To receive an update from Dr Womersley of the CCG.
The Chair welcomed Dr Womersley and Mr James Wright.
Dr Womersley proceeded with a high level overview of the CCG, its aims and challenges. He informed the meeting that the Sustainability Transformation Partnership (STP) had been a concept introduced by the Government; a collaboration of all the providers and commissioners. The STP was now moving towards an Integrated Care System (ICS), which would involve working closely with local authorities. However, the Government had not approved the ICS yet as further building blocks needed to be in place but it was hoped an application to become an ICS would be submitted in the autumn.
Health care and social wellbeing are strongly interdependent. The focus this year is around wellbeing with its links to housing, education, health services, employment and social and medical care.
Northern, Eastern and Western Devon CCG and South Devon and Torbay CCG had agreed to merge to the new Devon CCG and this was on track to be completed by the end of March 2019. The CCGs will become the NHS Devon CCG. In addition, within the commissioning system, the CCG had applied to be commissioners of the GP services (primary healthcare services) which is currently covered by NHS England. Having a single strategic commission will enable hospitals and GPs to work alongside each other more effectively.
The health commissioners are also looking to work with local authorities to become joint commissioners of the system. This had worked well in Plymouth. In Devon the single strategic commission will be the collaboration with Devon County Council. An example of where the CCG already works well with DCC is the Better Care Fund, where money is allocated to DCC but it is used to relieve the pressure within the heath service.
Services must be commissioned around people, not money.
There will be activity at 3 main levels:
· Places – the collaboration with DCC
· Neighbourhoods – will be tailored to reflect Devon’s geographical needs but at the same will make medical sense. It was acknowledged that although Northern Devon was isolated, it did have its own district hospital and the link road.
· Networks – the pooling of GP and nursing services to provide care for 30,000 – 50,000 patients. This will provide “improved access”, more extensive care, perhaps offering Saturdays and Sundays and longer hours. To achieve this, practices may not need to merge but to work together. This would also alleviate the issues around the workforce in primary care. As an example of the difficulties, Dr Womersley cited the situation in Plymouth, where there are 30 unfilled GP positions.
Practices are being encouraged to extend their range of services to include pharmacies, physio, mental health practitioners and occupational therapists. This is in keeping with the 10 year plan recently released by the Government and indeed some of the priorities had already been set by the North Devon STP, such as:
· Digital services
· Acute services review – takes in all the services
Other key issues being looked at:
· Equity – elderly v. children
· Mental health
· Integrated Care Module – out of hospital care services but without depersonalising care
In summary, the CCG aimed to provide as many services locally as possible but there would always be a need to use centres of excellence and specialist consultants elsewhere in Devon.
The financial challenges encountered a few years ago, a potential £500m deficit over 5 years, had been addressed. The Care Closer to Home programme had not been implemented, largely due to the financial pressures. NHS Devon hoped to break even this year and more money will be spent on prevention and out of hospital care.
In simple terms, the CCG planned to achieve more effective care through:
· Prevention – exercise easily available. One Northern Devon will be promoting social prescribing
· Self Help – Digitalisation will come into play.- “My Health Devon” website
• Resilient Communities –– making people with mental illness and disability feel part of the community helps to improve their mental health
Dr Womersley closed with an update on how the North Devon Hospital trust was coping over the winter.
Questions were answered by Dr Womersley and it was noted that:
· Admin costs have significantly reduced over the years. Commissioners buy, monitor and regulate and look after the acute services and community services but communities need to be more active, which might be something for One Northern Devon and Community Connectors
· Delivery of services for small rural communities will be different to the urban centres. Whole teams will be upskilled within the networks. There will be more advice and guidance from consultants. There should be no need to travel for care but if specialist services were required then there would be.
· Patient Participation Groups (PPGs) are the patients’ voice.
· The limiting factor on the NDHT is not money but staff.
· 280,000 appointments are estimated in North Devon Hospital over the next year.
· There has been an increase (20+%) in the number of urgent referrals coming from GPs for suspected cancer cases as GPs now have much clearer guidelines.
· In response to a question as to whether the NHX ‘exists’, given the national structure of CCGs, the NHS does still exist and oversees statutory issues such as 4 hour waits and cancer waiting times and ensures that every area has an appropriate level of funding.
· A feedback system is in place to protect staff and the organisations supplying staff are bound by regulations to ensure staff wellbeing. The NDHT staff survey was remarkably good; one of the best in the South West.
· There are local services which are provided by communities, not purchased by the CCG, including websites. The CCG does have oversight of GP communications.
· Dr Womersley suggested an additional sum to be added to Council Tax to employ Community Connectors. The Head of Paid Service advised the meeting that the authority was facing a 40% reduction in funding and local authorities were capped on Council Tax increases, although parish council were not. The priority of the local authority was to provide statutory services and other existing services, so there would almost certainly be nothing left over to fund Community Connectors.
· The CCG will support communities to the tune of £100,000 over the next year.
· A national programme is currently assessing social prescribing.
· With regard to the re-opening of beds at Holsworthy hospital, an assessment of local needs was being carried out and whichever organisation took on the management of the temporarily closed beds would need to demonstrate that the provision would be sustainable. This will be reviewed in the autumn. The beds were temporarily closed but will reopen when proved to be safe and sustainable.
· There is a plan for mobile visiting.
· Local authority funding cannot cross a boundary but health money can, which reflects the move to provide patients with choice.
· The recruitment campaign to bring in nurses from abroad had been successful in some areas.
· The CQC will be following up with the North Devon Hospital on the issues raised in their 2018 report.
· The Better Care Fund is money allocated to councils and is ring fenced to support and sustain social care and reduce pressure on the health service.
· If there is not enough social care, patients remain in hospital - integrated commissions will address this.
· There is a full system for carers’ health checks and there is a duty of care and assessment.
The Chair thanked Dr Womersley and Mr Wright for the excellent presentation.
Dr Womersley, Mr Wright and Councillor Patrinos left the meeting.