         Patients could provide feedback on their experiences within the NHS by using the NHS Choices service. This service, although unknown to Panel Members, had been around for 10 years and was closely looked at by the CCG.

AGREED

1.    The Panel NOTED the update and work of the Better Care Together partners.

2.    The Panel AGREED that their Member, Mrs June Fox, would send the details of her resident’s experience with the district nurse service directly to the Chief Operating Officer of ELR CCG for investigation.

3.    The Panel AGREED that Healthwatch Rutland should assess residents’ knowledge and usage of the 111 service by examining the data already collected, taking further information if needed, and reporting back to the Panel.