Agenda item

Resolved: that the Committee would be able see a copy of the Plan and be sent information about the next meeting. 

Barry Quirk (Chief Executive) introduced the report. The following key points were noted:

·         The NHS forecasts that without change there will be £30 billion shortfall in its budget by 2020-21 – mostly driven by the cost of caring for the country’s increasing and ageing population. The Government has agreed to provide an extra £8 billion by 2020. But the NHS must make up the rest by improving efficiency.

·         These savings can’t be achieved by looking at individual hospitals. They have to be done by area, across a range of hospitals. As part of this, all NHS organisations have been asked to produce a local health and care system Sustainability and Transformation Plan (STP), covering 2016 to 2021. There are 44 ‘footprint’ areas across England that will submit their own STPs.  

·         South East London’s STP covers six boroughs in South East London: Bexley, Bromley, Greenwich, Lambeth, Lewisham and Southwark. The STP sets out how these boroughs will work together to re-organise and integrate the way health and social care services are provided across the area. The South East London STP is owned by all providers and commissioners of health and social care in these areas.

·         Amanda Pritchard (Chief Executive, Guy’s and St Thomas’ NHS Foundation Trust) is leading the work on South East London’s STP. Andrew Parson is the clinical lead, Andrew Bland is the Clinical Commissioning Group Lead and Barry Quirk is the lead for local government.

·         South East London’s initial STP was re-submitted today – after changes were made to bring it in line with NHS financial guidelines.

·         In South East London, there is forecast to be a gap in NHS finances of over £670 million by 2021. Some savings have been identified from, among other things, changing services (£145 million) and increased collaboration (£250 million), but it is still estimated that there will be financial gap of over £280 million after 5 years. If nothing was to change at all, the gap would be over £1 billion.

·         There are five key elements to South East London’s STP: improving the health of people; improving care and quality of service; improving organisational effectiveness of primary care and social care; establishing priorities; leadership and governance.

·         In terms of improving the health of people, Lewisham is doing well in some areas, like helping people who have recently come out of hospital, but not so well other, like access to GP services.

·         The priorities of South East London’s STP are: better contractual arrangements; establishing effective place-based governance; provider collaboration and accelerated delivery.

·         All South East London Trusts are in financial deficit, so there is a need to look at how to speed up the process and shift the focus to community-based care. Re-designing and integrating adult social care is critical. The cost of social care is probably greater than cost of hospital care.

·         Lewisham has discussed collaborative planning with several health partners across South East London, but local governments in the area are still a long way behind when it comes to collaborative working.

·         Some local authorities in South East London have already done well establishing new ways to work more closely with local health partners. But most collaboration has been at individual local authority level. Local authorities are not yet looking at the overall costs across South East London in 5 years’ time.

·         Because of the work already done as part of Our Health South East London (OHSEL), South East London is considered to be one of the most advanced areas, with good conditions for further collaboration – and has been asked to be a national exemplar.

·         Local government is generally under-represented at meetings about the STP and, without a South East London approach to social care, local government is in danger of being left behind.

Barry Quirk (Chief Executive) answered questions from the Committee. The following key points were noted:

·         South East London’s initial STP for 2018 to 2021 was submitted today – as well the individual local NHS organisations’ plans for 2016/17.

·         South East London’s final STP will be submitted in June. This doesn’t mean that any of the health devolution pilots are on hold, but they may have to be re-configured in the context of the STP.

·         The directors of adult social care in the 6 boroughs are involved in the STP, but it is still felt that local government input is ‘light’ overall. There is a feeling that local government is being squeezed out and that health care will increasingly dominate as adult social care gets closer to health care. Local governments need to have a voice at the appropriate times.

·         PFI deals will also be looked at as part of South East London’s STP. Several PFI contracts in the area have previously been renegotiated.

·         All meetings about South East London’s STP have been open to public and have also involved patient groups from the area.

·         There are some serious issues with patient safety across South East London. Clinical outcomes need to improve and South East London’s STP is also about improving levels of service – as well as making efficiency savings.

·         All the figures in the STP so far are only about the funding for NHS services. The financial gaps in social care funding have not yet been worked out. Local authorities need extra funding for programme management to do this effectively.

·         There will be further discussions, with the programme director of South East London’s STP, about how the public are being consulted.

The Committee made a number of comments. The following key points were noted:

·         The Committee expressed some concern that South East London’s STP was being described as a good thing when there were concerns that it would fragment health care, introduce further cuts and oversee the decline. Members expressed concerns about the burden of PFI deals on hospital finances. 

·         The Committee also expressed concern about the possibility of social care becoming merely an extension of medical care, with those who do not need medical care being side-lined.

·         The Chair pointed out that the relevant scrutiny chairs across South East London have been working jointly through the South East London Stakeholder Reference Group.

·         A copy of South East London’s STP will be shared with the Committee and it may be added to the Committee’s work programme again later in the year.

Resolved: that the Committee would be able see a copy of the Plan and be sent information about the next meeting.