Agenda item

To consider updates on the following key strands:-

·         Health and Social Care Integration – a joint report of the Chief Operation Officer, Stockport CCG and the Service Director (Adult Social Care), Stockport Council

·         Primary Care Strategy

·         Healthier Together

Two documents considered by the Greater Manchester Health & Wellbeing Board in August relating to the Primary Care Strategy and Public Service Reform are attached for information.

(i)            Health & Social Care Integration

A joint report of the Chief Operating Officer, Stockport Clinical Commissioning Group and the Service Director (Adult Care Services), Stockport Council was submitted (copies of which had been circulated) updating the Board on progress at a local and Greater Manchester (GM) level with the Health and Social Care Integration Programme. The report outlined the drivers for integration, as well as the challenges and opportunities this would present to organisations involved.

A report considered by the Greater Manchester Health and Wellbeing Board on health and social care reform was also considered (copies of which had been circulated).

The following issues were raised/ comments made:-

·         Further work was being done to understand the financial costs of the new models of delivery, as well as the likely savings these new interventions were likely to generate. Releasing funding from hospital services in isolation would not meet the future funding gap, nor would the smaller projects designed to improve outcomes and make efficiencies, such as extending the rapid response service.

·         A whole economy approach was needed to address the future funding needs of health and social care, to view each organisation’s resources as an integrated resource, and to set the governance arrangements accordingly.

·         Announcements had recently been made about further central government funding to support Emergency Departments to address additional pressures. The purpose was to make sustainable improvements, rather than to ‘cope’ in the short term.

·         Even if the assumptions of both the integration of health and social care and of Healthier Together programmes were correct, then the improvements and savings this would release may not be enough to meet the future funding gap. Therefore other strategies were needed. At a GM level, having a consistent approach to thresholds and standards of care had been identified as a further mechanism, building on existing thresholds and standards, such as those in NICE Guidance.

·         Nationally there was a push for consistency on eligibility criteria to avoid a ‘postcode lottery’ in care. An individual’s eligibility was most often down to a professional judgement, so the issue of contention would become what type of service/ combination of treatments was provided to an eligible person. The best models were designed to make sure decision-making on that issue were as close to the person as possible, but these also needed to be evidence-based decisions. The implication of this was that services which were ‘much loved’ may need to be discontinued if there was no evidence that there were improving outcomes.

·         As part of the process of reform, it was important to ensure residents had sufficient ‘health literacy’ to make informed decisions about what were appropriate services to access. One possibility was to have ‘inductions’ for new residents when registering at a new GP.

(ii)          Primary Care Strategy

Rob Bellingham (Director of Commissioning) Local Area Team of NHS England, attended the meeting to provide the Board with an update on the development of a Greater Manchester strategy for the commissioning of primary care services.

A copy of a presentation made to the Greater Manchester Health and Wellbeing Board on the Primary Care Strategy was also considered (copies of which had been circulated).

The presentation focussed on the following issues:-

•      Need to reduce unwarranted variation in outcomes and care pathways

•      Extending access to primary care

•      Ensure focus on self-management, wellness and prevention

•      Need to ensure integration with other services and organisations

•      Addressing workforce issues

•      Potential for increased efficiency

It was stressed that the Primary Care Strategy was closely aligned with the Health and Social Care Integration and Healthier Together Programmes.

The following comments were made/ issues raised:-

·         A recurring theme from public consultation was access to GPs. Although this was an important issue for the public, it was not within the scope of the Strategy to address nationally agreed contracts. Any improvements to access would need to be negotiated within the parameters of the existing GP contract.

·         The priority for the use of transformation funding for 2015/16 was to invest in primary care as a way of rebalancing the health system away from the dominance of secondary care.

·         As part of the development of the consultation arrangements for the Strategy, work was being undertaken to develop a series of standards or pledges relating to care, based on feedback received to date, and which would provide a base against which the Strategy could be measured.

·         A particular concern for service users was out-of-hours care and the lack of ‘walk-in’ facilities in Stockport, particular in light of problems with the 111 Service.

·         While the Strategy was seeking to reduce variation across the primary care system both within Stockport and across Greater Manchester to improve outcomes, it was vital to ensure that high performance in Stockport was not affected in order to reduce variation through a ‘one-size-fits-all’ approach.

·         There would need to be a range of partners involved in delivering the Strategy, including local authorities.

(iii)         Healthier Together

Rob Bellingham (Director of Commissioning) Local Area Team of NHS England and Dr Ranjit Gill (Chief Clinical Officer), Stockport Clinical Commissioning Group updated the Board on progress with the Healthier Together programme to reconfigure hospital services.

It was expected that consultation on initial proposals would begin in January 2014, with implementation starting in the second half of 2014 and running for approximately two years. It was expected that by 2017/18 the anticipated improvements in outcomes would begin to become evident.

RESOLVED – That the reports and updates be noted.