Liz Davenport (NHS Devon) and Jane Harris (NHS Devon) delivered the Peninsula Acute Sustainability Programme (PASP) Draft Case for Change to the Board, and discussed:

a)    The recent publication of the Darzi review would likely lead to new programmes of work and priorities, which would influence the PASP presented today;

b)    The strategic shifts in the Government narrative matched the priorities for change from the Devon health and care system: moving from ‘sickness to prevention’, ‘analogue to digital’ and ‘hospital to community’;

c)    The PASP aimed to develop a sustainable health and care system, focussing on ‘health and happy lives’, ‘equal chances for health and wellbeing’, ‘supporting independence’ ‘enabling choice’, and promoting ‘lives free from harm’;

d)    The key challenges that the PASP sought to overcome were workforce and value for money: There were five hospitals across the peninsula but only enough staff to operate four of them, and services cost more to provide than the peninsula received in income;

e)    Engagement workshops with communities had been undertaken, and feedback centred around: long waiting times, concerns for staff workload, frustrations with lengthy process and bureaucracy, lack of integration between health and social care, inequality of access to services, lack of an electronic record, and staff fatigue;

f)     The Darzi report identified a 17% increase in workforce since 2019-2024 however, productivity had declined;

g)    The PASP focussed on establishing a sustainable acute service model, starting at the ‘front door’ with assessment and diagnostic functions;

h)    Having established a shared understanding of the problems in phase one, the PASP would now move into phase two – developing the ‘case for change’;

i)     The One Devon Elective Pilot had shown significant successes, using the Nightingale hospital to optimise capacity and reduce waiting times;

j)     Early indications suggested that the Government was likely to commission an extensive engagement programme with the public, staff and key stakeholders towards the challenges and future of health services.

In response to questions, the Board discussed:

a)    The challenges of engagement and need to mitigate digital exclusion: The Board urged NHS Devon not to rely exclusively on digital engagement, and offered the use of existing resources and networks to assist with future engagement; 

b)    The role of the Nightingale hospital in providing efficient clinical pathways, and its utilisation by Plymouth’s consultants. Patients’ positive feedback and the ability for rapid same-day treatment demonstrated the benefits of joint working across the peninsula;

c)    The importance of including children and young people in the PASP engagement;

d)    Concerns around the exclusion of patients who were not able to travel for care, particularly relating to disability and financial exclusion. It was reported that ensuring equity of access and outcome was a central priority for the PASP;

e)    The requirement for a long term commitment to engagement and consultation with communities, and the fundamental importance of addressing health inequalities;

f)     Potential utilisation of existing structures and networks for the PASP engagement, particularly for children and young people. Plymouth City Council had a number of community engagement activities underway, which could be utilised by NHS Devon when developing the ‘case for change’;

g)    The role of the University of Plymouth in delivering trained professionals to assist with the NHS workforce plan, and challenges faced by centrally allocated placement numbers;

h)    The need to coordinate separate programmes of action and engagement across the peninsula into one central strategy and consolidated effort;

i)     The need to recognise and address the barriers people faced to engagement, access to care, and care outcomes;

j)     The cumulative effect of waiting lists and delays to accessing care on productivity and medical deterioration. 

The Board agreed:

1.    To endorse the approach being undertaken by NHS Devon in engaging with local people;

2.    To support raising awareness locally and to encourage local people to take part in the engagement;

3.    That the PASP returned to the Board at a future date, following analysis of the implications of the Darzi report.