Agenda item - Sussex Health and Care Plan -The Local Response to the NHS Long Term Plan

Joint report of the Managing Director, Brighton and Hove Clinical Commissioning Group, and Executive Director, Health and Adult Social Care Brighton and Hove City Council (copy attached)

           RESOLVED – That the Board agrees to the following:-

(1)  To note the further developed SHCP 5 year strategic plan as set out at Appendix 1 to the report;

(2)  That a progress update report will be provided to the January Health & Wellbeing Board. This report will update the Board on the:

 Submission and outcome;

 The development of the operational delivery plan;

 Financial implications for Sussex and the Brighton & Hove Place Based Plan

Any targets that have been set and monitoring arrangements; and

That the report be forwarded to Full Council for information.

27.1    The Board considered the joint report of the Executive Managing Director, Brighton and Hove Clinical Commissioning Group and the Executive Director of Health and Adult Social Care, Brighton & Hove City Council which set out the proposed local response to the NHS Long Term Plan.

27.2    It was noted that the Special Meeting had been called to consider and deal with this matter as a formal response to the Plan was required by 15 November 2019 and this requirement had not been known before the last Health and Wellbeing Board meeting took place in September 2019. The Special meeting had therefore been called and timed in order to allow time for the discussion and comments from the Board to be taken into account.

27.3    It was explained that the NHS Long Term Plan (LTP) had been published. Each area of the NHS was required to produce a response to this plan explaining what they needed to do and what they wished to achieve in response to the needs of their local community whilst also achieving the key objectives as set out in the NHS Long Term Plan. The Councillors S27.1 The Board considered the joint report of the Executive Managing Director, Brighton and Hove Clinical Commissioning Group and the Executive Director of Health and Adult Social Care, Brighton & Hove City Council which set out the proposed local response to the NHS Long Term Plan. The Sussex Health and Care Partnership which was made up had formed a Partnership of the CCG’s and health bodies that covered East and West Sussex and Brighton and Hove, the Sussex Health and Care Partnership (SHCP). The respective local authorities would be collaborating with the Partnership and needed to produce a five year strategic plan for NHS England outlining what they wished to achieve. The Full Plan and the three area placed based plans were set out in Appendix 1 to the report. The plan represented the CCG response to the local health and care needs of the populace and included commitments to change how health and care organisations worked together to transform patient pathways, addressed financial defecit addressed the workforce gap and delivered the significant number of initiatives included in the Long Term Plan.

27.4    In answer to questions by the Chair, Councillor Moonan, it was explained that work and consultation on the Plan as presented had been on-going since January of this year and had to be agreed by a specified deadline. A response was required and it had to follow a timetable, it had been prepared as part of the on-going long term planning process locally, was integral to the allocation of funds in the medium and longer term.

27.5    The Deputy Chief Executive and Chief Operating Officer of the Sussex and East Surrey CCGs, Karen Breen, responded to the concerns raised by the Deputees and others who were present in the Chamber. Ms Breen explained that the CCG were very aware of the concerns which had been voiced locally about the risks to the NHS of privatisation. Nothing set down in the Long-Term Plan suggested that working in this way would increase privatisation in the NHS. What was very clear however from what had been said by the local population as well as nationally was that more needed to be done to increase collaboration across organisations so that care was much more seemless and joined up. Importantly, no new care system was being set up, the integrated care system for Sussex would not be a decision-making body. Decision making would remain with the various CCGs and the NHS trusts serving Brighton and Hove.

27.6    In responding to the questions raised in respect of the consultation process it was explained that discussions had taken place with a number of partner organisations and that more than 4,000 con conversations had taken place with Brighton and Hove residents about the response. The Director of Commissioning and Deputy Chief Officer for the Brighton CCG, Ashley Scarff confirmed that this was the case also that meetings where discussions had taken place had been public meetings. Those elements of the Plan which required approval by the other constituent CCG partners had already taken place and approval been given.

27.7    The Statutory Director for Adult Care, Brighton and Hove City Council, Rob Persey, stated that the Plan as put forward set out the with the aims of partners in order to provide cohesive strategies which were aligned. The Plan would form the basis of continued discussion and he confirmed that those discussions were regular and on-going.

27.8    Lola Banjoko and Ashley Scarff, CCG, stated that the plan represented a continuation of what was already in place and how that would continue to be delivered, it set out the key aims and importantly strategies to address the longer-term health needs of those who had multiple conditions and sought joined up delivery of services. As with all strategic documents, changes were anticipated. The recent Queen’s Speech had highlighted that it was intended that legislation would be introduced to further support the NHS, an Adult Social Care White Paper was also awaited and these could impact on the Plan and it was very important therefore to have a continuing Plan in place which indicated the direction of travel for services. There was an on-going commitment to engaging with the Board and local residents as/when the Plan needed to be refreshed. Jayne Black,CCG, confirmed that the Plan had been drawn up in consultation with staff and also provided them with a degree of surety going forward.

27.9    The Chief Executive, Brighton and Hove Healthwatch, David Liley, explained that Healthwatch had an on-going monitoring role and in that capacity had regular conversations with the public, the CCG, third sector organisations, patients and the public in relation to service delivery. Healthwatch were of the view that going forward the manner in which consultations could be broadened out could be improved and that that was worthy of discussion. The Plan itself was an important building block and should therefore in his view be noted and supported in general terms.

27.10  The Chair, Councillor Moonan, noted all that had been said and the passions and concerns which had been voiced by those in the public gallery. She understood and shared some of those concerns, which in her view formed part of a wider debate on the future of the NHS. She considered that means by which making consultation processes could be improved or made more inclusive in future should be explored in order to see whether/what practical changes could be made. Noting the Plan was however a necessary process and seeking to delay that process would not in her view be beneficial for anyone. The Board had the power to note the Plan and a further update would be brought forward to the January 2020 meeting. She considered that it could be helpful for this matter to be forwarded to Full Council for information and for elected Councillors if they considered it appropriate to put together a Notice of Motion or to use other mechanisms to broaden the debate in relation to the wider concerns and issues which had been raised.

27.11  Councillors Shanks and Nield stated that they also shared a number of the concerns expressed and considered that it was very important that the Plan had been brought forward for the Board’s consideration and that it was important for a wider debate to take place in the correct forum. All the consultation being referred to was the “Big Health and Social Care Conversation” about the Joint Health and Wellbeing Strategy, and there had been no public consultation specifically about the Local Response document at all. All that was positive in the report was set against the backdrop of the NHS being expected to close its deficit by 2023/24, which locally stood at £200 million, and so the pressure would be on to use all the innovation in the report to close that financial gap even where it did not provide a fitting solution or give good service. Councillors Nield and Shanks proposed an amendment which was that the report should be deferred for more consultation stating that they could not support the Long Term Plan.

27.12  Councillor Shanks proposed that points 1.1 and 1.2 of the report recommendations were deleted and that the submission of the response to the Long Term Plan was delayed to allow for wide consultation with stakeholders, this was seconded by Councillor Nield.

27.13  In response to issues raised during the course of the discussion, The Head of Legal Services, Elizabeth Culbert, confirmed that it would be appropriate for the report to be forwarded to Full Council for information should the Board wish to do so.

27.14  A vote was then taken. The Chair formally put the proposed amendment that consideration of the report be deferred (as set out in paragraph 27.12 above), that was lost on a vote of 4 to 2 (Councillors Nield and Shanks voted against noting the Plan). A vote was then taken on the substantive recommendations as set out in the report which were agreed on a vote of 4 to 2. It was also agreed subsequently that the report be referred to Full Council for information.

27.15  RESOLVED – That the Board agrees to the following:

(1)  To note the further developed SHCP 5 year strategic plan set out at Appendix 1 to the report; and

(2)  That a progress update report will be provided to the January Health and Wellbeing Board. This will update the Board on the:

Submission and outcome;

Development of the operational delivery plan;

Financial implications for Sussex and the Brighton and Hove Based Plan;

Any Targets that have been set and monitoring arrangements.

RESOLVED TO RECOMMEND – That the report accompanied by an extract of the minutes of the special meeting be forwarded to Full Council for information.

27B     ITEMS REFERRED FOR FULL COUNCIL

27.16  Councillors Nield and Shanks requested that the report be referred to Full Council for information which was agreed.

27.17  Item 27 – “Sussex Health and Care Plan – The Local Response to the NHS Long Term Plan”