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 level to highlight the risks of, for example, undergoing surgical treatments when at BMI 35 or above.

At a national level the general public must be made aware that, by looking after their own health, they play a part in improving the health and sustainability of the NHS into the future. 

Fair Distribution of Funding

The review was not assured that the allocation of funding across the CCG area was fair. The review agreed that the Caring Plymouth scrutiny panel consider this issue in detail in the new municipal year.

Primary and Specialist Care Commissioning

The review agreed to the consideration of the inclusion of specialist care commissioning within the section 75 regulations and supports the Government’s move to include Primary Care commissioning with section 75 regulations.