Meeting Details

Apologies for absence had been received from County Councillors C Sargeant, C Weston, and Uttlesford District Councillor Vic Ranger.

Councillor A Wood declared an interest as a Governor of the Essex Partnership University NHS Foundation Trust (EPUT).

Councillor A Brown declared an interest as the ECC representative on the North East Essex Clinical Commissioning Group.

Maldon District Councillor N Pudney declared an interest as a semi-retired Nurse and elected representative on the Members Board at Broomfield Hospital.

Councillor J Beavis declared an interest as the ECC representative on the Mid Essex Clinical Commissioning Group.

Councillor B Egan declared an interest as a representative on the Castle Point and Rochford CCG.

David Sollis, Healthwatch Essex observer, declared an interest with HWE Insights Ltd and its involvement with the Sustainability and Transformation Partnerships (STPs).

Ms Pauline Amos, Dr Shan Newhouse and Ms Jan Plummer, indicated that they had questions in relation to the Sustainability Transformation Partnerships (STPs), and they were invited to ask these by the Chairman.  The detailed questions were as provided in the appendix to these minutes.

The Chairman indicated that these questions would be covered during the meeting and would be helpful to the Committee in carrying out its scrutiny of the STPs.

The Committee considered a report (HOPSC/26/17) which provided an update on the Suffolk and North East Essex Sustainability and Transformation Partnership (STP).

The following were in attendance to participate in a question and answer session:

• Nick Hulme, STP Lead for Suffolk and North East Essex and Chief Executive of Ipswich and Colchester Hospitals
• Susannah Howard, STP Programme Director
• Kirsty Denwood, Chair of the STP Finance Group and North East Essex Clinical Commissioning Group Financial Director
• Isabel Cockayne, Communications Engagement Lead

During discussion the following was acknowledged, highlighted or questioned:

• In July 2017 the STP had been assured as "advanced" on its systems by NHS England and NHS Improvement;
• Successful bids had led to a receipt of £2.8m of additional capital funding to support primary care schemes in Clacton and Newmarket;
• A STP Delivery Board had been established and involved the clinical leads, as well as representatives from the community and voluntary sector.  There was an appetite for more integration between partners;
• Residents are concerned about having to travel further for healthcare services.  This can be particularly stressful for those living in rural districts without their own transport.  The STP team would investigate the possibility of holding clinics earlier in the day to enable villagers to use public buses for return journeys;
• There would have to be a clear clinical benefit in order for any services to be moved, and any significant reconfiguration of services will need to go into a public consultation;
• New health and social care models were being piloted by West Suffolk and the University of Suffolk;
• If adequate time had been allocated to engagement and consultation, and concerns regarding a lack of public trust with consultations and the need to set realistic expectations.  Healthwatch Essex had been involved in helping the STP to engage with vulnerable communities;
• Members queried the level of democratic accountability and the role of Public Health in the governance structure.
• As part of the STP, an IT sub-group was challenging the technology and processes;
• The clinical strategy would drive the programmes of change;
• A review of the whole patient pathway was underway;
• The STP team was keen to engage with local groups and continue the dialogue where it was already happening;
• The five year forward plan for Primary Care was a priority.  Central Government funding is available, but as there is a shortage of GPs flexibility is needed to allow expenditure on other qualified healthcare workers to help provide the care;
• In regard to the future joining of Colchester and Ipswich Hospitals, issues relating to staff roles and salaries were being examined.  More training opportunities could be offered as part of a new large organisation and in turn, help to retain staff.

It was agreed that:

1.  The STP Delivery Board would consider its size and balance of representation and provide an update on its review to the HOPSC.

2.  The STP would provide a response to the recommendations submitted by the Joint Essex and Suffolk HOSC.

3.  The STP would consider improving elected member and Public Health representation in the STP governance structure

4.  The Senior Democratic Services Officer would plan for the Suffolk and North East Essex STP representatives to attend a future HOPSC meeting, most likely in January 2018, to give a further update on progress.

The Chairman thanked the contributors for their attendance and input.

The Committee considered a report (HOPSC/27/17) which provided an update on the Mid and South Essex Sustainability and Transformation Partnership, and plans for public consultation on its proposals in the autumn.

Andy Vowles, Programme Director, and Wendy Smith, Interim Communications Lead, Mid and South Essex STP, were in attendance to participate in a question and answer session.  David Sollis also joined the contributors for this item, as a commissioned partner through HWE Insight Ltd:

During discussion the following was acknowledged, highlighted or questioned:

• The background to the Mid and South Essex STP which had grown out of the Success Regime;
• Following wide engagement on the possibility of specialising the A&E departments, it had been agreed that these three departments will remain largely as they are.  Strong concerns had been expressed about the model in relation to how night time emergencies would be handled and the impact on the Ambulance Trust;
• Residents will be consulted on ten specific areas of hospital care where there is strong evidence to show that consolidation can improve the outcomes for patients;
• Subject to funding, they plan to move services from Orsett Hospital into four healthy living centres, close to the local communities – capital funding would be required for this;
• The consultation will involve workshop events and support from Healthwatch Essex to engage with the wider public in line with the Equalities Act;
• Concern was expressed about how the complexities of the options will be presented so that residents can understand the consequences of proposed changes;
• A User Advisory Group will be asked to test the draft consultation document;
• A reminder that Parish Councils should be involved as well as groups for the Disabled and Travellers;
• The intention to start the 14 week consultation in November raised some concerns for members, as the HOPSC wanted to see more detail on how the Trust Board would be involved with the process, as well as the finances and challenges relating to the plans.  The Committee also wanted to know more about what activities were underway to save money and how discharge of care would be handled.  The suggestion to have a shorter 12 week consultation to start in January 2018 was raised, but not supported as the consultation process needed to be aligned with Central Government capital programme arrangements.  Any delay in the consultation could lead to a loss of public confidence in the process. It was emphasised that there would be a continual opportunities for feedback and ongoing discussion beyond just the formal consultation period;
• The lack of information about the future plans for community hospitals was highlighted.

It was agreed that:

1.  Bearing in mind the length of the proposed consultation period (14 weeks) and that the STP had already held various engagement events in the preceding months, the HOPSC could support the launch of formal consultation in November as there should still be adequate time both before and after the Christmas and new year period for the STP to plan and carry-out effective engagement.

2. A copy of the detailed itinerary on how the consultation will progress through the internal governance processes would be provided to the HOPSC.

3.  An advance copy of the draft consultation plan would be provided to the HOPSC to enable its comments to be included in the finalised consultation document.

The Committee noted that officer discussions regarding the possibility of establishing a Joint HOSC with Southend were ongoing, and the legal implications of delegating its role and powers as statutory consultee for this STP.  The Committee indicated that it supported the establishment of a Joint HOSC in principle.  The Committee agreed that the issue of joint working would be discussed at its November meeting.

The Chairman thanked the contributors for their attendance and input.

The Committee considered a report (HOPSC/28/17) which provided an update on the Hertfordshire and West Essex Sustainability and Transformation Partnership.

Peter Cutler, Programme Director, Hertfordshire and West Essex STP, was in attendance to participate in a question and answer session:

During discussion the following was acknowledged, highlighted or questioned:

• The challenge of moving from an environment of competition to collaboration;
• The emphasis on prevention not being neglected;
• The need to replace the buildings at Princess Alexandra Hospital and West Hertfordshire Hospitals.  It was anticipated that a decision would be known in November on whether they would receive capital funding for new builds.  If they were successful, a detailed business case would then be produced;
• The need for organisations to adapt to the demands of the new generation workforce;
• The benefits of bringing apprentices into the health service;
• The STP work was being driven by the Chief Executives Board.  A new clinical oversight group was being formed to help find solutions to the blockages in the system.  There were seven clinical workstreams looking at improving performance;
• Hertfordshire and West Essex STP was taking a lead on talking with the pharmacy profession about the high proportion of hospital budgets being spent on medicines;
• The need to develop a collaborative accountable care system, and how examples from Spain and New Zealand were being explored;
• The benefits and disadvantages of using PFI options to fund new builds, and whether former hospital sites could be sold for housing developments;
• The challenge of breaking down the silos within the workforce, and in particular, those within the middle management levels;
• How patient experience needs to be consistent across the hospital sites;
• There was some resistance to change from the GPs, but this was mostly from the small practices.  The NHS was encouraging a federation approach as this gives GPs shared back office teams, greater flexibility and capacity to provide services and makes it easier for commissioners to negotiate with them;
• The intention that people will be supported at home and not be admitted into hospital unless there is a real need to do so.
• Members queried the democratic accountability in the STP governance structure.

It was agreed that:

1.  HOPSC would be kept updated on progress and be shown early draft documentation for its comment.

2.  Details on the future build of Princess Alexandra Hospital would be provided to the HOPSC when available.

The Chairman thanked Peter Cutler for his attendance and input.

The Committee considered a report (HOPSC/29/17) on the actions taken to establish a joint Task and Finish Group with the People and Families Policy and Scrutiny Committee to look at issues with the rate of hip fractures in Essex.

The Committee agreed:

(i)  To endorse actions taken to establish a joint Task and Finish Group with the People and Families Policy and Scrutiny Committee to look at issues in connection with the rate of hip fractures in Essex;
(ii)  To approve the proposed membership; and
(iii) That the Task and Finish Group report back to the Committee after it has completed scoping so that the intended focus of the review can be endorsed.

The Committee supported Councillor A Brown's suggestion that the Sensory Services Partnership Board be involved with the Group as the scope of the review was a frequent topic for those with sight loss.

The Committee noted that the next activity day would take place at 9.30 am on Wednesday 8 November 2017, in Committee Room 1, County Hall.  The Chairman confirmed that there would not be a formal meeting open to the public that day.