Agenda item

The Board received a report which updated the Health and Wellbeing Board on the development of the North Central London Sustainability and Transformation Plan (STP). The report was introduced by Zina Etheridge, Deputy Chief Executive Haringey and was included in the agenda pack at pages 5-17.

The Chair advised that the draft Sustainability and Transformation Plan and the joint statement were published in October on all 5 NCL council websites following submission to NHS England. The Chair raised concerns with the overall lack of public engagement that had been undertaken around the STP and welcomed the opportunity to hold a discussion in public with both Health and Wellbeing Boards. The Board were advised that they were not being asked to endorse the STP, instead this was an opportunity to raise any concerns or seek clarification, and that a note of the discussion would be sent to those leading and managing the STP process for NCL.

The Board were advised that the STP estimated a financial gap in NCL NHS Services of £876m by 2020/21. For social care, the combined social care budget gap across NCL’s boroughs would be in excess of £300m by 2020/21. A number of opportunities for public engagement had been carried out since publication of the NCL STP, including via each respective council and CCG website, a public event convened by Keep Our NHS Public on 15^th December, meetings with the voluntary sector and respective CCG meetings held in public. In addition the NCL Joint Health Overview & Scrutiny Committee undertook a review of the draft NCL STP, they received written and verbal evidence from a range of stakeholders and published a report which set out a number of recommendations to challenge and inform development and delivery of the plan going forward.

The aim of the STP was to set out how to transform the whole system in order to improve both system sustainability and to make financial savings, whilst also improving outcomes. The Deputy Chief Executive advised that a key concern with the STP was a failure to consider the implications for wider care services within the overall health care system.

The Chief Executive, Bridge Renewal Trust reiterated concerns raised around a lack of public consultation and a lack of clarity about what exactly the STP would look like.

The Haringey Cabinet Member for Finance and Health welcomed the fact that the STP gave equal consideration to mental health and wellbeing and physical health but commented that further consideration needed to be given on how to support the voluntary sector in providing more community level care, given the significant financial constraints on the voluntary sector. The Cabinet Member for Finance and Health further commented that the STP needed to set out how to capacity build within the voluntary sector to support the development of community level mental health and wellbeing services. The Cabinet Member for Finance and Health sought clarification on what the next steps were in terms of the formal sign off process and the process of public consultation, given the lack of visibility and public scrutiny.

In response, the Chief Officer Haringey CCG acknowledged that the CCG shared the concerns raised around public consultation and suggested that the Wellbeing Partnership may want to consider the lessons learnt from this. The Board considered that the document published in October set out the key concepts and was orientated at a fairly high level. Over the next few months, more detailed delivery plans were being developed and that this process offered an opportunity for broader public engagement. The Chief Officer Haringey CCG, advised that the CCG were developing stakeholder plans to set out a clear engagement process going forward. The Board was advised that the plans would not be completed by the end of March and that the wider STP sign-off process was ongoing.  It was anticipated that there would be further opportunity to involve the voluntary sector.

The Chief Executive LB Islington, emphasised some of the concerns raised in the report and commented that the looming spectre of an £800m funding gap resulted in the STP having a disproportionate focus on the sustainability element at the expense of transformation and system change. The concern was that funding for adopting a preventative approach and provision of care services would be swallowed by a short-term approach to bridging the funding gap. The Chief Executive LB Islington advised that transformation was a key focus for local authorities and that there were a significant concerns with getting social care and issues around Children’s Services recognised as part of the process.

The Chair welcomed that the report and highlighted the social care funding gap of around £300m against the back drop of the STP’s overall focus on sustainability. The Chair advised that the both increased sustainability and the transformation of the social care system was going to necessitate much greater integration.

Cllr Watts reiterated that there were well documented frustrations with the STP process, such as the very top down approach and what felt like unnecessary levels of secrecy which was damaging to public consultation. It was noted, that there were also some significant positives to highlight, such as the parity of esteem between physical and mental health services, the care close to home proposals and the facilitation of conversations on the long term sustainability of the health and care system. Cllr Watts raised concerns that at present the STP was not a long term strategic transformation plan but more a short term deficit funding plan for the NHS. Cllr Watts suggested that social care and a focus on what integration of health and care meant in practice was key to the STP being a long term strategic transformational plan. The Committee considered there were significant issues across the two boroughs around the demand for urgent and emergency care and Cllr Watts commented that the STP did not present a case for a reduction in urgent and emergency care services across NCL, instead it was advocated that NCL needed an increase in urgent and emergency care services due to a long term failure to manage demand in this area.

The Chair, Healthwatch Haringey commented that there was a lack of public engagement around the STP process and also questioned what kind of model of public engagement might be used. The Chair, Healthwatch Haringey queried whether the Board could agree a sense of what kind of level of public engagement might be undertaken and how that might be structured. Cllr Kober responded that it was not possible to undertake a satisfactory discussion at this juncture but acknowledged that the Board was keenly aware that the process had not been handled well enough, and from the outset the need for greater transparency and accountability had been pressed on the NHS. The Chair commented that the Board would ensure that a process of public engagement was put in place locally if it was not done through NCL.

Simon Pleydell, Chief Executive of Whittington Health acknowledged that NCL was under significant strain in terms of the numbers of patients presenting at an emergency department and that the system was near the limit of how far it could be stretched, as a result it was not envisaged that there would be a reduction to urgent and emergency care services. The Board considered that the overall objective in urgent & emergency care was to keep more people out of hospital and to treat more patients locally in the community. The Chief Executive of Whittington Health advised that the STP was currently at such a high level that it was difficult to undertake any meaningful consultation with either users or the public as it was not possible to say what the impact would be in terms of local service provision. It was anticipated that NHS partners would be reviewing the high level numbers over the coming two to three months following which a process of meaningful public and user engagement would be developed.

The Chief Officer Haringey CCG advised that a communications and engagement lead had been appointed to improve the engagement process around the STP and the Chief Officer, Haringey CCG agreed to speak to the communications and engagement lead and arrange a meeting. Action: Sarah Price.

The Director of Children’s Services advised that the governance arrangements around the STP had been altered recently and that Healthwatch were going to be part of the oversight group and the delivery group. The Director of Children’s Services also raised concerns that the parts of the STP process had felt transactional rather than transformational.

Cllr Watts summarised that there was a balance to be struck between the need for meaningful public engagement and having firm proposals to be able to consult upon. Cllr Watts urged that as more practical considerations began to emerge that there would need to be a high level of engagement with both the public and with local politicians  and welcomed the Chief Officer, Haringey CCG’s offer to lead on engagement with NHS bodies. The Chief Executive, Islington Healthwatch agreed to draft some principles of engagement.  Action: Emma Whitby.