Agenda item

Simon Perks, Director of System Transformation, Kent and Medway STP was in attendance for this item.

(1)      The Chair welcomed Mr Perks to the Committee.  Mr Perks began by informing the Committee that Mr Douglas had been called for Jury Service and was not available to attend.  Mr Perks said that Mr Douglas, Accountable Officer and Dr Bob Bowes, Chair of the Steering Group are leading the Programme and that he was supporting them both.

(2)      Mr Perks drew attention to the two diagrams presented in the report and explained that they gave a conceptual outline, and that work was being undertaken in December with Providers and Commissioners to add detail to this.  He highlighted that the NHS Improvement and NHS England consultation, launched last week on their future shape, will in turn shape the strategic commissioning role for Kent and Medway.  Mr Perks continued that the Vanguards on integrated care systems, operating across the country, were working on the learning and would also provide guidance.

(3)      Mr Perks emphasised that it was important to get it right and be progressive in approach as Kent and Medway was the sixth largest STP area in the country and the process would clearly have implications for the population.  Mr Perks highlighted that there were many operational and financial challenges that face the system.  He said integrated provision at a local level, such as the Whitstable Vanguard can show benefits but acknowledged that within the health system there were differences in decision making such as Freestyle Libre and IVF that could not be ignored and that he hoped to move to a coherent single decision-making process.  Mr Perks understood there were concerns about a single strategic commissioner and the facilitation of services at a local level, but work was being undertaken to address this.

(4)      Members enquired about the system being similar in nature to previous NHS structures and potential changes in legislation.  Mr Perks said that he did not anticipate any legislative change and that any new commissioning entity will have to be in a form of CCG.  He confirmed that CCG Chair have come to a view on the forming of a single commissioner across Kent and Medway, but it was to be remembered that they are membership organisations, with members needing to be convinced of all the arguments.

(5)      Members expressed concern about finances, including transitional time and costs and workforce.  Mr Perks said that the early work within the STP was to build a business case which would show the financial gap projections.  He said that the Strategic Commissioner would utilise variation data to understand variations in resources deployed against outcomes attained.   He acknowledged the transactional costs of the current system, with a lot of commissioner time being spent on operating contracts in the commissioner/provider split, was not a good use of effort and time.  Mr Perks elaborated on the design process of Care Pathways, which he believed were created in isolation and emphasised that benefits could be seen in bringing those together.

(6)      Mr Perks explained that there was a real difference in this revised commissioning arrangement. The STP was being led by clinicians with clinical leadership being intrinsic in a way never seen before. 

(7)      Mr Perks agreed that workforce was a bigger issue than money. Work was being undertaken to harmonise agency pay rates and to introduce capping but there was a concern that staff were not available in the first instance.  Mr Perks continued by explaining that integration would assist the nature of provision and that teams covering broad specialisms helping manage workload, enrich job planning and aid retainment.  He believed that the STP collaboration could bring benefits, referencing the Kent and Medway Medical School’s successful application as an example.

(8)      A Member asked about timelines and for specific plans to be brought to the Committee.  Mr Perks informed the Committee that the ambition was to have the Strategic Commissioner up and running in April 2020, with integrated care providers working within 24 months post-2020.  He confirmed that this was broad thinking, but that NHS England and NHS Improvement would be involved in the process.

(9)      The Chair enquired about the first area of STP focus on cancer services.  Mr Perks said that in the summer the Steering Group looked at areas that could be comfortably commissioned once across the County.  Cancer access standards were an issue and there were several parties involved in the organisation and commissioning of services.  He said that any work undertaken would be reported back to Committee. 

(10)   Mr Perks continued that future commissioning approaches could be focussed on digital and estate infrastructure.  He confirmed that a Joint Committee of Clinical Commissioning Groups (JCCCG) would provide oversight of these areas.

(11)   Ms Frazer, Kent County Council STP Programme Lead, was invited to speak by the Chair.  Ms Frazer explained that the elements referenced by the Chair were being developed now with the STP looking at pathways and ways to improve integration.

(12)   Ms Duggal, Deputy Director of Public, Kent County Council was invited to speak by the Chair.  Ms Duggal said that as part of the work being undertaken prevention was a key element, such as the smoking cessation service.

(13)   RESOLVED that the report be noted, and the Kent & Medway STP be requested to provide a detailed update in six months’ time.