Decision details

Mr David Bonson, Chief Operating Officer, Blackpool Clinical Commissioning Group, Mr Roy Fisher, Chairman, Blackpool Clinical Commissioning Group and Ms Jeannie Harrop, Senior Commissioning Manager, Blackpool Clinical Commissioning Group presented an update regarding the development of health and social care integration in Blackpool (as part of the wider Fylde Coast local delivery partnership).

Members had considered integration first in November 2016 in the early stages of development. They had felt that there was not sufficient detail of local work within the Sustainability and Transformation Plan (STP) for Lancashire and South Cumbria nor financial costings. Members had recognised that NHS England had given little time for draft plans so a comprehensive progress report had been requested for summer 2017 included detailed cost savings proposals. 

Mr Bonson explained that integration required strategic direction and practical changes to service delivery which were being jointly developed by councils and the health sector. He explained that Sustainability and Transformation Plans had been developed nationally as five-year plans (2016-2017 to 2020-2021) as part of NHS England’s Five-Year Plan. There were 44 ‘vanguard’ pilot geographic areas which were leading on transformation and integration of NHS and Social Care services. Lancashire and South Cumbria was one pilot area.

Mr Bonson referred to the Lancashire and South Cumbria Sustainability and Transformation Plan within which were five local ‘footprint’ geographic areas responsible for delivering services, one being the Fylde Coast area including Blackpool and eight themed workstream programmes.  The local areas were based on populations, locations of services and actual patient flow rather than traditional local authority boundaries.

Mr Bonson explained that the Sustainability and Transformation Plan aimed to develop major transformation to meet patient, population and financial demand. He added that NHS funding had increased but was being outpaced by patient and population demand. There was a drive towards more community and locality based services (including promoting self-help and better health for people avoiding illness) and reducing the need for hospital admissions.

Mr Bonson explained that the Fylde Coast delivery arm was now also one of eight pioneer Accountable Care Systems being developed nationally. These were leading on developing integrated working arrangements between council, health and other partners including the pooling of budgets. They were not legally binding but designed for partners to make the best use of resources and hold each other individually and collectively to account. Ms Harrop added that on a practical level the Accountable Care System would allow joint commissioning to integrate spending and provide more seamless care pathways for patients.

Ms Harrop referred to New Models of Care (NMC) work which had been developing over recent years. These aimed to develop alternative primary care options closer to people in local neighbour hubs with the co-location of professionals (GPs, mental health staff, social workers, nurses and other groups) and promote preventative action to reduce costs and hospital admissions. She gave examples of health and wellbeing workers going to people’s homes and helping devising individual care plans. She added that the team were growing and that there would be several hubs across Blackpool.

Ms Harrop gave particular examples of New Models of Care. The Extensive Care System, supported people locally who had several complex long-term conditions. The Enhanced Primary Care Service also supported people locally who had complex conditions. End of life care was being developed with local hospices. To help manage patient turnover, there would be more effective ‘step up, step down’ approaches as people’s health needs changed.

Ms Harrop gave other examples of New Models of Care. Extra funding had been awarded for telemedicine and IT equipment to be developed with care homes to allow better patient monitoring and quick responses to simple needs by contacting the neighbourhood hub teams rather than resorting to unnecessary hospital admissions. Care homes were a big source of patients using the ambulance service and Accident and Emergency when not absolutely necessary. The care homes had been given assurance that primary care would still be available. A self-care strategy for families was being pursued which had involved local consultation.  Self-care was supported by initiatives such as a new directory of web-based information services for the Fylde Coast area. The directory covered health and social care services as well as community activities.

Ms Harrop added that it was aimed to involve the voluntary sector, e.g. Carers’ Centre, as part of the staffing for hubs. A New Models of Care Business Planning event was being held on 18 October 2017 with the voluntary sector invited.

Ms Harrop concluded that performance indicators were being developed and would be monitored through the ‘Vanguard’.

Members noted the good progress with building multi-disciplinary teams of professionals (GPs, social workers, community and district nurses, mental health staff and other groups) in local hubs closer to communities and providing tailored levels of care such as extensive, enhanced and end of life care. However, they noted that the New Models of Care were still only supporting relatively small numbers of people and there had been no real reduction in hospital admissions. They queried how better patient outcomes would be measured including over the busy winter period. Mr Bonson explained that NHS England did monitor return on investment, e.g. target of hospital admissions reduced by 20%. The New Models of Care were collectively helping, e.g. reviewing falls. He added that the self-care preventative work was important and communities needed to be supported to develop self-care. Ms Harrop added that a Sustainability and Transformation Plan impact report would be available in the next month which would be circulated.

Members queried whether people were still properly catered for when services ‘stepped down’ including being active and options such as disabled facilities grants were used. Assurance was given including health and wellbeing workers supporting people to become independent, the voluntary sector would be used to support people to become more active. Integrated commissioning made the best use of grants and equipment was sought from various means led by Blackpool Coastal Housing. Members requested some neighbourhood hub (patient) case studies for the next progress report.

Members noted that efforts were being made to involve the voluntary sector which had been previously requested.

GPs were understood to be able to cover 25% of work done in Accident and Emergency, i.e. patients who did not need to present at and thereby reduce Accident and Emergency pressures. Members queried whether there was effective use of pharmacies, e.g. use of repeat prescribing to reduce the burden on GPs who could then in turn take on relevant non-emergency hospital work and thereby reduce some pressure on hospitals. Mr Bonson confirmed that pharmacies were used effectively but would provide current details, e.g. on repeat prescribing and ‘Minor Ailments Scheme’. Ms Turner-Birchall added that Healthwatch Blackpool had undertaken some work on community pharmacies which she would share.

Members welcomed the Directory of web-based info services but were still not fully convinced that the draft Self-Care Strategy, which was due to be consulted upon following initial stakeholder involvement, could easily create the cultural change required. The Clinical Commissioning Group agreed but added change would take time.

Members had previously requested detailed cost savings. Mr Bonson explained that there appeared to not be much detail available locally. He undertook to check with the Finance lead officer for the Sustainability and Transformation Plan.

Members still needed more assurance that the Sustainability and Transformation Plan objectives could be delivered and were on track given that the Plan was now at the mid-way point of the five year timeframe. They did recognise that it was a long-term programme.

Members recognised the importance to monitor Health and Social Care integration and Sustainability and Transformation Plan progress at reasonable intervals and requested another comprehensive update for around May 2018. Interim progress could still be requested. Members also requested that a team leader from an integrated neighbourhood hub attended to outline ‘on the ground’ progress. Attendance of a clinician would also be welcomed. Members were informed that could attend neighbourhood hub meetings.

The Committee agreed:

1.      To receive a progress report on health and social care integration, including detailed financial profiling as part of the Sustainability and Transformation Plan update, New Models of Care patient case studies (including ‘stepping down’ after-care support) for the May 2018 Committee meeting and attendance of a team leader from an integrated neighbourhood hub for that meeting.

2.      To receive a copy of the Sustainability and Transformation Plan Impact Report in autumn 2017.

3.      To receive details of how pharmacies were being used effectively to support patients and reduce demand on GP practices.