Members will be asked to make any declarations of interest in respect of items on this agenda.

There were no declarations of interest made.

To receive reports on business which, in the opinion of the Chair, should be brought forward for urgent consideration.

There were no items of Chair’s Urgent Business.

The Chair welcomed everyone to meeting and thanked Jerry Clough, Carole Burgoyne, Ann James, Steve Waite and Kelechi Nnoaham to the meeting today to help the Panel to understand the underlying issues effecting the health and social care service today.  The Chair also invited NHS England to the meeting under the regulations pertaining to this committee.  NHS England sent their apologies and therefore would not be attending the meeting today and we will investigate this.

This review on Plymouth’s Health Economy results from the significant pressure that was present in the health and social care system.  This was the first opportunity to have the major organisations together and to have that public discussion on how the system could be improved.

The review hopes to address some of the following –

·         NHS England allocations and related impact on Plymouth;

·         Market forces factor and national tariffs;

·         Public Health settlement;

·         Regulatory bodies.

The Chair invited each of the health representatives to share with the Panel their main funding streams, challenges and recommendations on what could be done to improve the system.

Kelechi Nnoaham, Director of Public Health, Plymouth City Council.

Kelechi reported that Plymouth currently receives £47 per head compared to Portsmouth who receive £77 per head.  The target figure for Plymouth would be £58 per head.   The poor settlement Plymouth receives results from a poor baseline allocation and formula.  The Department of Health uses the standard mortality rates for the under 75s as a basis for allocating funds and there was a strong case to rethink the use of this formula for allocating funding.  In addition to this Plymouth has poorly invested in public health services in relation to other cities in the country. 

Kelechi stated that a strong case should be made when looking at prevention, when it comes to allocating funds we do not invest appropriately in this area.  The integration of health and social care was a huge opportunity to address the commissioning of health and social care services from prevention to wellbeing.

Carole Burgoyne, Strategic Director for People, Plymouth City Council

Carole reported that she has responsibility for a budget of £121m which included a projected overspend of £4.5m.  This overspend was due to pressures in the system, such as children coming into care and the cost of high level need for residential and secure placements and the demands on domiciliary care.

It was also reported that from the 1 April 2015, the Integrated Health and Wellbeing, delivering “One System, One Budget” would be in place.  This system would ensure that individuals would receive the right care, at the right time in the right place as well as meeting the financial challenges and demands in health and social care over the next 3 to 5 years. 

Jerry Clough, Chief Operating Officer of CCG and Managing Director, Western Locality, NEW Devon CCG

Jerry reported that NEW Devon CCG’s budget was £1.1bn, for Plymouth this was £320m and for Derriford Hospital was £420m.  The CCG’s deficit for 2014-15  ...  view the full minutes text for item 3.

The panel will take the opportunity to review its findings and form recommendations for submission to Cabinet.

There are a number of issues which have contributed to the current financial crisis within the Devon health economy.  The review has agreed that “Plymouth Health Deal” will be developed by council officers and partners which will reflects the following –

Structural Funding Issues

National Tariffs for Emergency Care

·         Recognition that the current Tariff system, in failing to fund Emergency Departments appropriately, risks destabilising acute trusts.

·         National Tariffs for Emergency Care should reflect actual costs, and cost effectiveness, of providing high quality emergency care.

Market Forces Factor

·         Reform of the Market Forces Factor within health service funding allocations is required to address the significant underfunding of health services on the Peninsula.

Public Health Settlement

The NHS is becoming increasingly aligned to local priorities and stakeholders and Health and Social Care integration in Plymouth is testament to that. As such NHS resource allocation will need to be seen within the whole system with alongside the other public funding which contributes to health and wellbeing.

·         A formula-based approach, based on a Standardised Mortality Ratio, will not help determine the overall scale of resources needed to improve health inequality. This formula has led to a systematic under-funding within the local authority.  If the allocation system is a tool for achieving wider policy goals a fundamental review of the formula to is required to reflect local need.

Recruitment, retention and agency staff

NHS is undergoing enormous change and is experiencing considerable pressure with increasing demands in the working environment. Whilst there will always be a need for external agency staffing to cover short-term absences that occur there is a significant cost to using external agency staff and the amount spent in 2013-14 on contract and agency staff by NHS trusts was £1.2billion. 

The panel was concerned that reliance on external agency staff is placing a considerable burden on NHS trusts. The review agreed that the Department of Health should consider a cap on commission rates for external agencies providing medical staff to the NHS.

In addition the review agreed that the development of “nurse pool” which offers guaranteed shifts and provides the opportunity to work throughout the health service should be considered as employment gateway to provider organisations on the Peninsula. In addition a casual nurse bank for the Peninsula should be developed.

The panel has noted that Peninsula Postgraduate Medical Education is performs well but feels that a review of fill rates may be in order to understand the underlying reasons why 8 Health Education South West training programmes are below 90% subscribed.   The panel remains particularly concerned with low fill rates within Geriatric Medicine and General Practice. The review agreed that a recruitment marketing campaign to attract graduates to clinical positions in Plymouth and the Peninsula.

Education campaign

The review agreed of the opinion that increasing demand across the system can only be abated by significant investment in public health interventions. 

Whilst the Thrive Plymouth initiative provides a starting point, a conversation with the public should be initiated at a national  ...  view the full minutes text for item 4.

To consider passing a resolution under Section 100A(4) of the Local Government Act 1972 to exclude the press and public from the meeting for the following item(s) of business on the grounds that it (they) involve the likely disclosure of exempt information as defined in paragraph(s)   of Part 1 of Schedule 12A of the Act, as amended by the Freedom of Information Act 2000.

There were no items of exempt business.