Agenda item - Brighton & Hove Caring Together: Update

Verbal update.

56.1    This item was introduced by Adam Doyle, John Child and Rob Persey. Adam Doyle explained that Brighton & Hove Caring Together (BHCT) is the local health and social care transformation programme and the city’s contribution to the Sustainability & Transformation Plan (STP) and to the Sussex & East Surrey Alliance place-based plan (SESA). The CCG has held a number of BHCT engagement events already and will be bringing a detailed delivery plan to a future HWB. Additional resources to support BHCT are in place, including James Corrigan the new Programme Director. Key details of BHCT, including the federation of city GPs, have been discussed with the CCG clinical leads. Rob Persey added that the city council is working closely with the CCG on this – for example in terms of the successful roll-out of the “Discharge to Assess” scheme which is now operating across eight wards at the Royal Sussex County Hospital. This is a good foundation to build upon.

56.2    Mr Doyle told the Board that GP sustainability is a key challenge, and that this is central to the BHCT programme. There is ongoing discussion with GPs to develop a future care model. In terms of the broader STP, NHS bodies have struggled to date to effectively articulate a vision for clinical and financial sustainability. An engagement plan is being developed and this should be available for the March 2017 Board meeting.

56.3    David Liley commented that Healthwatch fully supports the focus on improvement via a city-based plan.

56.4    Councillor Page expressed concerns that a future Multi-Speciality Community Provider (MCP) might be a private sector organisation. Cllr Page agreed that the focus on GP sustainability is key. He also welcomed the forthcoming engagement plan, but noted that the autumn BHCT engagement events had been disappointing, with no real focus on the financial situation. Cllr Page questioned whether it was really possible to improve services whilst significantly reducing funding. Mr Doyle responded by telling members that the MCP will integrate current NHS primary and community services with local authority social care. This is not about bringing in independent sector providers to run the MCP. Mr Doyle agreed that GP sustainability is a key challenge: the CCG is risk-rating local surgeries to try and identify and support those at greatest risk. Mr Doyle acknowledged the comments about the autumn BHCT engagement events:  the CCG is working closely with Healthwatch to ensure that future engagement better matches public expectations. Mr Doyle also acknowledged that the challenge to improve services whilst addressing deficits is significant. However this is about transforming rather than simply cutting services. Locally, the CCG is near to having a balanced budget although there are a number of financially challenged organisations within the footprint and there is an STP-wide conversation about how best to address this issue.

56.5    Geoff Raw added that the city council is used to working with diminishing budgets and is using this experience to support the CCG. Although challenging, it is sometimes possible to redesign services so as to deliver better outcomes with less funding. The council recognises that engagement to date has been problematic and is committed to engaging properly.

56.6    In response to a question from Councillor Penn on specific budget pressures, Mr Doyle told the Board that the CCG is required to deliver a 1% surplus, requiring savings of around £30 million. Currently the CCG is predicting a £4M shortfall against this target, but is confident that the gap can be bridged by year end. B&H CCG has not had to make really major efficiencies in past years and this puts it in a good position to deliver these savings.

56.7    David Liley noted that there is a risk of focusing too much on the financial drivers for change. It is more important to look at evidence: for example, why it is believed that planned changes will improve outcomes for patients. This will entail much more clinical and patient involvement. Cllr Page acknowledged the importance of focusing on evidence, but stressed that some financial issues were inescapable, particularly as it is evident that the NHS nationally has insufficient hospital beds. The worry is that services will be reduced leading to patients waiting longer and travelling further for treatment.

56.8    Councillor Anne Norman noted that elected members understand the need for the council to work closely with the NHS to reduce duplication and exploit new technological advances. It is also important to recognise how good much of the care is locally, particularly at the Royal Sussex, despite the pressures the system is experiencing.

56.9    The Chair thanked everyone for their comments.

56.10  RESOLVED: The Board noted the information.