Report of the Head of Legal and Governance
Colin Monckton, Director of Strategy and Policy, attended to brief Councillors on the implications of the NHS Long Term Plan for Nottingham, highlighting the following points:
(a) the Plan was published on 7 January 2019 and sets out the NHS direction over the next 10 years, with £20.5bn to be spent over 5 years with the priorities of better integration of health and social care, improving prevention and early intervention, and addressing health inequalities. There will be a commitment to mental health, children and young people, with changes to make procurement processes more efficient and further investment in community teams, to help Local Authorities (LAs) take on more responsibility for good performance;
(b) as part of the plan, systems will be:
(i) restructured, with the clear expectation that LAs will aim to participate in their local Integrated Care Systems (ICS). ICSs will have partnership boards to include LAs with accountability and performance frameworks. There will be a stronger role for the NHS in commissioning preventative health services and the NHS will support local approaches to blending health and social care budgets where councils and CCGs agree;
(ii) redesigned, with a comprehensive rollout of personalised care and personal health budgets. Where outpatients and testing move from acute into community care, LAs will work in partnership with hospitals with major Accident & Emergency departments to reduce delayed transfers of care. New commitments will be in place for reablement and community care to an age-appropriate model;
(iii) reoriented, to create a service design aim that will avoid preventable hospitalisation and tackle the wider underlying factors of mental and physical ill-health. It will tackle health inequalities and include place-based prevention, early intervention and a focus on wider lifestyle, and facilitate the rollout of social prescribing;
(iv) refurbished, so that data management will be improved. The property estate will be maximised, teams and targets will change with the new NHS workforce implementation plan later this year, with community two-hour crisis teams, two-day access to reablement and clinical support for care homes; and the improvement of technology over the next 10 years;
(c) the Plan will be implemented alongside the Adult Social Care Green Paper due in early 2019, the publication of Local Plans for 2019/2020 by April 2019, the publication of local 5-year plans by Autumn 2019, the National Implementation Programme spending review of decisions on social care and Public Health, the Green Paper on prevention and proposed changes to legislation on competition in procurement;
(d) for funding, every area in England will receive a cash increase of at least 17% over the next 5 years, including a minimum rise of 4.4% in 2019/20, with £1bn a year distributed according to greatest need. NHS England will introduce a more accurate assessment of need to ensure the allocations formulae is more responsive to the greatest health inequalities and unmet need from April 2019;
(e) the primary risks include: a potential lack of detail, with the NHS planning guidance still to follow; that the ICS plan will not take a sufficiently place-based approach; that funding is used to fill the holes rather than to create change; that the NHS simply adds a new community function, rather than transforming its general approach; that the commissioning culture does not improve; and that the workforce does not exist to deliver the aims.
Following questions and comments from the Committee, some additional information was provided by Colin Monckton, Serena Broughton and by Dr Hugh Porter:
(f) 111 is a free number to help patients of all needs navigate to the right service, but it also has a clinical function and is able to make appointments for patients at GPs with electronic booking systems. A major objective of the system is to ensure that patients are not forwarded to multiple different points of contact before they reach the service that they need;
(g) the current situation with regards to tackling issues such as gambling addiction is being assessed to develop a collaborative approach to this and related issues;
(h) achieving joined-up, cost-effective decision-making is a major objective, and carers could be given access to the details of a patient’s course of treatment to support them in following it;
(i) currently, the areas of greatest financial need are identified using a formula-driven process lead by the Accounting and Corporate Regulatory Authority (ACRA). It is anticipated that the formula will be financially positive for the City, but it is not yet clear to what degree;
(j) there is a national requirement for the provision of 24/7 mental health crisis services by 2021, with more funding being allocated to help meet the challenge of recruiting and retaining a suitable workforce. A significant effort will be made to improve home resolution and to ensure that patients are not moved outside their community for treatment. A major focus will be on helping people to not reach the crisis point, with more guidance to be issued as part of the Long Term Plan;
(k) a local and collaborative response on commissioning of services is required to avoid perverse incentives encouraging one body to seek to pass costs to another under the pressure of the demands of regulators, rather than aligning resources to being the greatest benefit.
1) thank the Director of Strategy and Policy for sharing the initial information on the NHS Long Term Plan; and
2) consider the NHS Long Term Plan in more detail at the next meeting.