Saturday 26 November 2016

How effective was Brent Scrutiny's consideration of the STP?

The Sustainability and Transformation Plans for the NHS have come in for severe criticism as a cover for cuts.  The Brent Community and Wellbeing Scrutiny Committee of September 20th discussed the plans.  This is the official minute of their discussion:

The committee considered the report from the Chief Executive of Brent Council and Chief Officer of Brent Clinical Commissioning Group on the Sustainability and Transformation Plan (STP). Rob Larkman (Chief Officer, Brent Harrow Hillingdon CCGs) advised that the requirement for the production of the STP was introduced by the NHS England in 2015. The purpose of the STP was to help local organisations plan how to deliver a better health service by addressing three key areas; improving health and wellbeing, improving quality of care and tackling the financial gap. The STP moved away from an organisation by organisation view to establish a broader strategic approach. Brent fell under the STP for North West London. It was acknowledged that work for this was taking place at several levels. At the North West London Level work was underway to draw together the place- based planning taking place in Brent and the seven other North West London Boroughs which were encompassed by the North West London STP. The STP was required to be submitted by the end of October 2016. It was emphasised that the timescales set out for the creation of the STP were extremely challenging. A draft NWL STP had been published and it was now necessary for all the statutory bodies affected by the STP to consider the details in line with their respective governance arrangements.
Addressing concerns regarding transparency and accountability, Carolyn Downs (Chief Executive of Brent Council) explained that the task of creating high quality plans to the level of detail required within the timescales set out had been extremely challenging. However, the NWL STP was recognised as one of the more detailed plans created and was the only one in the country for which joint governance processes had been supported to ensure political input from all affected local authorities. Reflecting this, five of the eight local authorities had jointly commissioned work to test the assumptions in the plan specifically related to the cost of additional out of hospital care to social care as a result of any proposed changes to acute services. The NWL STP was the only plan in the country to specifically address the social care funding gap. The NWL STP was also one of only two plans to have been published and a series of public engagement events would be held. Councillor Hirani (Cabinet member Community Wellbeing) added that events would be held out in the community in places such as supermarkets, stations and high streets to inform and engage residents.
Sarah Mansuralli (Chief Operating Officer, Brent Clinical Commissioning Group) outlined the work taking place at a local level. Members heard that a STP Brent- level working group had been established bringing together statutory partners including the Acute Trust, the Central and North West London Mental Health Trust and Brent Healthwatch, to break down organisational barriers. The working group had sought to identify the initiatives that would have the highest impact in Brent for addressing the three key issues at which the STP was targeted. Phil Porter (Strategic Director, Community and Wellbeing) detailed the five areas which had been identified as part of this work noting that this included prevention and self- care, renewing the ambition and focus in Brent’s Better Care Fund schemes, using the OnePublic estate model, ensuring mental health and wellbeing had equal focus with physical health and wellbeing and, underpinning all the rest, integrated workforce and organisational development.
At the invitation of the Chair, Simon Crawford (Director of Strategy, London North West Healthcare NHS Trust) emphasised that the STP provided a vehicle for collaborative working on the out of hospital agenda and integration and Brent was one of the most advanced in identifying what this meant locally. Julie Pal (Healthwatch Brent) expressed her confidence in the process being followed in Brent, having experience of delivering across a number of STP areas and noted that Brent residents’ voices were clearly contributing to the shaping of the transformation agenda.
Members questioned the extent to which Brent had been able to influence the setting of local priorities within the STP. A Member emphasised that housing was integral to the safety and security of those with Mental Health issues but that taking up employment could create a significant barrier for accessing appropriately supported housing. In view of this and with reference to plans to develop a multi- disciplinary team with a remit for mental health, employment and housing it was questioned what would be done to address this issue and ensure necessary support was provided. Further details were sought regarding the planned engagement activity and how this had been advertised. It was suggested that local pharmacists be approached within this engagement work in recognition of the level of contact that they had with people and similarly, that consideration be given to involving other local organisations and bodies including voluntary organisations and the patients forum. Questions were raised regarding extending access to GPs and investment in the Central Middlesex and Willesden sites. Addressing the tight timescales involved, the committee queried whether this posed any risks in terms of gaps in delivery.
Rob Larkman and Sarah Mansuralli confirmed that the borough had absolute discretion in determining the priorities for Brent. Local priorities had been established with reference to the Joint Strategic Needs Assessment and had then been consolidated at the NWL level. Similar processes had been followed by other NWL authorities. Phil Porter acknowledged the significant challenge posed by housing and employment issues for those with mental health needs and noted that a dedicated housing officer was now in place and work was underway to build a network of private sector landlords willing to offer secure tenancies. Carolyn Downs welcomed the insight provided by members into this area. It was suggested that the committee consider at a future meeting the West London Alliance Mental Health and Employment Integration National Trailblazer which aimed to bring together GPs and wider organisations to support people into employment.
Addressing queries regarding the community engagement activity, Councillor Hirani emphasised that public meetings would be held alongside a series of events at public locations. Members of the public would be invited to share their views in a variety of ways. Work was also currently being carried out to allow residents accessing acute and hospital services to feed their views into the process. Sarah Mansuralli welcomed members suggestions regarding approaching pharmacists and other groups including patients’ forums and confirmed that these would be taken forward. A Health Partner Forum was scheduled for 19 October at which the CCG commissioning intentions (based on the STP) would be discussed. Members were further advised that an online engagement tool had been launched for the whole of North West London and had been widely circulated.
Rob Larkman confirmed that extending access to GPs was a crucial element of the STP and now that co-commissioning arrangements were in place between NHSE and CCGs, greater influence could be exerted. Addressing queries about investment in the Central Middlesex Hospital and the Willesden Hospital sites, Sarah Mansuralli explained that the intention was to fully utilise each site for out of hospital provision. The demography of the area around the Central Middlesex Hospital was changing and consideration was being given to how best to organise service provision accordingly. Carolyn Downs emphasised that the work on the STP would remain an alliterative process and the flow of investment, savings made and outcomes achieved would need to be constantly reviewed.


.        (i)  that the officers and colleagues present be thanked for contributing to the detailed and open discussion held;
.        (ii)  that the committee welcomed the work being undertaken to ensure that issues regarding transparency and accountability were highlighted as part of the process of creating the Sustainability and Transformation Plan;
.        (iii)  that an update be provided to the committee on the OnePublic Estate, including an update on the Central Middlesex and Willesden Hubs;
.        (iv)  that efforts be made to engage with Health Scrutiny across North West London with regard to the Sustainability and Transformation Plan;
.        (v)  that consideration be given to collaborative work with Healthwatch groups to support engagement around the Sustainability and Transformation Plan
.        (vi)  that a regular progress report on the Sustainability and Transformation Plan be provided to the committee, the first of these to be provided six months from the date of the current meeting.

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