Nicola Gardner Programme Director, North-East London Sustainability and Transformation Plan, (STP), July Low, Director of Provider Collaboration North-East London STP and Ian Tomkins, Director of Communications and Engagement North-East London STP introduced the report and presentation which provided an update on the development of an STP in the North-East London NHS area.  This set out how the NHS five-year forward view would be delivered and health and care services will transform and become sustainable and be built around the needs of local people.

 

Mary Burnett (a former social worker) and Terry Day (Formerly a  Non-Executive Member of Whipps Cross Hospital; Board) representing North-East London Save Our NHS made the following representations:

• STP representatives were asked to justify the approach that had been taken in delivering the STP, in the context of the statement made by Stephanie Clark regarding the requirement for formal consultation when considering a substantial variation in service provision (such as that proposed in the NELSTP) and
• asked JHOSC to consider if this this requirement can be met within the timeframe notified by NHS England (namely that the STP was to be signed by December 23rd 2016).
• Ms Day although not arguing against the integration of community care put forward that the overall financial deficit will counteract the intended benefits of the plan and,  coupled with the expected population increase, it was not credible that the STP could deliver its intended benefits.
• Ms Burnett noted:
  •  That the NHS plans are not quantified and NHS providers are being forced into the transformation program in order to gain access to funds.
  • The proposal for a whole system change in the period proposed was not achievable.
• Ms Day put forward:
  • That it was necessary to test the provision before bed-base is reduced.  This testing was not taking place and therefore creates risk in the inherent service delivery.
  • There is no plan to meet the service requirements.

 

The Committee noted these submissions and the Chair then invited the Programme Director, North-East London STP to make her presentation.

 

The Programme Director noted the challenges to delivering the STP described by Ms Burnett and Ms Day.  She made her presentation informing the Committee that:

• The STP Project Team was presently translating the ideas of the STP into the procurement.
• There would be no sign-off of the plan  on 23 December 2016 because feedback was presently awaited.
• Paragraph 6 of the report outlined the plan to deliver a single sustainability and transformation plan across the seven North-East London Clinical Commissioning Groups (CCGs).
• There were eight work-streams including services, property, workforce, and new roles to address short-term and medium-term shortages and IT/ media.
• NHS England was presently beginning to work up proposals and these would require further work over the coming months.
  • Plans were to be worked up by clinicians, local authorities and stakeholders.
  • NHS England was, eager to receive input into the proposals from local authorities and agencies.
• Mr Tomkins acknowledged that notice of the STP had not been communicated in an ideal way.  However it was necessary:
  • to continue to progress the project and
  • to enable people to understand the aims and content of the STP and the difference it will make to services.
• Attitudinal and behavioural change was required and therefore NHS England was looking to engage with groups (especially to hard-to-reach groups) to communicate to this change.
• In order to achieve communication they needed to connect the networks and to publish more information on the website.

 

The Programme Director further informed the Committee that:

·         She was eager to make plans available to the public therefore these had been published in advance of the NHS recommended dates.

·         Where significant changes to services were required, she was determined that these changes would be informed by consultation.

·          The STP was not a constituted body but has a governance board to ensure that there is participation in the programme.

·         Financial challenges would need to be met and the financial gap closed by the following:

o   By noting the savings being worked towards,

o   Collaborative back-office roles,

o   Focus on community and out-of-hospital care.

·         Transformation of STP is a condition of access to funding.

 

The Committee considered the report and public submissions and this was followed by questions and comments from Members.  These are summarised below and attributed to Members of the Committee at their request:

 

Questions, Comments and observations:

 

Revised sign-off deadline

Ms Gardner responded to Councillor Harrisson, who noted that historically the NHS undertook its annual planning in a cycle ending 31 March, and asked

·         for clarification of what was to be signed off on 23 December 2016 and

·         its value.

Ms Gardner informed the Committee that NHS England had instructed that the date to be brought forward by three months to give a period of stability. The deadline applied to contracts between the CCG's and hospitals; each organisation had its own operating plan which must also be signed off. It was noted that this signature related to plans for future years.

 

Scope of the Procurement

Mr Black responded to Councillor Munn’s enquiry regarding what contracts will be put through TST in the coming year and Councillor Sweeney’s enquiry as to what order the contracts would be placed.  He advised the Committee that the initial phase would involve the following areas:

• outpatient redesign,
• diagnostics/unnecessary testing,
• improving access to GP specialist advice.

Other plans would continue to be developed but would not be signed off on 23 December 2016.  He noted that, on the deadline date, even the above areas notified might not be signed off in their final form.

 

Latent consequences

Ms Lowe responded to Councillor Sweeney’s question whether STP representatives could guarantee that latent financial facts would not be created that might later come to light and force a particular service on an irreversible path.  She advised the Committee that that most of the arrangements related to intra-NHS services.  The STP was a five-year programme and the plan required many more consultations to be undertaken.  The advantage of implementing an early deadline was that savings will be identified and agreed on 23 December and foster a period of stability during which the budget will be known before its implementation on 1 April. No such facility presently operated.

 

Data

Councillor Ben Hayhurst noted that no numerical information was presented in the report and argued that the process was therefore based on an assumption.  He asked what the decrease figure was.  Mr Black responded that:

• The total amount would increase but not necessarily in line with the demographic.
• At present it was not possible to give definitive numbers because contracts were under offer. 
• The value of the transformation for Barts NHS Trust was £14 million on a £6 million patch.
• The value for the Hommerton NHS Trust was not known. 
• Details of the value of year one of the STP would be provided to members in writing.

Ms Douglas informed the Committee that local CCGs possessed this data as the offers had originated with them.

 

Action by: Mr Black, Chief Finance Officer NHS Tower Hamlets CCG / Joseph Lacey-Holland, Strategy Policy and Performance LBTH

 

Responding to Councillor Hayhurst’s enquiry regarding what were the differences between offers and counter offers Mr Black advised that some CCG's had their own savings plans and made their calculations after the local facility plan. He agreed to provide figures to Members after the meeting.

 

Action by: Mr Black, Chief Finance Officer NHS Tower Hamlets CCG

 

Consultation

Councillor McAlmont, referencing the submission from Ms Clark, enquired what the plans for consultation were.  Mr Tompkins responded that, at present, the plan was in draft.  Once the proposed changes to the services were known, formal consultation would be undertaken.

 

Mr Tompkins responded to Councillor Harrisson’s enquiry concerning what was the threshold for determining significant changes.  He advised that STP representatives were not able to answer at present but a response would be provided later.  Ms Lowe noted that there was no suggestion that STP in its entirety was subject to statutory consultation but only specific proportions of the plan.  At present there were no proposals to undertake any changes which met the threshold to trigger formal consultation.

 

Action by: Mr Tompkins, Director of Communications and Engagement North-East London STP

 

Ms Lowe responded to Councillor Masters’ comment that consultation should take place at the point where plans were being formed and that in this case however plans were already defined considerably.  She advised that the statement was a legal definition of consultation but was not used for the entire STP.

 

Mr Tompkins responded to Councillor Munn enquired what would engage people on the STP. He advised its about the encompassing process and pulling strands together as the area was very large and covers many diverse services.  Ms Gardner advised also that had already been consultation with local health trusts about what the engagement should look like.  Councillor Munn further enquired what organisations had been engaged with and Mr Tomkins advised that STP would meet with Redbridge who have been procured for engagement.

 

Legal/Governance

Ms Gardner responded to Councilman Mead, who noted that on 31 January 2017 local authorities would be asked to sign a memorandum of understanding and enquired how they would be able to do so in the absence of information on costs.  She advised that the memorandum of understanding concerned an agreement to work together to develop the STP, in terms of establishing governance arrangements. It was noted that these arrangements were not binding.

 

Service Resourcing

Councillor McAlmont expressed concern that, under the STP, it would be necessary to deliver efficiencies year-on-year while the population continued to grow.  This arrangement implied there would be a cut in resources for services.  Through ongoing the years, CCG will return to seek efficiencies which will ultimately result in cuts to frontline services.  Therefore it was necessary for TST to have ballpark figures of what savings must be delivered in the current year.  He noted that INELJHOSC had been given no information about what cuts were being mandated.

 

Councillor Hayhurst put forward that if a substantial variation threshold had been crossed, value of the figure suggested would be £540M, equivalent in financial terms, to the closure of the Hommerton Hospital for two years.

 

Ms Lowe responding to Councillor Munn’s enquiry on whether there was information on the consolidation of pathology services, informed Members that pathology was part of the provider productivity work stream and there were issues at Hommerton due to the review in hand.  As the STP footprint was too large, there were questions around pathology at Royal London and Queens working collaboratively together which rendered it unlikely that the service would to go to a single pathology provision.  Councillor Harrison enquired whether it was necessary to wait for the work to be completed.  Ms Lowe advised that the work at Homerton was being reviewed but will continue since it was not reliant on work at other hubs..

 

Councillor Munn also enquired whether money would be taken from services to plug gaps elsewhere.

 

Councillor Mbachu, asked that the data requested by Members should be provided as soon as possible by email.

 

Action by: Mr I Tompkins, Director of Communications and Engagement North-East London STP

 

 

Councillor Harrisson requested that the following information be provided:

• In-year devolved financial information on savings
  • against priorities,
  • against CCG,
• how things will be allocated,
• where savings will come from,
• figures year-on-year against timescales, and
• governance.
• how the STP would be segmented to enable INELJHOSC to consider any proposals brought forward in a timely manner.

She advised that INELJHOSC would give engagement but needed appropriate levels of detail so that they can engage with STP effectively.

Mr Black informed Members advised that STP was not a statutory body and was therefore not able to compel any parties to do anything against their wishes.  Additionally there was no plan to reassign money.

 

Action by: Mr I Tompkins, Director of Communications and Engagement North-East London STP

 

 

Councillor Mbachu, asked the Committee to examine/investigate whether the STP contained within it, significant variations that that would trigger statutory consultations.  In particular she asked for the Committee to consider and determine whether services and proposals were being artificially ungrouped so as not to trigger the statutory consultation threshold.  The Chair agreed that the CCG would be requested to specify the elements of the STP.

 

Action by: INEL JHOSC Members

 

 

The Chair:

·         summarised the discussion and noted the Committee’s intended activities in forthcoming meetings and

·         thanked NHS England (STP) representatives attending for their presentation and report.

 

RESOLVED

1.         That the report and discussion on the North East London NHS STP be noted

2.         That the data requested by Members during the discussion be provided post- meeting.