Members welcomed the Director of Strategy and Partnerships for Worcestershire Health and Care Trust and the STP Communications and Engagement Lead to the meeting to discuss the Herefordshire and Worcestershire Sustainability and Transformation Plan (STP). During consideration of this matter the following points were highlighted for Members’ consideration:
· In 2016 the NHS had been required to produce STP plans across the country. Locally, a decision had been taken for Herefordshire and Worcestershire to work together on an STP.
· The STP had provided an opportunity for different branches of the NHS to work together to address health issues in the local area.
· Increasingly the focus was on wrapping services around the needs of local communities rather than shaping services around the requirements of organisations.
· At a national level there was a movement towards an accountable care system. This had been interpreted by some as an attempt to privatise services but the real aim had been to enable the private sector to work better together in the delivery of care services.
· There was a lot of duplication in the NHS. The aim through working together was to identify duplication, streamline services and then use available resources to meet community needs.
· The Herefordshire and Worcestershire STP had progressed more quickly than some STPs in the country, partly because the organisational composition of the partnership working arrangements was less complex than in other locations.
· A key aim through work on the STP was to improve the performance of existing services. However, unfortunately in some cases services would not be available locally, including Tier 4 mental health beds, which meant that referrals had to be made out of the area.
· The NHS long-term plan had been published in 2019 and required further changes moving forward.
· There were some key objectives in the long-term plan, including to improve cancer services, improve mental health service outcomes, improve waiting times and to address issues, including waiting time at A&E. Many of these issues were a problem nationally, not just locally.
· Since the last Redditch Overview and Scrutiny Committee meeting when an update had been provided on the STP, Worcestershire Healthwatch had undertaken a significant amount of consultation with hard to reach groups.
· There had been a number of messages consistently raised during this consultation process including the complexity of the NHS and social care system, the need for transport to be available to help people access services, the valuable work undertaken by carers and the need to provide support to them and problems accessing general practice.
· Consideration was being given to providing services in alternative formats to the traditional approach in order to meet the needs of patients. For example people who worked might appreciate a telephone conversation at an appointed time. In order to identify suitable alternatives the NHS needed to consult with the public about their needs and preferences.
· The local Neighbourhood Teams in Redditch were working to develop resilience within general practice.
· More support was being provided to eating disorder services and to mental health services than ever before.
· Social proscribing was increasingly being used to help those who approached their GP for help but who did not necessarily require a medical intervention. Social proscribing could also result in preventative action that helped people to avoid needing medical interventions at a later date.
· The Clinical Commissioning Groups (CCGs) in Worcestershire were shortly due to merge from four into one. It was anticipated that the new Worcestershire CCG would have a more strategic focus than the four CCGs had had in the past.
· At the local level detailed spending plans had been developed In response to the national long-term plan. These plans would be reported to the NHS West Midlands and would be reviewed on at least an annual basis.
· There was an expectation that organisations’ plans would match local plans in the STPs and then this would also be reflected at a regional and national level.
· There remained a number of challenges facing the NHS locally which were generally replicated at a national level. This included medical staff shortages and financial challenges. There was a need to both encourage existing staff to remain in post and to promote medical careers to future generations.
· The collaboration that was taking place locally felt very positive and appeared to be different to the past. As part of this process organisations were working together to identify how to respond to different health challenges and were pooling funding.
Following the presentation of the update report Members discussed a number of points in detail:
· The potential impact that Brexit would have on the NHS. The Committee was advised that guidance had been provided at a national level in respect of planning for Brexit.
· The funding that would be available to the NHS once Brexit had taken place. Members were advised that the finances in the national funding plan for the NHS had been announced earlier in the year and was intended for; aging well, primary care, learning disabilities, cancer and mental health services.
· The good quality care that was received from staff working in the NHS. Members unanimously praised staff for their hard work and dedication.
· The difficulties that people often encountered when first attempting to access care services and the frustration and anxiety that this could cause, particularly to people diagnosed with cancer when placed on a waiting list.
· The performance of Worcestershire Acute Hospitals NHS Trust (WAHT). Members noted that many targets had been missed in service provision and this caused concerns for the public.
· The action that was being taken to address the performance issues for WAHT. Members were informed that the STP and long-term plan both focused on driving up performance. Urgent care and cancer services both had their own work streams and actions that were designed to reduce waiting times.
· The need to encourage people to access a range of services, not just A&E. The Committee was advised that other parts of the country adopted a more active approach to encouraging people to use alternative services which meant that A&E in those areas concentrated on the more urgent cases.
· The systems in place within the NHS and the need for these to be streamlined to ensure that they did not act as barriers to effective service delivery.
· Mental health services for young people and the age at which children could start to access these services. Members were advised that there was a Children and Adolescent Mental Health Services (CAMHS) support group for those aged under five.
· The age at which young people transferred from CAMHS to adult mental health services. The Committee was informed that the Government was considering increasing the age at which this occurred from 18 to 25.
· The increasing demand for the services of CAMHS which had been identified at a recent meeting of the Worcestershire Health and Wellbeing Board.
· The important role of schools and GP practices respectively in terms of enabling early intervention in cases where children and young people were experiencing mental health problems.
· The issues that the Suicide Prevention Task Group had already identified, in terms of accessing crisis care and the funding available for mental health services. Members were advised that, whilst there were no Tier 4 mental health beds in the area, there had been an increase in investment in tier 3+ services which had helped to reduce demand at the tier 4 level.
· The difficulties for people experiencing social isolation, including people with caring responsibilities. The Committee was informed that Voluntary and Community Sector (VCS) organisations were delivering projects to tackle social isolation, including Age UK’s Social Connecting project.
· The problem in Birmingham of people from outside the city registering at GP practices inside the city and the impact that this had had on demand. Members were advised that this was not a problem in Redditch.
· The digital introduction to the CAMHS service that was available for young people to use. Members were advised that lots of young people preferred to have a digital introduction to the service before they physically met with practitioners.
· The bar that had been set in order to access CAMHS services and the need for support to still be made available for those children and young people who did not meet this threshold. Members were informed that the Reach for Wellbeing service had been introduced in 2018 which was designed to provide services to children and young people before an intervention was required from CAMHS.
· The potential for information about local wellbeing services to be publicised in a single directory. Members were advised that it was likely that a single directory would be published by the Council in future.
· The difficulties encountered by children and parents if they had to wait for a lengthy period of time in A&E before treatment and the impact that this could have on a child’s education.
· The capital investment funding that had recently been announced for WAHT and how this would be spent. Members were advised that a lot of capital spending was on hold in the NHS as discussions were taking place about how it would be released.
· The evidence basis for work on the STP and long-term national plans. The Committee was informed that much of the evidence basis was from other countries. For example in Holland demand was kept down through helping people to maintain independent lives in their own homes.
· The date when all of the plans would be fully implemented and no further change would be required. Members were advised that this was unlikely to occur due to advances in medical treatments and technology.
· The changing local demography and the challenges that this presented for the NHS and social care services. Members were informed that in the following five years there would be an increase of 49 per cent of the number of people in their 80s living in Malvern Hills district alone and they would have particular medical needs.
· The delays that some Members had encountered to ambulance services and at A&E and the impact that these waiting times could have on vulnerable residents.
· The process for making complaints about the quality of care received by residents and measures that could be taken to ensure that health services were held to account. The Committee was informed that complaints could be made directly to the relevant organisation. Reports could also be made to the Care Quality Commission (CQC) and NHS services were held to account by the Worcestershire Health Overview and Scrutiny Committee (HOSC).
· The role of NHS West Midlands. Members were advised that NHS West Midlands had been formed in the region following the merger of NHS England and NHS Providers.
· The positive recent development whereby it had been agreed that the drugs needed by some stroke patients within an hour of having a stroke could be administered at any location subject to approval by a consultant over the telephone, rather than the deadline being missed due to capacity issues.
· The potential for 5G to be introduced in Redditch and the medical advances that could then be made at the Alexandra Hospital as a consequence.
Members concluded by agreeing that a further update in future to the Committee would be helpful.
the report be noted.