Agenda item

The Board received a report which was included at pages 37-40, copies of the NCL STP progress report and the case for change were also included in the agenda pack at pages 41 and 69 respectively. The report provided an update to the Board on the development of the STP, which was a five year, strategic plan for the health and care system across the five boroughs of North Central London. The report was introduced by Julie Billet, Joint Director of Public Health Camden and Islington.

The Chair commented that they welcomed that the Board had the opportunity to put some of the information involved with the STP into the public domain and expressed frustration with the level of transparency around the process to date. The Chair also commented that it was clearly in the interests of both populations that the two Health and Wellbeing Boards were engaged and sat round a table discussing the STP, as the impact would be very significant. The Chair furthered that whilst the Board was happy to engage, they would reserve judgement until more concrete proposals were in place and the outcomes were known.

The Joint Director of Public Health Camden and Islington identified that as part of the STP process, officers were developing a plan on how to improve outcomes and financial sustainability across the health and care system. An initial high level STP plan was submitted in June 2016.  Over the summer, further work was undertaken to further develop the STP and a final plan would be submitted to NHS England on 21^st October. Following submission on the initial plan in June, partners across the health and care system continued to develop the ‘case for change’ and to develop plans across the following key workstreams:

• Population health and prevention
• transforming primary care
• mental health
• urgent and emergency care
• optimising planned care pathways
• consolidation of specialties
• organisational-level and system-level efficiencies

Discussions around transitioning to an accountable care partnership model were also being discussed through the NCL STP process. The Joint Director of Public Health Camden and Islington advised that there had been an initial engagement process around the STP, with a series of public events taking place in September. Although the final plan was due to be submitted in October, this version would not have been formally endorsed by any of the statutory constituent bodies of the STPs and would need to be approved by the individual Health and Wellbeing Boards.

Lesley Seary, Chief Executive, Islington Council commented that it was important to get the relationship right between the work involved in the Wellbeing Partnership, and the work involved in the STP process and the change of commissioning arrangements across NCL. The Chief Executive emphasised the need for subsidiary in the process to be able to deliver at a local level where it was most appropriate. It was considered that one of the important messages that needed to be conveyed as part of the STP process was about the need for space to develop the Wellbeing Partnership to contribute to overall NCL and the STP goals, and for it to not be undermined by a restrictive governance structure.

In response to a request for clarification on the process following submission of the final STP on 21^st October, the Joint Director of Public Health Camden and Islington advised that concrete timescales after this point were largely unclear. It was advised that the plan would be presented to NHS England and would then go through a process of assurance through NHSE’s internal governance arrangements, and also to ensure buy-in and sign-off within NCL. The challenge and complexity involved and lack of democratic accountability in the process would mean that the final plan submitted on the 21^st October would not have had widespread system support behind it and as a result there would need to be some subsequent engagement with each of the governing bodies, provider boards and individual HWB Boards involved. The Board was advised that delivery plans would be developed from November onwards and there would be an opportunity, both as individual organisations and collectively to review those. 

The Chair of Islington CCG advised that she saw the STP not as a definitive set of objectives, but more as the beginnings of a series of conversations about how things would need to be done differently. A key element of this would involve how services were paid for within the NHS and how some of the contractual levers that currently existed didn’t necessarily result in delivering the best quality service in the best and most appropriate way.  The Chief Executive of the Whittington Hospital NHS Trust reiterated that as accountable statutory organisations, all partners would get the opportunity to consider and approve the submission made on the 21^st October and that they would not be doing so lightly and without proper scrutiny. In terms of how the system worked from a health perspective, it was commented that once the numbers were hardwired through the Treasury there was no going back. As a result partners needed to be quite focused on what they were committing to. 

The Chair echoed some of the comments made by the Chair of Islington CCG, and stated that having re-read the case for change it was apparent that whilst the process had been pushed through at speed there were still significant gaps in the information around what it was that was going to be delivered. Furthermore, the current iteration of the plan and the information surrounding it was at a very high level. The Chair stated that the conversations that were taking place around the Wellbeing Partnership felt very important as a result, as they were at much more accessible level and based on a recognisable geographic area. The Chair of Islington CCG summarised that the case for transformative change across the health, social care and wellbeing agenda was clear. However, further consideration needed to given to how this was to be implemented and what was needed was some space to be able to develop something that worked at a local level, in contrast to some of the big changes proposed that felt unaccountable to the local area and local communities.  The Chair of Islington CCG emphasised the need for the organisations around the table to be able to influence the process and be able to remain in charge of their own destiny.

RESOLVED

1. That the progress to date on the development of a Sustainability and Transformation Plan for North Central London be noted.

2. That the overall objectives, vision and emerging plans for the transformation of the health and care system across NCL, and its implications for and synergies  with the Islington and Haringey Wellbeing Partnership be noted.