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Declarations of Interest
There were none received.
Report of the Accountable Officer
The following representatives were in attendance for this item;
Andy Donald – Stafford and Surrounds CCG and Cannock Chase CCG, Accountable Officer
Sharon King – Head of Programme
Paul Giles – Patient Champion
The CCG Accountable Officer introduced the report and made the following points;
· It had taken four years to get the Programme off the ground.
· The objective was for professionals to focus on the individual, to improve patient experience and survival rates.
· In terms of end of life care, it was important to provide choice and enable people to have a good death.
· There had been a focus on the methodology rather than the objectives of the Programme. Some were ideologically opposed to the Programme and had concerns regarding privatisation.
· In January 2015 the Programme had been paused following the collapse of the Uniting Care contract in Cambridge and Peterborough.
· There had been a number of reviews which had confirmed that the objectives of the Programme were correct and that the methodology was not unreasonable Procurement and legal advisors had considered NHS England’s reviews, and the programme had taken on board the recommendations.
· A number of internal reviews had identified that the Programme was on track and NHS England had given the go ahead to move forward with it.
· A lot had been learnt from the Uniting Care contract and this would inform the next steps.
· There was no guarantee that the procurement would progress to award of contract therefore alternative options were being considered.
· It was important not to lose site of the need to make improvements for the population.
· It was hoped that the cancer care procurement and approval process would conclude by summer 2017.
· A cancer consortium bid would be subject to robust review and be subject to national sign off. There were two major NHS providers involved in the consortium.
· The focus was on ensuring better outcomes for patients.
The Patient Champion stated that initially he was part of the Cancer Not For Profit group and had been opposed to any privatisation of the NHS. He had recognised however that work was required to change the way in which care was provided. He referred to the appointment system and the wasteful use of resources. Patients had been involved in the Programme and had challenged the process the whole way through to ensure that the focus remained on patients and carers. It was important to ensure that the NHS saw the person and not the disease or statistic. Patients had a pivotal role in the Programme. It was important for people to live and die well.
The Chair thanked the Patient Champion for his contribution and noted his commendable role in the process.
A Member referred to the Staffordshire and Stoke-on-Trent Sustainability and Transformation Plan (STP) and that one of the reasons discussed for poor outcomes was late diagnosis. It was queried how the procurement process would have an impact on this?
The Accountable Officer confirmed that earlier diagnosis was one of the objectives ... view the full minutes text for item 103.
Report of the Cabinet Member for Health, Care and Wellbeing
The Cabinet Member for Health, Care and Wellbeing introduced the report, highlighting that;
· The paper summarised the recommended new configuration of drug and alcohol treatment services for 2017/18 and beyond, following the funding reductions associated with the Better Care Fund.
· The plans represented the best way to use the available resources with high risk people not required to wait.
· Consultation had been carried out to look at ways to mitigate the impact.
· Concerns had been expressed by clinicians, the community and providers.
· Department of Health estimates suggested that there were between 150,000 and 200,000 adults in Staffordshire who regularly drank above the recommended levels.
· There was an estimated 35,000-40,000 ‘clinically’ dependent drug users (around 5000) and drinkers (around 30,000) in Staffordshire.
· Around 4000 dependent drinkers/drug users had sought and been engaged in treatment services each year.
· The proposed changes would mean that fewer people would receive treatment but every effort had been made to maximise access to services given the availability of resources.
· There had to be a balance between capacity and activity.
· A prioritisation framework using a RAG system had been developed and it was hoped that ‘Red’ clients would be treated with minimal waiting times.
· In order to maximise efficiency and activity, the range of community (non residential) interventions would reduce significantly.
· It was a very difficult decision to make and the consequences were very serious. The Cabinet Member understood the possible implications. If more could be done then it would be. He had been confronted with the financial challenge and was doing all possible to support social care activity.
The Director of Health and Care confirmed that the proposals had been developed in close conversation with providers. The proposals were not without risk but were thought to be the best way of doing things next year. A session with clinicians was held providing an opportunity to understand concerns and confirm what would happen so that it could be undertaken smoothly.
The Senior Commissioning Manager referred to the balance between providing a service capacity that meant high risk people were not required to wait and ensuring that the service was able to cope safely and effectively with the number of people in treatment. The proposed solution was to reduce the number of people in treatment at any one time to a maximum of around 1700. It was however difficult to predict demand. There had to be a balance between quality and activity. It had been proposed that capacity was utilised from the Intensive Family Support Service to ensure that no client with child safeguarding concerns was required to wait for access to the general One Recovery Services. The flexible use of staff could be used to mitigate the risk to other high risk clients such as those within the criminal justice system. Previously intervention had focussed on a cross section of the client’s needs but going forward there would need to be referrals to other services such as Job Centre Plus to address a clients needs. ... view the full minutes text for item 104.
Report of the Scrutiny and Support Manager
The Scrutiny and Support Manager introduced the report summarising the arrangements for and outcomes of the Joint Health Accountability Sessions held in the 2016-17 municipal year and requested Members views on the way forward. It was confirmed that scrutiny of the STP would be undertaken by the Healthy Staffordshire Select Committee as the County Council must take the lead on this. The informal joint scrutiny meeting with the City of Wolverhampton Health Scrutiny Panel on the 13 February 2017 was referred to.
The Chair suggested that any recommendations that the Committee had regarding the Accountability Sessions should be considered in the Work Programming in the new municipal year.
A Member raised concerns that if the meetings were expanded to incorporate more Members from District and Borough Council Health Scrutiny Committees and/or Members from other neighbouring local authorities then the meetings would be too large to Chair effectively and interaction would be limited, reducing the opportunity to scrutinise the Trust effectively. Shorter Self Assessment reports were suggested. It was felt that providing access to a webcast of the meetings negated the need to host them around the county.
A Member suggested that as there were only six NHS Trusts in Staffordshire, each one should continue to be held account at Accountability Sessions and they were keen that the Committee continue to hold the sessions. It was recommended that the Trusts should report on what they planned to do in the future and on any proposed changes or developments rather than just providing past data. A more direct line of questioning was suggested and a more informal arrangement to meet with the Trust Chief Executives,
The Scrutiny and Support Manager explained that relationship management meetings which had been held with Trust representatives in the past had resulted in no formal actions or recorded minutes which could be accessed by the public. Concerns raised by Members had been emailed to the Trusts who were then asked to address these in their presentations to the Committee.
A Member expressed concern that the Committee did not know everything. The Chair confirmed that this was the reason why Trusts had been requested to attend Accountability Sessions.
It was recommended that the Committee should prioritise which Trusts to hold to account. The 2017/18 Committee needed to decide its own Work Programme and not be restrained by the legacy of the previous municipal year’s committee. There needed to be a clear focus on where there were issues. There was no support for holding meetings in the District/Borough locations. Comments regarding minimising the size of the Committee for Accountability Sessions were supported. It was noted that the District and Borough Councillor representatives on the Committee were not regularly attending and that there was a need for committed representatives on the Committee as there were a large number of meetings.
The Committee Chair confirmed that Members views on the Work Programme were sought at every meeting.
A Member referred to difficulties in travelling elsewhere to go to meetings and that ... view the full minutes text for item 105.
Report of the Scrutiny and Support Manager
The report was received and considered.
The Work Programme was accepted.