Agenda item

To provide an update regarding the key developments in the NHS Long-Term Plan and initial steps that are taking place in North West London to develop and deliver that plan.

Jonathan Turner (Deputy Managing Director, Brent CCG) introduced the report updating the Board regarding the key developments in the NHS Long-Term Plan. He referred to the initial steps and the engagement activities that were taking place in North West London to develop and deliver that plan.

The report noted that the NHS Long-Term Plan was published on 7th January 2019 after a delay. It set out the strategic direction for the NHS over the next 10 years containing a number of high-level deliverables, together with a 5-year funding settlement for 2019-2024. It also included the funding settlement for the NHS and implications on local delivery.

In considering the key headings of the update report, the Board noted:

·         some of the national public engagement activities including ‘be heard’ and learning disability participation events on 3 and 8 May 2019;

·         the development of an Integrated Care System (ICS) in North West London by 2021; and

·         the move to a single CCG and a summary of the over-arching programme areas that were being worked upon.

Describing the report as the strategic level paper which was ‘work in progress’ and needed the work to ‘make it real’, Jonathan Turner, highlighted the vital sections to the Board and invited their comments on the update and the proposed ‘revised’ priorities for 2019/20.

·         Healthy communities and prevention

·         Maternity, children and young people

·         Primary, social and community care

·         Urgent and emergency care

·        Mental health

·         Cancer care

·         Hospital and specialist care

Highlighting that the implementation of 10-year national plan in North West London for the NHS, the paper stated that the aim was to improve the quality of patient care and health outcomes by focussing on:

·         enabling everyone to get the best start in life;

·         helping communities to live well; and

·         helping people to age well.

Jonathan Turner, supported by Phil Porter (Strategic Director - Community Wellbeing, Brent Council) highlighted the challenging financial situation which meant that although the CCG was receiving an increase in its allocation of 5.9% in 2019/20, it was also reporting an 18/19 deficit of £11.2 million. Phil Porter informed that this financial situation was a trend across North West LondonCCG and beyond, with 7 out of 8 CCGs were projecting a significant deficit in 2019/20. This meant that despite the CCG receiving a 5.9% uplift in its allocation, some of this would have to be passed through to Trusts in the form of a tariff uplifts, which would also off-set the planned increase. This was because the national tariff had been uplifted this year to account for inflationary pressures within provider organisations on an assumption that an average acute tariff would be uplifted by 2.8% and the non-acute contracts will be uplifted by an average of 3.9%. All this meant that there would only be a small sum for demographic and non-demographic growth in activity. This period of financial recovery meant that centralised financial control processes had been put in place for all new investments exceeding £20k must which now must be approved by an NWL level investment committee with difficult decision ahead.

Jonathan Turner, referred that the ‘co-produced plans’ for the local implementation of the ‘Long-Term plan’ were being pursued with Healthwatch Brent, the Citizens’ Plan and other key stakeholders (including the Local Authority) and the work on the single CCG structure was underway which was expected to be completed by April 2020.

In considering the update report and to facilitate a frank and constructive exchange of views, Councillor Farah (Chair), opened the floor to receive the Board’s comments and views on the update report. During the discussion, the following key points were noted:

·         Highlighting a total lack of joined-up approach and the absence of genuine local engagement with key stakeholders, Carolyn Downs (Chief Executive - Brent Council), stated that the 10-year NHS Plan seemed to be one of the most top-down plans in public service with a dictate to create a single CCG without any meaningful consultation was breath-taking. She noted that the Responsible Officer (Mark Easton) had failed to attend any Board meetings. While other requests and efforts for a meeting were ignored, her request for a meeting had finally resulted in ‘only one possible date’ being provided to her office. She emphasised the need for the local stakeholders to promptly work together to device a local solution that worked instead of the one being imposed from outside. Citing the example of Hammersmith and Fulham Council, she added that, in the worst case scenario, Brent Council could choose to refuse the co-operation in local implementation if it felt that the genuine local concerns were not being listened to or addressed;

·         Cllr McLennan requested more information about how people were being selected to be on the Citizens’ Panel.

·         Dr MC Patel (Vice Chair) concurred with the views expressed by Carolyn Downs and stated that it was the right time to stand up for local solution and what the Board felt was needed to be done. He added that part of the problem was no one seemed to know what ICS really was; and

·         Councillor Farah (Chair) stated that the Council and its Health and Wellbeing Board should not be legitimising the process and implementation if we did not know the details of the plan and its impact on local residents and services.

After detailed discussion, the Board RESOLVED that:

Based on the above discussion, highlighting relevant concerns, together with a formal request for meeting - a suitably worded letter for the Responsible Officer on behalf of the Brent Health and Wellbeing Board be drafted by Jonathan Turner (Deputy Managing Director, Brent CCG) and sent accordingly.