Agenda item

To consider a Cover Report of the Executive Director Core Services at Barnsley Council (Item 6a attached) in respect of a report on the Hospital Services Programme (Item 6b attached).

The following witnesses were welcomed to the meeting:-

Lesley Smith, South Yorkshire and Bassetlaw (SYB) Integrated Care System (ICS) Deputy System Lead and Lead for Strategy, Planning and Transformation Delivery as well as Chief Officer at Barnsley Clinical Commissioning Group (CCG);

Will Cleary-Gray, Chief Operating Officer SYB ICS;

Helen Stevens, Associate Director of Communications and Engagement, SYB ICS;

Alexandra Norrish, Programme Director, SYB Hospital Services Programme.

In introducing the item, Members were made aware that the Strategic Outline Case (SOC) had been to the CCG Governing Bodies in the area and had received their approval and it had therefore been formally published.  Members noted that an easy to read version had been developed and published alongside the SOC in response to feedback from the Committee.  Also published was a report detailing the engagement which had been undertaken over the summer.

Members were reminded of the two main themes to build on the potential for shared working facilitated by the ICS, and to develop sustainable care across the acute sector.

The SOC contained a number of proposals which included establishing Hosted Networks, to further enable shared working, standardise care, share best practice and maximise the impact of the workforce.  The proposals also included plans to build on innovation, ensuring this was adopted across organisations and across geographical boundaries.  Proposals for transformation, ensuring patients are dealt with in the most appropriate setting by a flexible workforce were also included.

In addition further development of models for reconfiguration was proposed, to ensure future sustainability, and clinical working groups had been established to drive this agenda. Public consultation would be ongoing throughout and appropriate consultation would take place once options had been more fully developed.

Members noted that work to develop Hosted Networks was ongoing with the aim to appoint hosts around Christmas, 2018 and have these operational by April 2019. 

The Committee noted the need for local consideration of place based plans through Health and Wellbeing Board and Overview and Scrutiny Committees once proposals were more developed.

Questions were welcomed from the Committee and the following concerns were pursued:-

In considering reconfiguration, Members were concerned that there may be unforeseen impacts which could potentially lead to further health inequalities.

Assurances were given that the ICS approach was one where any intervention should not make inequalities worse, with the principal for this included in the Memorandum of Understanding.  In addition the terms of reference for the Hospital Services Review had ncluded the consideration of health inequalities. 

The proposals contained within the SOC were intended to standardise care across the area in order that everyone receives the best possible care.  Members also noted that in taking forward any reconfiguration, any evaluation criteria would consider health inequalities.

It was acknowledged that when considering travel and transport, modelling would be undertaken at Lower Super Output Area (LSOA) level, and that the patient and public forum would include a wide range of representatives.  It was noted that it was proposed that these would be recruited through South Yorkshire Housing Association. In addition the clinical working groups would consider the clinical issues associated with transfer.

With regards to how confident officers were that plans would be delivered within timescales and resources, it was noted that these differed for different workstreams but that these were expected to be deliverable with resources to undertake the work set appropriately.  Members were assured that the resource implications of any changes would be considered carefully as part of the modelling.

In respect of making the public aware of proposals, questions were raised regarding the availability of information through sources other than the internet. It was noted that easy to read leaflets would be distributed in public places, and as part of the next phase detailed conversations would again take place.  An offer was made for the Committee to consider the communications plan which they requested be undertaken.

Members noted the discussions taking place between bordering trusts and STPs/ICSs with regards to the impacts of potential changes in maternity, and this would involve consideration of travel times and distances.

An overview was given of the governance structure, with workstreams feeding into a steering group which then fed into wider ICS and Trust governance.  Members were assured that ongoing dialogue with the Committee would also continue. The important role of Elected Members having oversight of change, ensuring wherever patients were seen they received the same level of care, and that any changes did not increase health inequalities was acknowledged.

The Committee discussed the drive to ensure consistency in care, and the potential for some services to deteriorate as part of any equalisation.  Reassurance was provided that any intervention would be to try to bring any area of underperformance up to a required standard.  Many of the proposals included intervention to increase staff recruitment and retention in order to do so, and the Committee requested a further report on workforce issues to be presented for consideration.

In relation to the establishment of Hosted Networks, it was noted that hosts were expected to be appointed by the end of the year, the hosts would then be responsible for further development of the network in their speciality area, which would include detailed conversations with relevant parties.  Members noted that hospitals did work closely, however the networks would help provide structure to this.

RESOLVED:-

(i)            That witness be thanked for their attendance and their contribution;

(ii)          That witnesses acknowledge the general improvements required in relation to communications highlighted throughout the meeting including using local authority networks and Health and Wellbeing Board;

(iii)         That the communications /engagement plan be submitted to Committee Members in 4 weeks for their consideration;

(iv)         That a further report be submitted to Committee Members within 4 weeks detailing workforces issues and plans to address these.