STP Board Overview

The STP Board met in September to discuss and debate a variety of key topics and below is a brief overview of the decisions made.

Following the Senior Responsible Officers Report several key decisions were concluded:

  •     The Memorandum of Understanding and the Governance structure was agreed.
  •     The Board agreed to the Lay Chair of the Partnership Engagement Forum sitting on the STP Board.
  •     It was reported that there are a number of interim arrangements currently supporting the STP core team functions as well as an external consultancy. The consultancy support will finish at the end of September.

The Board discussed the need for the core team to take the STP forward including a finance role and a full time programme development director. There was agreement from the Board to support the resourcing of the STP core team.

NHSE Specialised Commissioning East Midlands Hub requested a seat on the STP Board to ensure that Derbyshire service development/transformation proposals are properly informed and integrated with specialised commissioning plans and priorities.

The Board agreed to NHSE Specialised Commissioning East Midlands Hub becoming part of the STP Board.

Derbyshire System Performance Report

A report was provided by Dean Wallace, Director of Public Health of Derbyshire County Council, on the development of a System Intelligence Hub. The Hub is being set up to make sure what we are delivering actually improves people’s lives and makes sure we are delivering what we set out to achieve.

The team will be working with workstreams to finalise a STP Performance Framework which will incorporate national reporting and system level indicators and existing performance data. Once complete the framework will be used to report performance to the system including Health and Well Being Boards.

It was agreed that it is key that the analytic resource should be shared across all organisations and there was a strong commitment from the CCGs to work with the two Departments of Public Health to develop one intelligence hub.

The Board agreed to support the work and make sure it is developed at pace.

System Financial Performance

The ongoing challenge organisations are facing around balancing organisational priorities with system priorities was reflected in the system’s financial position.

Providers and commissioners pledged to work closely together across the health and social care system, to make the changes needed to deliver care in the right place, in the right way, at the right time, while rising to the financial challenges faced – as elsewhere in the country.

It has been reported repeatedly that there needs to be a shift away from working in organisational silos and doing nothing, as the estimated financial gap of more than £240m in our health system and £136m in our local authority over the next three years remains a challenge.

At the Board meeting it was reported that the transformation planned last October has not moved as fast as needed because of the difficulties around balancing organisational priorities with system priorities. As a result the system wide financial position has not improved and this year there is a financial gap of around £70m in the NHS.

The focus on new ways of managing and sharing financial risk across the health and care system was discussed and the Board were asked to consider:

  •     Agreeing a year-end financial position for 2017/2018 as quickly as possible to allow focus and time on 2018/2019
  •     Plan collectively, rather than bilaterally.
  •     Incentivising transformation, by using different contractual mechanisms.
  •     Maximising financial flexibility by taking a system approach.
  •     Developing a system plan, rather than separate unconnected organisation plans.

The Board is dedicating an away day in October where there will be a focus on the financial plan and work steam priorities.

The Better Care Fund

A presentation was made on The Better Care Fund (BCF), which joins-up health and care services, so people can manage their own health and wellbeing, and live independently in their communities for as long as possible. Each year the budgets are set by the NHS and local authorities and used to fund social and out of hospital services.

This year additional iBCF funding has been allocated to assist with three areas including supporting hospital discharges. This money is subject to a Government review in November and there is a risk that if Derbyshire does not perform well on delayed transfers of care, the iBCF funding could be reduced.

Currently the BCF is managed through a separate BCF programme Board but the potential for integrating management into the STP was raised and will be considered by the LAs and CCGs.

It was confirmed that System DTOC performance will form part of the STP intelligence and performance monitoring framework being developed.

Derby Teaching Hospital Foundation Trust and Burton Hospitals NHS Foundation Trust merger

An update was provided on the merger of Burton Hospitals NHS Foundation Trust and Derby Teaching Hospitals NHS Foundation Trust. The two hospitals continue to work on the full business case for the merger, which will need to be complete by January next year. This is a large piece of complex work and many people across the trusts are focussed on making sure key deadlines are met to achieve the goal which aims to improve the quality of care for patients.

Senior Responsible Officer Update

At the meeting Tracy Allen, chief executive of Derbyshire Community Health Service NHS Foundation Trust, announced she will be leaving the role as Interim Senior Responsibility Officer for the STP. The recruitment for this role will be led by our regulators, NHS England and NHS Improvement and we will keep you informed of any updates going forward.

New Chief Finance Officer for the Clinical Commissioning Groups

The Governing Bodies of the four Clinical Commissioning Groups across Derbyshire (North Derbyshire CCG, Southern Derbyshire CCG, Hardwick CCG and Erewash CCG) have confirmed the appointment of Louise Bainbridge as Chief Finance Officer. Louise will be joining the organisation from Nottingham City CCG, and will officially start at the beginning of November.

Louise has a strong track record of delivery at Nottingham City CCG where she has been Chief Finance Officer since 2013, having joined the former Primary Care Trust in 2007.

Dr Chris Clayton, the new joint Accountable Officer. Is due to start his new role on October 2nd.

Engagement

Together with Derby and Derbyshire Healthwatch and voluntary organisations we have attended 11 events across Derbyshire to start the conversation about the future of health and social care.

People across the county and city have given us their views and have answered the questionnaire which aims to raise awareness of the changes needed to be made to health and social care and get their views on the initial priorities.

During the events we have reached more than 500 people and 120 people have filled out a short and simple questionnaire.

Online 44 people have filled out the questionnaire.

The questionnaire has been shared extensively through all channels across the 11 organisations, Healthwatch and Voluntary organisations.

The engagement will run until October 31st and during September there will be a focus on:

  •     Promoting the questionnaire and working with organisations to involve staff
  •     Approximately eight – 10 sessions specifically for carers
  •     Working on engaging with young people
  •     Healthwatch Derby will focus on reaching specific communities in the city

If you have any suggestions about where we could go either in your organisation or meetings we could attend in your local area in Derbyshire please get in touch. To answer the questionnaire visit https://www.surveymonkey.co.uk/r/joinedupcarederbyshire

If you are interested in getting involved in Joined Up Care Derbyshire or have a question please contact joinedupcarederbyshire@nhs.net       

Updates from other meetings taking place in September

Clinical representatives from all organisations involved in Joined Up Care Derbyshire (our Sustainability and Transformation Plan, or ‘STP’) came together for the first Clinical and Professional Reference Group (CPRG) and our local Providers of services met for the first Provider Alliance Group (PAG).

CPRG and PAG form a key part of the Joined Up Care Derbyshire governance which will support the change and new ways of working across Derbyshire.

CPRG will drive change from a clinical perspective and support the delivery of clinical quality standards. PAG brings together the Senior Responsible Officers (SROs) for each work stream and is vital in supporting the work streams to make things happen.    

Highlights from workstreams

The Place workstream is rolling out a simple initiative launched by Hardwick Clinical Commissioning Group (CCG) to support people living in care homes receive the treatment they need and as a result reduce hospital admissions and speed up discharge.

The “Red Bag” keeps important information about a care home resident’s health in one place, easily accessible to ambulance and hospital staff so they can determine the treatment a resident needs more effectively.

This work which focussed on Bolsover and Alfreton has already seen better person-centred care for the patient. Other areas in the country have been using this initiative for some time which has improved care and ironed out potential problems for patients and their carers that can cause confusion and delay.

Delays in the discharge of patients place a huge burden on the NHS nationally and locally. Figures show that more than a million hospital days were lost due to delayed discharges in 2015. In 2012-13, more than a million people were readmitted to hospital as an emergency within 30 days of discharge. This cost the NHS £2.4 billion.

As a result of the evidence Derbyshire County Council are purchasing 300 red bags to introduce the initiative in care homes across the county.

Access to Primary Care workstream also reported that 35% of people in the county already have increased access to GPs and primary care services at evening and weekends. More people are now set to benefit as the additional access to GPs is being introduced in other parts of the county from this month.