Agenda item

A series of presentations were received by the Panel regarding the three individual items.  A discussion took place which is outlined below.

 

Sustainability Transformation Plan

 

It was discussed that some local Councils had not been consulted with in respect of the Sustainability Transformation Plan although other Councils within the South Yorkshire and Bassetlaw had.  It was clarified that some areas were looking at the Place Plan.  An acknowledgement was made that in upcoming years there would be some difficult decisions and challenges to be faced especially with 25 different organisations involved.  Members were informed that the next stage would be to consult with the public.  It was recognised that both Emergency and Planned Care were the right things to be doing and also presented the biggest opportunity to start working together.

 

Place Plan

 

In respect of the Place Plan, it was explained that the plan was about the ‘integration’ staff on the front line and having the right quality of care once patients reached the right place.  It was recognised that getting frontline staff together to ensure that duplication was being reduced was a key challenge.  It was shared that the plan was about enabling partners to come together and the vision was about building on documentation and strategies tailoring to community strengths and keeping patients well in their communities whilst providing excellent quality care.

 

Members were informed how the Intermediate Social Care addressed the gap of what was being done to ensure that it meets the needs and demands of the population whilst removing unnecessary complexity and duplication.  It was recognised that prevention was a way of decreasing demand.  Members were informed that Doncaster leaders have had conversations and were clear on the vision for providers to work together and respond collectively on what was being commissioned.  It was explained that the work merges well with that of Team Doncaster as there was a need to include other elements such as housing. It was added that enablement and recovery draws heavily on what was already been undertaken by the authority.

 

In respect of engagement, Members were informed that the Implementation and Framework plan was going to take at least two years and build upon momentum of Doncaster organisations.

 

Intermediate Care

 

It was recognised that this would be a significant piece of work and a real opportunity for a new model of provision.  .

 

Finances and Monitoring Arrangements

 

It was explained that in respect of health, work was being undertaken to renegotiate the process with providers and identify where money can be saved to address the gap.  It was recognised that at present, this was a question colleagues both within health and social care felt was challenging with the constraints that exist.  It was recognised that if it doesn’t work nationally then there would be a different conversation with the Government and the public. It was added that it was believed to be the right plan and that there was presently too much of a focus on hospital services when more emphasis should be on keeping people within their own communities.

 

Regarding difficult decisions it was explained that these may include: -

 

·            Work streams and where best located.

·            Development of specialist centres and improving outcomes.

·            Development and improvement of the community service to enable more people to be treated at home.

·            Growing integration, moving forward and impact on workforce.

 

Members were informed that at a higher level there would be a full evaluation on what the new model will mean for patients and what it is like for organisations to come together.

 

Reference was made to the financial impact on patients who may lose money (for example, due to being self-employed) from staying longer than necessary in hospitals.  It was recognised that there was a need to develop increased patient care involvement and look at what was best for them through shared decision making.  

 

Concern was raised whether these plans were achievable and what would happen if they weren’t.   Members were informed how every organisation in the system that signed up would have overall total control so there would be a need to balance the books and that plans needed to show what we were doing and whether it was affordable. Members were also assured that the governance arrangements for this new model were being considered with the possibility of a strategic partner being brought in through the Better Care Fund. 

 

It was explained that all existing governance models would continue whilst the new plan and model was being developed which would later require a scrutiny and public view as to how well it’s working.  It was further explained that a Memorandum of Understanding would be in place to sign up to and a shared risk register in existence to manage risks jointly.  It was added that enablement and recovery draws heavily on what was already been undertaken by the authority.

 

Members were informed that the timeline would likely to be approximately longer than 2 years.  It was explained that all health and social services would be placed on a four neighbourhood plan model.  It was acknowledged that this plan was in place to avoid complexity and expenditure with a single point of access being the best course of action.

 

It was questioned how money would be saved when less people would be seen when visited compared with the number of people attending a clinic.  Reference was made to the current duplication and complexity that existed within the system which often resulted in patient ending up in the most expensive part of primary care or by going to the hospital where the plan will be to avoid that. 

 

In respect of duplication that existed within services, it was explained how, for example, in relation to skill levels that these existed within teams and were not being used to the maximum.  It was recognised that there was a will across providers that they needed to change what they currently do.  It was added that it was about using these skills lower down the system to be able to provide a better service, making sure that the right people were in the right place and bringing professionals together at the front of services. 

 

Engaging with Hard to Reach Groups

 

In relation to engaging with hard to reach groups, Members were informed that the plan from the NHS perspective outlined what more the NHS could do particularly through utilising better risk assessment tools within social care practise.  It was added that it wasn’t just about undertaking a health assessment but about a social care assessment, looking at other issues such as loneliness and isolation, food, home and transport and taking an approach that it’s simpler and easier to signpost individuals.

 

It was recognised that there was a need to work collectively together which included Health and Wellbeing Boards and Team Doncaster having a role in the planning for Doncaster and being able to create the right environment.

 

Regarding people being able to live in a safe environment, Members were informed how, for example, the Fire Service was now doing a fall service when they did prevention visits.  It was explained that consideration was being given to personnel who might identify those who are vulnerable but not present within the adult and social care system.

 

In relation to changing roles, concern was raised regarding what effect such changes would have on our GPs and pharmacies.  Concern was also raised whether ambulance staffs were becoming more of an administrator type role.  It was explained that staff looked at how the number of patients being taken to hospital could be reduced within the ambulance service, by undertaking an assessment at home which was better for the patient. 

 

It was explained that professionals need to facilitate a better way of working together and begin to use the same documentation and technology. It was admitted that there was a long way to go but the ambition is there and steps will be taken to integrate them to be able to see the journey of that person.

 

Health Inequalities

 

In regards to health inequalities, it was recognised that some gaps were widening and it was questioned what were the blockages in addressing them.   It was believed that there was a tendency for health inequalities to be seen as a health system responsibility when certain areas fall outside of it.  Opinions were expressed that no one should get left behind or slip through services.

 

Engagement and Participation

 

A Member questioned the existence of an engagement strategy when previous mechanisms no longer existed including forums and places where agencies could attend to obtain feedback from communities.  Members heard that engagement was taking place on a number of levels as part of a Communication and Engagement Strategy.  Members were pleased to hear that officers across communication streams were meeting with each other more and that there would be a great deal of engagement work to be undertaken with individuals before work takes place. 

 

In respect of joining up, Members were assured that experts would be brought in to ensure that messages and the methodology is more than a document and that different mediums are considered. That new ways of engaging with the public are looked at such as workshops, particularly to engage with those individuals who have complex needs.  It was also explained that discussions were taking place with HealthWatch about how high level engagement can be undertaken as they have national presence. It was recognised that engagement work needed to link with Team Doncaster

 

It was also commented that change would only be achieved when society stops seeing older people in a negative way. It was added that Members were of the opinion that no major change in this respect had been made.

 

Action: Intermediate Care Engagement Strategy to be circulated

 

RESOLVED that the Panel;

 

i.              Note the information presented; and

ii.             Supports the overall direction of travel within the Doncaster place plan and notes that the plan will be subject to changes;

And that consideration is given to;

 

iii.            The whole of Team Doncaster embracing Health Inequalities as a priority; and

iv.           What can be done to ensure that engagement strands across health and Team Doncaster are effectively pulled together.