Agenda item

To consider a presentation from the Stockport Clinical Commissioning Group on the development of a Strategic Vision for health and social care partners in the borough.

Ann Schenk (Director of Strategic Partnerships, Stockport NHS Foundation Trust) attended the meeting and made a presentation, with Terry Dafter and Gaynor Mullins, on behalf of key partners about their work in ‘Developing a Single Vision and Strategy for Health and Care Services in Stockport’.

The presentation outlined the key drivers for this work, including

·         health inequalities in Stockport - those in the most deprived areas living 11 years less than those in the least deprived;

·         increasing prevalence of major disease groups and the need to tackle the lifestyle factors underlying these increases;

·         the challenge of managing long-term conditions that account for an increasing percentage of NHS and social care spend and resources;

·         an aging population in Stockport that will be older than the England average; and

·         the significant financial shortfall for the health and social care economy by 2018/19 in the event that action is not taken to reduce or manage demand and improve capacity.

The presentation went on to highlight the work of partners to address these challenges, focussed around four key areas:-

·         Prevention and equipping people to manage.

·         “Proactive” care for people who already have a known need.

·         Planned care for people needing some kind of intervention.

·         Urgent care for people who need help today (including emergency care for people with immediate needs).

The presentation then covered some of the key elements of the projects to redesign services to meet these objectives, including indicative milestones for taking the project forward.

A draft report to the Council’s Executive on this topic was also submitted (copies of which had been circulated) for consideration and comment by the Board prior to its consideration by the Executive on 17 March 2015.

The following comments were made/ issues raised:-

·         There was a key role for the Health & Social Care Hubs in facilitating the integration of services, but simply integrating teams would be insufficient without providing services differently. Delivering genuinely proactive care would require significant cultural change.

·         It was anticipated that from July 2015 a detailed design process would begin in relation to the service areas identified.

·         Partners in Stockport had been successful in gaining NHS England ‘Vanguard’ status for its model for integration as part of the ‘New Models of Care Programme’ to arise from the NHS Five Year Forward View. This would mean additional resources would be available to support this development. Further details would be circulated when they were available.

·         It was queried how integration of services between existing local providers would allow for patient choice in the provision of care. It was commented that the ‘Vanguard’ project would provide clearer information about how to balance choice and integration.

·         In relation to the ‘quick wins’ referenced in the presentation, these included improving out-patient appointments; the new preventative commissioning strategy; expanding end-of-life pathways. These quick wins should make immediate improvements to patient experience although the organisations involved may take longer to accrue benefits. The real challenge to partners was to manage and control the growth of demand in the shorter term that would allow for savings to be ‘recycled’ into prevention etc., for the longer term.

·         The importance of supporting patients as they progressed through their treatment and the ‘system’ was emphasised. Expecting patients to understand and navigate complex health and social care systems was not appropriate.

·         In relation to the Vanguard proposals, queries were raised about when the detail of the project would be available and the timeline for when decisions would be taken and the project implemented. The importance of robust governance was highlighted.

·         The capacity and expertise within the existing health and social care workforce to deliver change on the scale proposed was queried. It was stated that there was sufficient capability within the existing workforce but that the challenge was their capacity to deliver change while maintaining services. Members emphasised the need to ensure that capacity was found within the partner organisations rather than reliance on consultancy. It was also commented that there was likely to be resistance from the workforce to new and unfamiliar ways of working.

·         It was queried whether the local partnership working would complement the work at a Greater Manchester level and in particular the devolution agreement. It was commented that the devolution agenda was in accord with this work as the proposals would enable borough based organisations to focus on their particular needs and design services to meet them, while at the same time to work collaboratively on a wider footprint where appropriate.

·         Given the interconnectedness of the key elements of the integrated services, the impact of long lead in time for preventative activity to ‘bear fruit’ was queried. In response it was stated that there were certain lifestyle improvements that would have immediate and lasting improvements to health, such as stopping smoking, taking more exercise and achieving healthy weight.

RESOLVED – (1) That the presentation be noted and Ann Schenk be thanked for her attendance and contribution.

(2) That the Strategic Vision for the integration of health and social care be endorsed.

(3) That the ‘Integrating Health and Social Care’ report be noted and the Executive be informed that the Board:-

·         supported the broad principals of the Strategic Vision for the integration of health and social care services;

·         emphasised the importance of realistic and robust timetables for the implementation of service redesign, and in particular the ‘New Models of Care Programme’/ ‘Vanguard’ proposals;

·         emphasised the importance of clear and robust governance arrangements for the oversight of implementation of new models of service; and

·         recommended greater reference in the vision to reducing health inequalities, improving healthy life expectancy and increasing focus on services patients need rather than where it is delivered.