Agenda item

Barry Quirk (Chief Executive), Dr Marc Rowland (Chair, Lewisham CCG) and Aileen Buckton (Executive Director of Community Services) introduced the report. The following key points were noted:

·         The south-east London STP has benefited from some involvement of the six local authorities in south-east London. This has been to continue to develop an integrated approach to health and social care. The local authorities are helping to make sure that local improvements to social care fit in with planned changes in health services locally (in alignment with the STP) and that cost shunting across sectors and boroughs is minimised.

·         The combined financial challenge for social care across the six local authorities in south-east London is £242m. The six authorities have identified the scale of their challenges but they have got to coordinate their six operational plans at a six-borough level so that health changes are addressed more collectively.

·         The south-east London STP was published early because NHS England was pleased with the level of cooperation within the NHS and across partners in south-east London.

·         Lewisham partners have also been pleased with the level of cooperation across the system. The STP has encouraged acute providers, and their commissioners, in south-east London to cooperate with each other and consider potential improvements to the whole south-east London system.

·         The level of cooperation within the NHS is much improved and very different to a few years ago, where institutions were working very separately and more competitively.  NHS partners are working more collaboratively and trying to look at how the whole system can change rather than just their part of it. For example, by working together to try to achieve changes in the acute sector the aim is to invest more in prevention and primary care.

·         The cooperation within the development of STP does not, however, detract from the concerns about the aggregate level of funding nationally of the NHS.

Barry Quirk and colleagues answered questions from the Committee. The following key points were noted:

·         It is important that local authorities bring critical challenge and point out any service and financial gaps in the STP.  It is not for local authorities to agree the plan – set at the sub-regional level, it is principally an NHS plan devised with involvement from Councils who secure social care services locally. In Greater Manchester the creation of a combined authority (for social care and other functions) city regional devolution includes health and social care.  Other places, including "sub-regions" within London are less developed.  But, at the same time, all social care authorities do need to make changes as a result of their own service challenges and financial pressures. It is important that they work with health services in doing this.

·         The STP is not principally about financial cuts, although it does involve cost reduction, efficiencies and productivity improvements. However the scale of the aggregate financial challenge for the entire NHS system in SE London is very high (£1 billion). Partners across south-east London are working together to bring some of the projected overspend down by doing things differently – working more efficiently and cost-effectively while improving quality. Local authorities are there to feedback on what this means for social care.

·         Local authorities are not being asked to sign or endorse the STP separately, but they are being invited to consider them at local and sub-regional level.  Given that the STP process is proceeding, Councils do need to continue to work productively with their health partners. Just because a local authority is sceptical about certain aspects of the STP process and direction, it does not mean that it can sensibly withdraw from involvement: those vulnerable people in receipt of social care and patients (often the same people) require Councils to coordinate their services closely with the NHS. Local authorities have a responsibility as stewards of social care. There are significant financial consequences if changes to health and social care are not made. At present, there are no other plans being developed within the NHS and all partners have to make it work as best as they can.

·         Lewisham CCG has found the involvement of local authorities very helpful. It has provided a different way of looking at the challenges.

·         The fundamental difference between London STPs and others around the country is that the population in London growing. The STPs in London are therefore principally concerned with improving productivity and changing the pattern of services so as to reshape them for a growing population.

·         The integration work going on in Lewisham is based on many of the same principles that underpin the STP – for example, the principle that most people do not want to be in hospital and want to be cared for closer to home. But local authorities will need to talk about the impact on social care if integration work not done properly.

·         A campaigner from the Save Lewisham Hospital campaign, Tony O’Sullivan, said that he is strongly in favour of community-based care and inter-agency working, but argued that the STP is just about money and very dangerous. He said that if the plan does not achieve its aim it is not just the NHS that is going to be impacted – it is going to devastate social care as well. He argued that providers will be put into special measures and £1bn of savings will be imposed – with all options on the table.

·         The campaigner also drew attention to the fact that one year into the five-year plan the financial challenge has already increased by £80m. The productivity challenge has also increased to 5.5% per year for four years – which he described as an unprecedented and impossible target.

·         Another campaigner made a number of requests to the committee. He recommended that the committee insist that there is consultation on every part of the STP; that the option of an enhanced status quo is seriously considered as part of the upcoming consultation on elective orthopaedics; and to scrutinise closely the financial figures provided so far.

·         A representative of the Pensioners’ Forum, Cathy Ashley, is worried about how people who do not have easy access to the internet are going to be consulted fully.

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

·         The Committee expressed concern about how people without easy access to the internet will be able to participate fully in any consultation process.

Resolved: the Committee noted the report.