Agenda item - Sustainability & Transformation PLan (STP): Special Item

41.1    This item was introduced by Adam Doyle, Accountable Officer; and by John Child, Chief Operating Officer, Brighton & Hove CCG. Mr Doyle outlined the purpose of the STP; explained that the footprint is divided into three parts, with Brighton & Hove forming part of the Central Sussex & East Surrey Alliance (CSESA) locality; and pointing out that our local integration programme, Brighton & Hove Caring Together, feeds in to locality and footprint-wide planning.

41.2    Cllr Allen commented that integration is a worthy goal, but we need to be mindful that the context is one of being required to make huge cuts locally. Given this, the deliverability of the STP has to be in doubt. Cllr Allen also questioned the Multidisciplinary Community Provider (MCP) model, querying who would run MCPs: there was public concern that these would come to be run by the corporate sector. In addition, Cllr Allen noted that the STP submission was full of jargon and NHS acronyms, making it almost unreadable; and that STP communications to date had been appalling, although the decision to publish the submission was to be applauded.

41.3    In response to a question from Cllr Allen, Mr Doyle confirmed that the current financial position (i.e. the ‘do-nothing’ deficit for 2021) was £865M.

41.4    In answer to a question from Cllr Allen on GP support for the STP, Mr Doyle responded that the STP has been discussed locally with GPs, although more debate is required. Some other areas within the STP are more advanced in these discussions.

41.5    In response to a query from Cllr Allen on the lack of local representation at a senior level in STP governance structures, Mr Doyle acknowledged that this is an issue and that he is working to ensure that the city is properly represented.

41.6    Cllr Sykes commented that it is clear that the STP is driven by the requirement to make savings, and it is unfortunate that this is not properly acknowledged in the Plan. The STP’s commitment to prevention and to social care is laudable, but is hard to square with recent Government cuts to public health and adult social care funding. Mr Doyle acknowledged these concerns, and the scale of the challenge locally, but noted that we have to use the resources we have in the most effective way, for example by reducing unnecessary hospital activity.

41.7    In response to Cllr Sykes criticising the language in the STP as very obscure, Mr Child told the committee that this problem was acknowledged and work was underway to produce more accessible material.

41.8    In response to a question from Cllr Sykes on the cost of the STP project, Mr Doyle responded that he did not have the figures to hand, but would circulate them after the meeting.

41.9    Cllr Marsh commented that this felt like groundhog day in terms of grand NHS plans. This is clearly a financially-driven initiative and the lack of transparency to date is worrying. Cllr Marsh also questioned whether GPs were truly ‘on board’ with the STP.

41.10  Cllr O’Quinn queried why the system had not done much more to prepare for the challenges of an ageing population that we are now facing. Cllr O’Quinn was also worried by the scale of the proposed changes, and questioned whether they were actually achievable.

41.11  Cllr Peltzer Dunn noted that the STP sounded similar to previous plans for NHS reorganisation which had not proved successful. Whilst front-line NHS staff are generally excellent, NHS systems are not.

41.12  In response to a question from Cllr Peltzer Dunn on how demand for beds can be reduced when the population is both ageing and increasing, Mr Doyle told members that demand for acute hospital services can be reduced by eliminating unnecessary hospital admissions and by moving some services (such as outpatient appointments) from an acute to a  community setting.

41.13  In reply to a query from Cllr Peltzer Dunn on whether it wasn’t rather late in the day for winter planning, Mr Doyle assured members that planning has been in place for some time for this winter, and there is a good deal of work going on to plan over the longer term to better manage predictable seasonal pressures.

41.14  In response to a question from Cllr Cattell on how local estates planning fitted in with the STP, Mr Doyle responded that this would be picked up in the ongoing One Public Estate work. The ‘3T’ renovations of the Royal Sussex County Hospital are designed to be future-proofed, so will accord with any likely STP plans.

41.15  In reply to a question from Cllr Cattell on GP sustainability, Mr Doyle told members that there was a national shortage of GPs. Part of the solution to this was to look at how best to provide the required skill-mix in general practice: this may mean employing healthcare professionals other than GPs to take on some tasks traditionally undertaken by GPs.

41.16  In answer to a query from Cllr Deane as to how confident he was in the success of the STP, Mr Doyle told the committee that he was very confident that local elements of the STP plans would be delivered and would prove effective. Mr Child added that it was important to bear in mind that the local plans were not new – they have been some time in development and are tailor-made to deal with Brighton & Hove issues.

41.17  In response to a question from Colin Vincent asking to which bodies the STP was submitted, Mr Doyle confirmed that the submission was made to both NHS England and NHS Improvement. However, the submission will evolve into far more detailed implementation plans.

41.18  In answer to a question from Mr Vincent on public involvement in the STP, Mr Doyle acknowledged that there had been limited engagement on the STP itself to date, although there has been engagement on local plans. However, there will be much more engagement going forward.

41.19  In response to a question from Fran McCabe on whether the Central Sussex & East Surrey Alliance area is coherent and sustainable, Mr Doyle told members that the locality makes sense in terms of patient flows and also in terms of similar clinical approaches to the challenges we face. Ms McCabe also noted that there had been no engagement with Healthwatch Brighton & Hove on the STP to date.

41.20  In answer to a question from Zac Capewell on whether more could be done to provide emergency services in community/General Practice settings, Mr Doyle told the committee that it was important that as many people as possible received treatment in community settings. However, very sick people would still need to attend A&E in order to access specialist care.

41.20  Cllr Allen proposed an amendment to the report recommendation: that an additional recommendation be added: “That members agree to set up a working group to examine the implications of the STP for the residents of Brighton & Hove.” This was seconded by Cllr Marsh and agreed by committee members.

41.21  RESOLVED – that members:

(1)  Agree to note the information in the report; and

(2)  agree to set up a working group to examine the implications of the STP for the residents of Brighton & Hove.