Professor Sir Malcolm Grant will attend the meeting to discuss NHS England’s priroties for 2016-17 and take part in a discussion with Board Members.
Minutes:
The Chairman introduced Professor Sir Malcolm Grant, Chairman of NHS England, who had been invited to attend the Board to address Members on NHS England’s priorities for the forthcoming year and to present views on the health and care agenda.
Sir Malcolm provided the Board with background information on the history of NHS England, who lead the NHS and encourage and inform the national debate on how to improve health and care, and the current national picture in terms of funding and provision of services. NHS England allocated £106 billion in funds and held organisations such as Clinical Commissioning Groups (CCGs), Primary Care Trusts, pharmacies and dentists surgeries to account for spending money effectively. They had a level of independence which was underpinned by a model to look at outcome and not process. NHS England had a good working relationship with local government, but Sir Malcolm commented that there remained a certain amount of silo working, particularly over funding from the Government.
He highlighted that demand mist be controlled and reduced; attendances at A&E, and general admittance to hospitals, was increasing, the GP workforce was struggling to meet demand, and the country had an ageing population. It was anticipated that an additional £30 billion in funding was required by 2020/21 to keep the current service, with additional money required for improvements.
On STPs, Sir Malcolm explained that NHS England were seeing profound results. The focus was on pathways of care and moving away from silo funding to pooled funding, enabling local leaders to think about population health in the round and how funding flows could be redirected in more efficient ways. NHS England hoped that STPs would provide a better service to patients with limited budgets. They presented a unique opportunity to bring about change and, although there had been challenges, all STPs would be published by the end of December 2016. Good local leadership was required, and all STPs had some level of local authority engagement, although there was huge variety across the country and some would require a significant review of services. The STPs would not include full financial modelling, but it was hoped they would start the process of communities and local leadership coming together to improve services.
In the discussion with Sir Malcolm which followed Members raised the following points:
· A number of councils had agreed to move to an accountable care model, although geography was still an issue in some areas. One Member highlighted that his council had agreed to run this as a shadow for a year and that all local Trusts were involved. It was hoped that this would help to improve local services and allow partners to have a larger amount of funding to spend collectively. Public engagement on STPs was important, but the discussion should focus on structured principles and how a better package of care could be delivered.
· Members highlighted that STPs should be transparent, democratically accountable and person-centred, and this was unfortunately not the case in all localities. There was a cultural difference between local government and the NHS around democratic accountability, and accountability and responsibility were essential to meet local need. Sir Malcolm agreed that there was a strong case for local government political leadership of STPs, but that getting the right balance between local government and the NHS was vital.
· In response to a question on recruitment and training in ambulance services, Sir Malcolm commented that they were a victim of demand, and it should be possible to prioritise prevention so that ambulances crews were not put under undue stress. Recruitment and retention of staff in the service was an important issue, but there was no easy answer.
· It was highlighted that many STPs focussed mainly on institutions, and there was little focus on public health. More funding should be transferred to primary care and pre-care. Sir Malcolm praised local authorities’’ work on prevention, highlighting the dramatic drop in adult smoking over the last 40 years and current campaigns around childhood obesity and the sugar tax.
· Sir Malcom agreed with Member comments on calling for full funding for Adult Social Care from the Government. He explained that NHS England would work closely with the Treasury on this, and would continue to emphasise the importance of social care funding.
· Regarding housing, Sir Malcolm commented that a major determinate of health was poverty and poor living conditions. This had an impact on mental as well as physical health. He highlighted that mental health was a major theme in STPs.
· In response to a question on CCGs, Sir Malcolm stated that many CCGs were resistant to mergers, and NHS England would only endorse a merger if it was justified.
Decision
The Community Wellbeing Board noted Sir Malcolm’s comments and thanked him for his attendance at the Board.