Agenda item

4.1

The Board considered a report of the Director of Public Health and the Integrated Commissioning Programme Director concerning the development of the South Yorkshire and Bassetlaw Sustainability and Transformation Plan (STP) and Sheffield Local STP. Greg Fell, the Director of Public Health, introduced the report and confirmed that the existing statutory bodies had responsibility for governance relating to the Plan and the Board was requested to note the current position as regards the STP and Sheffield Place Based Plan and to provide robust challenge as appropriate.

4.2

The STP would be used to deliver what people wanted to be done in Sheffield, including better care, enabling people to be healthier and an NHS which ran more efficiently. A coalition of different organisations would work together to achieve those aims.

4.3

Members of the Board asked questions and made comments and responses were provided, as summarised below:

4.4

The Plan documents should make sure to mention children and young people as well as adults, for example in relation to mental health. The programme relating to children and young people was developing and there was an emphasis on increasing the proportion of children in the City who were school ready. There were also positive developments relating to dental health for young children and immunisation. 

4.5

There were inequalities relating to health in Sheffield. For example, many people did not go to their GP and there was evidence of people dying early when they might have received treatment for their health condition. A problem was how people might be encouraged to seek help when they were aware of symptoms. Action did need to be taken to help people who did not access health services. In some circumstances, investments may have to be made on wider determinants of health which would impact upon inequalities, such as work to increase the numbers of school ready children.

4.6

The Plan broadly referenced voluntary and intermediary groups and it could be more specific so as to include people who were volunteers, in voluntary and community organisations, in workforce programmes. It was also acknowledged that the voluntary, community and faith sector and Healthwatch were particularly effective in relation to involvement and engagement and it was suggested that the Board support the establishment of a working group on that issue.

4.7

Whilst the link between economic and health factors was mentioned in the Plan, there was a risk that the Plan became focussed too much on health services. Such factors as employment and health might be included to a greater degree in the Sheffield Local STP. Business and education sectors would need to be included in engagement to discuss such issues as sickness and wellbeing, employment and apprenticeships.  Attention should also be given to the inclusion of black and minority ethnic communities. 

4.8

Work and health were included in the Plan and a bid had been submitted to the Government’s Work and Health Innovation Fund with regard to a project which aimed to get people with certain health conditions back into employment. A report would be submitted to the next Strategy meeting of this Board regarding employment and health. The Transforming Sheffield Programme Board representing the Chief Executives of Sheffield’s health and social care organisations would consider the STP and with regard to support and sponsorship for the Sheffield based Plan, the Chief Executives of both the Council and Teaching Hospitals Trust were members of that Board.

4.9

It would be considered how broader commercial interests might be included within the STP and how investment in Sheffield might be used to stimulate the local economy and keep employment and business in the City.   

4.10

A comment was made that the Plan as it was written did not translate into a picture of transformation. Whilst success measures were good, it was not apparent how much change they might bring about. Although there was an opportunity to bring about transformative change, there was nothing in the Plan which said how it could be achieved. It would be important to identify how barriers which had prevented delivery could be removed. 

4.11

Governance was potentially a difficult issue and it might prevent the health and social care community from delivering its ambitions. Health and social care organisations did not share risk and operated in silos and this represented a barrier. Whereas, patients should be considered before organisations. The requirement for each organisation to balance a budget or achieve financial control targets did not help them to share risk. The governance issue should be identified as a potential risk.

4.12

Organisational boundaries presented a problem and on reflection, some plans had not been fully transacted because barriers were in place. However, the governance was something which had to be worked through and some difficult things had been achieved within existing governance arrangements. It was possible that NHS England could attempt to improve this situation where risks were identified, so that health and social care organisations were able to do bold things.

4.13

Describing what success looked like in the Plans was a challenge and might be achieved by looking at outcomes to understand what was understood by transformation in reality and on the ground. For example, improving children’s readiness for school could be measured by how well they were potty trained and whether they displayed good behaviour on entering school.

4.14

A memorandum of understanding had been agreed and signed by providers which would enable services and resources to move from one organisation to another.  This needed to be tested but it could form the basis of a different model of governance. The Chief Executives of Health and Social Care organisations had agreed to the Plan and they would be held to account. The idea of a single balance sheet had also been agreed. How this translated into contracting intentions was something which was being done through co-commissioning with the local authority in respect of children’s and mental health services.

4.15

A combination of primary care, community care services and the voluntary sector would be utilised to help deliver and more might be done by community services which may have otherwise been done in hospital settings. It was thought that the STP needed to say more about primary care, community care and social care.

4.16

General Practice was an important part of developing a strong and sustainable model of primary care for the City and the CCG had published a Primary Care Strategy and Practices were positive about the model of neighbourhood working to support people in staying well.

4.17

Areas to focus on included: inequalities; health and work; governance, including in relation to the use of financial resources and how these were accounted for, decision making and risk; primary and social care; raising the profile of things which were already happening; and recognising barriers and challenging them.

4.18

In relation to measures of success, there were some City-wide issues which might be considered, including children’s health and wellbeing, employment and equality as well as indicators of behaviours between organisations.  The plan also needed to add value to existing initiatives. Successful engagement was also an important factor. Success might also be defined by the extent to which issues which prevented change, including system governance, were addressed collectively.

4.19

It was considered that the construction of the plan was an iterative process. The next step was the submission of the detailed plans and an approach to engagement and communications would also need to be in place by that point in time.

4.20

RESOLVED: That the Health and Wellbeing Board:

(1)    notes (a) the context in which the Sustainability and Transformation Plan (STP) is being developed, and the challenging timescales that have been set; (b) that many of the constituent parts of the plan reflect plans that are already in train – both at South Yorkshire and Sheffield level; (c) that the plan represents an opportunity to transform service provision in a way that better enables us to meet the three goals of improved heath & wellbeing, improved service quality, and improved efficiency; and

(2)    notes the points raised during the Board’s consideration of the plan at this meeting and as outlined above, including its consideration of improvements to the way the plan is being developed that will enable greater involvement and engagement of groups not currently involved and elements of the plan or process that need to be made more visible and explicit.