Issue - meetings

To consider an update on Healthier Together.

The Board will invite members to provide an update on progress with the consultation on the Healthier Together proposals.

The Chair invited the Board to discuss the Healthier Together programme with the views of the Board being submitted as part of the consultation that was shortly to draw to a close.

The Clinical Commissioning Group (CCG) representatives stated that they would not be voting in relation to this item because they did not feel it appropriate as the CCG was one of the sponsors of the Healthier Together programme.

Tony Stokes (Healthwatch Stockport) submitted a report (copies of which were circulated) providing the Board with an update on Healthwatch Stockport’s involvment with the Healthier Programme and summarising the concerns raised by members during the consultation. The report also posed the Board a series of points that Healthwatch believed the Board needed to be satisfied had been met in preparing its response. The work of Healthwatch Stockport in relation to the transportation implications of the proposals was also highlighted.

The Chair reported that the Stockport NHS Foundation Trust Governors had recently met and had a lengthy discussion about Healthier Together. The Foundation Trust was planning on submitting a joint response on behalf of both the Board and Governors. The issues highlighted by the Governors had reflected the concerns summarised in the Healthwatch Stockport submission.

The Chair stated that the Health & Wellbeing Board were supportive of overall aim of the Healthier Together programme in seeking to minimise avoidable deaths.

The following comments were made/ issues raised:-

·         Concerns were expressed about the level of public involvement in the consultation, because of the timing of the consultation and the language used in the documentation. Anecdotally, there appeared to be a high degree of cynicism on the part of the public about the openness of the process and their ability to influence the outcome. Given the scale of the change needed the consultation period appeared to be relatively short. Because so much of the consultation was web based, this may have impacted on the level of engagement. It would have been more engaging for the public to have had the opportunity to participate in a dialogue about the important issues underlying the proposals and for case to be made more explicit about the benefits of reducing the hospitalisation of the health economy, increasing the focus on primary care, and integrated health and social care. The consultation questionnaire could have given the impression that decisions had already been taken as respondents were presented with a stark question about their preferred hospital configuration.

·         Insufficient focus has been given to the non-hospital strands of the Programme, namely Primary Care and Integration. The variability in outcomes between hospitals was not unique to that setting, but was also reflected in primary and community care, but there was less data available on mortality rates to evidence the case for change.

·         Centralisation of specialised services was not a new process and had been achieved successfully in a range of areas, such as stroke and cardiac care, and through outreach work from other hospitals, such as dermatology, and this should be continued where there was evidence of its efficacy. The labelling of ‘specialist’ and ‘local’ hospitals was therefore unhelpful and confusing.

·         In relation to health and social care integration, there was a significant culture shift required but it was important to ensure that user experience was central to developments in this area.

·         There was a tension between the public’s desire to have the best possible care even if this meant the need to travel, and the convenience of local services. It was a flaw in the consultation that residents were being asked to give a view about the best strategic direction of the health system when they were not well equipped to do so.

·         There remained value in persisting with a general hospital model but to continue with the concentration of specialist services as has already been underway. Efforts to reduce avoidable deaths and improve quality were not solely about  ...  view the full minutes text for item 4

Representatives of Stockport Clinical Commissioning Group will attend the meeting to make a presentation to the Committee on proposals for the reconfiguration of health services across Greater Manchester as part of the ‘Healthier Together’ programme.

All members of the Council have been invited to the meeting for this item.

Further detail on Healthier Together can be found online at https://healthiertogethergm.nhs.uk/

The Chair welcomed those councillors who had attended the meeting to take part in the discussion on the Healthier Together proposals and introduced representatives from the Stockport Clinical Commissioning Group, Stockport NHS Foundation Trust and the Council’s Adult Social Care service and invited them to outline the key features of the Healthier Together Programme and the possible implications to their organisation.

Healthier Together (HT) referred to a programme of proposals to change the way health services were delivered in Greater Manchester which included improved access to primary care, greater focus on prevention and management of complex conditions, and reconfiguration of some hospital services.

Dr Ranjit Gill, Chief Clinical Officer, Stockport Clinical Commissioning Group

Dr Gill outlined the drivers for the development of Healthier Together, including the need to improve health outcomes across Greater Manchester (GM), which were currently amongst the worst in England; to reduce variation in outcomes and standards of care between different parts of GM and between different facilities; to improve diagnosis of treatable conditions to provide more appropriate care and management that might otherwise lead to avoidable deaths; to respond to changing demographic requirements.

Dr Gill emphasised that the Programme was clinically-led, with the decisions being taken by the GM Clinical Commissioning Groups acting in concert, and that the focus was on clinical outcomes. He further stressed that the proposals were not driven by financial considerations as the cause of the variations and poor outcomes were systemic and organisational and that these problems could not be overcome through resources and investment alone.

Clarity was also provided on the scope of the HT proposals with respect to hospital services which would include specialist services (rather than specialised or tertiary services commissioned by NHS England) such as Emergency Acute Medicine, Emergency and Elective Surgery - services for the ‘once in a lifetime’ events.

Ann Barnes (Chief Executive) and Dr James Catania (Clinical Director) Stockport NHS Foundation Trust

Ann Barnes outlined the role of the Foundation Trust (FT) in providing both Acute and Community Care services for Stockport, but also for a wider catchment that included High Peak, Glossop, Macclesfield (acute) and Tameside (community), as well having a key role in the integration of health and social care.

She further emphasised the distinction drawn in the HT consultation between Specialist and Local Hospitals, the former retaining those specialitist services commissioned by the CCGs (detailed above) while the former would not (although both may provide specialised/tertiary services). One of the assumptions of the HT programme was that the concentration of services in this two tier system would mean that all the hospitals would be better able to meet the national clinical care standards.

In the options set out in the consultation, the geographical distribution of specialist/ local hospitals assumed at least three of the former, while respondents were asked to give a view on whether a further one or two specialist hospitals should be designated, and these would be from a short list of existing facilities clustered in either the north or the south of GM.

As part of the development of the HT proposals, further consideration would be given to access and transportation issues, which was of particular concern for the FT because a significant element of its wider catchment population (not including Stockport) lived in areas that were not easily accessible via public transport.

The HT proposals also contained standards for ‘blue light’ journeys to specialist hospitals of no more than 45 minutes. Given the potential spread of these with either the four or five specialist hospital model, this would present particular challenges.

It was the view of the FT Board that it was important that Stepping Hill be designated as one of the specialist hospitals, and that the five model option in the HT consultation was to be preferred. The Board was also committed to working in partnership with other hospitals in delivering services.

Terry Dafter, Service Director  ...  view the full minutes text for item 4

To consider an update on Healthier Together.

The Chair reported that the Healthier Together public consultation officially launched on 8 July 2014 and would run for 12 weeks until 28 September 2014. Healthier Together involved a major review of NHS services across Greater Manchester and a major part of the review would look at improvements needed in primary and community based services. The Review also focussed on the 10 acute hospitals in the Greater Manchester area, and although no hospitals or A&E departments would close there was likely to be some significant changes. Meetings would take place in each of the CCG localities with an event taking place at the Alma Lodge in Stockport on 12 August 2014 between 2pm – 5.30pm. The results of the consultation would be reported to a future meeting.

RESOLVED – That the report be noted.

To consider a report of the Chief Executive.

The Executive Councillor (Health and Wellbeing) (Councillor John Pantall) submitted a report (copies of which had been circulated) detailing proposals to appoint a Joint Scrutiny Committee for the purposes of responding to the ‘Healthier Together’ consultation and that the existing Greater Manchester Joint Health Scrutiny Panel be formally appointed as the Joint Scrutiny Committee.

RESOLVED – (1) That approval be given to the revised Terms of Reference and the renaming of the Greater Manchester Joint Health Scrutiny Panel to the Greater Manchester Joint Health Scrutiny Committee.

(2) That approval be given to the Greater Manchester Joint Health Scrutiny Committee for the purposes of the Healthier Together consultation.

To consider an update on Healthier Together.

Attached is a report considered by the Greater Manchester Clinical Commissioning Group Committees in Common setting out the business case for the transformation of Health and Social Care in Greater Manchester.

Contact: Ranjit Gill / Gaynor Mullins, 0161 426 9900

A report of the Clinical Commissioning Group Committees in Common was submitted (copies of which had been circulated) setting out the Business Case for the transformation of the Health and Social Care across Greater Manchester through the Healthier Together programme. The Business Case set out the case for change; described a future model of care and how this had been developed; detailed the pre-consultation engagement that had been undertaken prior to developing the model of care; and setting out the case for starting a public consultation.

The Chair of Stockport Clinical Commissioning Group highlighted that the development of the Healthier Together programme, emphasising that it was clinician-led and focussed on ensuring quality outcomes, primarily to remove avoidable variation in outcomes in hospital care across Greater Manchester.

The following comments were made/ issues raised:-

·         It was important to remember that changes in primary care were needed to ensure the success of this programme. In the current business case insufficient reference was made to this important area of work.

·         Although ‘social care’ was not included in the scope of Healthier Together (HT), it was referenced in the programme’s vision. Further consideration was needed to identify and make the most of opportunities HT may provide to support and enhance the work on health & social care integration.

·         The development of quality standards through the development of HT was welcomed, as was their link with both social care and public health.

·         It was important to recognise the role of improving mental wellbeing in improving physical health and reducing hospital admissions. While this may not be the focus of the HT programme, it was important that this remained part of the thinking when developing proposals for change.

·         There were significant pressures on hospital finances and it was inevitable that change would have to happen.

·         Many members of the board and officers of the organisations represented were involved in a range of activities connected to HT and were seeking to ensure it responded to the needs of residents.

RESOLVED – (1) That the report be noted.

(2) That the Board welcomes the vision set out in the Healthier Together pre-consultation business case but believes that further reference should be made to the changes needed to health & social care and primary care to support the aims of Healthier Together.

To consider a recent developments from NHS Greater Manchester, Greater Manchester Combined Authority and AGMA on possible arrangements for the locality-led stakeholder and public conversation and on sector led approaches.

The views of the Board are sought.

A report of NHS Greater Manchester was submitted (copies of which had been circulated) setting out a proposed framework for the locality-led stakeholder and public consultations on health and social care reform. The report had been produced following the agreement to the overall consultation process by the CCG Committee In Common and AGMA.

The following comments were made/ issues raised:-

·         There was a danger that the work being co-ordinated through Greater Manchester on Healthier Together, health and social care integration and primary care reform would be at odds with the work taking place within the South Sector, particularly since all these streams were moving at varying pace. Assurances had been provided that the Greater Manchester work would not conflict with the sector-led work but there remained a role for the Council and CCG to ensure these work streams were not pulling in different directions.

·         Feedback from the Patient Liaison Groups would be welcomed.

·         The structure of the document appeared to give precedence to consultation with professional and organisational stakeholders before patients and the public.

RESOLVED – (1) That the report be noted.

(2) That the Chief Operating Officer (Stockport CCG) and the Chief Executive (Stockport Council) be requested to ensure that in so far as possible, the South Sector led reform proposals compliments the Greater Manchester and locality-led proposals.

(3) That the Democratic Services Manager be requested to circulate a copy of the Clinical Commissioning Group plan for the locality-led consultation on health and social care reform.

Sue Wallis, Associate Director Partnership and Engagement, Service Transformation Directorate, NHS Greater Manchester will make a presentation to update the Scrutiny Committee on the Healthier Together Programme (formerly known as the Safe and Sustainable Programme).  The ‘Healthier Together – A review of health & care in Greater Manchester Programme’ is working to develop a clinically and professionally-led strategy that puts forward options for new ways of providing health care services in Greater Manchester.

The Scrutiny Committee is invited to ask questions and make comments on the presentation.

Officer contact: Jonathan Vali, jonathan.vali@stockport.gov.uk , 0161 474 3201

Leila Williams, Director of Service Transformation, NHS Greater Manchester, attended the meeting to make a presentation on the Health Together Programme (formerly known as Safe and Sustainable), a clinically and professionally led Greater Manchester wide project to provide strategic direction for the development of hospital services to address the significant variation in service provision and outcomes across the city-region.

The presentation heighted the following issues:-

·        The vision of the Programme was ‘For Greater Manchester to Provide the best health and care in the country.

·        Key outcomes for the Programme were to:

-       Improve the health and wellbeing of people in Greater Manchester.

-       Reduce inequalities of access to high quality care.

-       Improve people’s experience of healthcare services.

-       Make better use of healthcare resources.

·        The drivers for change included the increasing  demand for healthcare, changing needs with people often having complex and multiple conditions, changing demographic profile of the population

·        Challenge to improve the quality of services and the outcomes agains the background of challenging financial situation. The emphasis would need to be on whole system change.

·        Examples of progress with the reconfiguration of services to provide centralisation across Greater Manchester, such as with Stroke services.

·        The Programme Team were seeking to have a conversation with partners, stakeholders and users to inform them of the challenges, make the case for change and help shape the proposals before the start of formal consultation.

The following comments were made/ issues raised:-

·        Improving in acute care or hospital care was closely linked to primary and community care. Residents also need to take more responsibility for their own health through lifestyle choices.

·        There was a danger inherent in any consultation of this type because the views of residents as to what the best service would look like very often would be different from the views of professionals. Care that has traditionally been provided in a hospital setting can often be seen as second rate when provided in a community setting even though it may be a significant improvement. The experience of patients using the services in a community settings often changes this perception.

·        Framing the conversation around the financial context would be a useful to help the public understand the challenge of service redesign.

·        Stockport CCG was heavily involved in the developments and would seek to link the Greater Manchester developments with local service redesign.

RESOLVED – (1) That Leila Williams be thanked for her attendance and presentation.

(2) That the Scrutiny Committee would welcome a further report or update in the Spring of 2013 following the conclusion of the first round of public consultation.