Agenda item - Sustainability & Transformation Plan (STP)

Presentation on progress in developing a Sustainability & Transformation Plan for Sussex and East Surrey (verbal)

5.1       The Chair began by reading out the following declaration:

“I wish to declare that I have a Disclosable Pecuniary Interest in Item 5 as I am employed by Western Sussex Hospitals Trust. I have applied for and been granted dispensation by the Council’s Monitoring Officer to permit me to chair the Health and Wellbeing Board in its consideration of items relating to the NHS Sustainability and Transformation Planning and to speak and vote on those items, on the basis that that project to review health and social care services does not currently raise a direct or material conflict with my employment.”

5.2       Michael Wilson, Chief Executive of Surrey & Sussex Hospitals NHS Trust and Leader of the Sussex & East Surrey STP footprint; and Wendy Carberry, Chief Officer, High Weald Lewes Havens CCG, presented an update on the STP to the Board.

5.3       The Chair asked about the plans for public engagement on the STP and was told by Michael Wilson that public engagement had been complicated by the pace of the early stages of the STP process and by  election ‘purdah’ in relation to the EU referendum. In addition, this early stage has been focused on diagnosing and defining issues, which is necessarily a professionally-driven process. However, the leaders of all local partner organisations have been fully involved in the development of the STP to date.

5.4       Fran McCabe asked whether STP funding allocations would recognise that the South East had been running a deficit for decades. Michael Wilson replied that the STP now presented the only opportunity to access NHS transformation money funding. It is important to gain transformation funding, and also to ensure that the 3T re-development of the Royal Sussex County Hospital (RSCH) is successful. Realistically however, there will be no alternative to working within the current financial envelope. As a system we will need to address the fact that more than 50% of the regional deficit sits with Brighton & Sussex University Hospitals Trust (BSUH) and with East Sussex Healthcare Trust (ESHT). There has also been a limited level of investment in non-acute services, which presents challenges in terms of moving activity out of acute settings.

5.5       Of even more pressing importance, however, are problems relating to workforce. These will be central to the place-based local plans that form an essential element of STPs. The NHS does not have a strong history of co-ordinated workforce planning and this needs to change, with a greater focus on automation and the use of technology, and on more efficiently utilising worker skills.

5.6       Dr Christa Beesley confirmed that the STP was building on work done by the CCG into issues such as workforce and urgent care. This was really helpful and as a clinician she welcomed the STP priorities especially regarding prevention. Delivering much of this kind of work may be more cost effective at a regional scale.

5.7       John Child told the Board that there was a wider conversation about work force issues along with those of devolution, transport and housing.

5.8       Geoff Raw welcomed public interest in this issue and people’s clear desire to be engaged in the process. While this is a problem of resources, it is also about demographics: with huge demand pressures caused by the ageing population; as well as very high public expectations to manage. NHS England’s level of engagement with local authorities on the STP is very welcome. Devolution is an important factor to bear in mind, although to date there has been relatively little developed thinking on health and care as part of the devolution planning process. A big challenge will be to determine what can be done in the short term, whilst also keeping an eye on longer term outcomes.

5.9       Councillor Barford commented that local people were worried about the speed of the STP process and questioned whether trust could be maintained when things were so rushed. Michael Wilson agreed that there was an issue about the pace of the programme and there was a clear need for much more public engagement. Finding solutions to the STP challenges will entail making significant changes, but it will take time to build trust and some plans will be very challenging.

5.10    Denise D’Souza noted that the original planning guidance was rather prescriptive and was poorly explained. It was unsurprising that members of the public were concerned by its ambiguity and lack of detail. However, the planning process to date has largely been one of diagnosis and of building relationships at an organisational level, with public engagement to follow as concrete plans begin to be developed.

5.11    Councillor Page expressed concern that this process felt like it had been imposed from the top down and he agreed that workforce was a big concern, particularly in terms of morale and of the use of agency staff. Cllr Page also queried how more prevention work and a greater focus on primary care tallied with the closure of GP surgeries in the city. He was also concerned that local areas were being made responsible for deficits and that further cuts seemed to be inevitable. Cllr Page stated that the NHS was not being adequately funded and there had been very little democratic engagement in the STP process to date.

5.12    Councillor Penn asked if this process would involve digital improvements. Wendy Carberry replied that development areas could include shared information and digital records. Michael Wilson added that there was very good practice around services such as telecare, but that learning from this needed to be more widely disseminated. John Child explained that the aspiration was to include local authorities and the community and voluntary sector in the process. Councillor Penn thought that this would be welcomed by patients facing mental health issues. Michael Wilson explained that connectivity would be very complex as all organisations used very different systems, so while a lot was possible it would need careful planning.

5.13    The Chair thanked the presenters and said that he would be interested to see if the STP diagnostic process identified the same local issues as local strategic planning had already highlighted.