Agenda item
TRANSFORMING SERVICES,CHANGING LIVES PROGRAMME
Minutes:
The Chair welcomed Peter Morris from Barts Health, Neil Kennett-Brown from the NE London Commissioning Support Unit, and Dr Sam Everington, Chairman of Tower Hamlets CCG.
Mr Kennett-Brown reported that the programme had started in February 2014, with an interim case for change finalised in June. The engagement period had begun in July and would end on the 21st September, with a formal case for change and an outline of the work programme being in November 2014. Dr Everington advised Members that this programme needed to deal with health in general, not just health services, and find new, modern, and more productive ways of working to address the upcoming challenges to health care.
Councillor Winston Vaughan opened the questioning, asking whether the expected increased demand on hospitals from the predicted growth in population was to be addressed through current budgets?
Mr Kennett-Brown responded that an increase in patients would result in an increased budget, but that there would be a time lag on receiving it. He stated that policy and decision makers should be influenced to increase the speed. Dr Everington advised that the current funding formula was based on age, but deprivation levels in East London boroughs resulted in a 65 year old being equivalent to a 70 year old in health terms.
At a follow up request from Councillor David Edgar, Mr Kennett-Brown undertook to circulate a document summarising information on the funding formula.
Councillor David Edgar asked for more details concerning the level of engagement and the timing of the next stage of the process.
Mr Kennett-Brown replied that almost everyone recognised that this case for change as a fair and honest reflection, but wanted to know what changes would be made. Although the proposals were still being developed, Mr Kennett-Brown advised that CCGs would be presented with the formal case for change and proposals for work in November 2014, but that no details would be available until after the general election.
The Chair queried whether anything unexpected had arisen from the engagement process?
Mr Kennett-Brown confirmed that nothing had been a surprise other than that some basic services had been highlighted, such as late letters or general administration problems, as well as than clinical suggestions.
Councillor Ben Hayhurst queried why the details of the proposals were coming so late in the process, and whether there would be enough time for them to be considered and scrutinised properly.
Mr Kennett-Brown advised Members that they wanted to be as open as possible, and there was a requirement to consult fully on the proposals. Some changes would be a matter of communication (i.e. administration changes) and some would need formal consultation. In a follow-up question, Councillor Hayhurst queried whether any proposals would be made to close or merge A&E departments, and Mr Morris and Mr Kennett-Brown confirmed that there was no intention to shut any A&E or Maternity departments.
Councillor Dianne Walls enquired as to the movement to community based services, in particular the practical implications of such a move.
Mr Morris replied that a shift to integrated care to address the change in demographics and economics inevitably meant more resources would be needed in the community. He added that in primary care the biggest change would be cultural, not structural. Dr Everington advised that a joined-up approach was being sought to improve the patient’s whole journey; this would involve new technology and new roles, such as care co-ordinators.
In a follow up question, the Chair asked whether an argument was being made in favour of primary care funding during discussions with ministers. Mr Morris responded that that was the answer he would give if asked, and advised that better interconnectedness was needed in the NHS to ensure effective knowledge transfer. He added that if acute providers didn’t act now they wouldn’t be any space in hospitals in 10 years time as they would be full of patients waiting for elective procedures because of a failure to deal with the primary care aspects..
Councillor Rosemary Sales queried whether the proposals were based more heavily on monetary savings or on achieving efficiency?
Mr Morris replied that there were three drivers for the change: an economic one, the achievement of better interconnectivity, and to address the shift in demographics.
Common Councilman Dhruv Patel asked how improvements to the healthcare system requiring significant investment would be made during a period of budget cuts.
Mr Kennett-Brown responded that the NHS budget included schemes to provide invest-to-save schemes, and Mr Everington added that proposals would be about clinical changes that should be implemented for practical reasons as well as cost efficiency.
Councillor Ben Hayhurst asked about the £400million of quality and productivity savings to be made over the next five years.
Mr Kennett-Brown advised that pages 53 and 54 of the full case for change outlined the details.
Councillor Mahbub Alam queried whether technological improvements would replace jobs.
Dr Everington responded that there was no suggestion for a loss of jobs, that the technology would just enable a different, more efficient way for staff to work. It was hoped that improvements would provide an ease of service for most patients, and free-up staff time for more face-to-face interaction with patients needing direct communication.
In response to a question from a member of the public, Mr Morris advised that the cost of capital would be higher when derived from the private sector and that there was a need overall to smooth out the cost of capital, public vs private, in the NHS. He added that Barts had reduced the size of soft services in their PFI contracts which had reduced them by £8m per year. Dr Everington added that there needed to be a national solution to the PFI issue. Mr Kennett-Brown added that the overall focus of the proposals addressed the whole of the healthcare journey, offering a holistic service for patients. Services would have to join together within the NHS wherever possible to provide a seamless service while addressing the challenges ahead.
The Chair thanked the officers for attending and answering questions.
Supporting documents:
- Case for Change Briefingpaper v0.3, item 6. PDF 82 KB
- Presentation case for change INEL JOSC 210814 ZH, item 6. PDF 2 MB