Agenda item

This report presents the NHS Vale of York Clinical Commissioning Group (CCG) two year Operational Plan for information to the York Health & Wellbeing Board.

Board Members received a report which presented NHS Vale of York Clinical Commissioning Group’s (CCG) Operational Plan 2017/18 – 2018/19.

Board Members noted that, in accordance with the requirement for all CCGs to produce a plan detailing their work and focus for the next two years, this plan had been produced by Vale of York and submitted to NHS England (NHSE).  Board Members were informed that formal approval from NHSE was awaited but the plan was in the public domain and had been presented to all three Local Authorities.  The Medium Term Financial Strategy would be brought to the next HWBB meeting and would sit alongside the Operational Plan.

A briefing note had been circulated and Phil Mettam and Caroline Alexander from Vale of York CCG went through the key issues. 

Board Members were informed that the CCG was about to embark on a series of public engagement events and was seeking to be open and transparent in setting out its priorities for the next two years. 

Board Members’ attention was drawn to the three gaps in outcomes detailed in the plan:

·        Gap 1: Health and Wellbeing Outcomes

·        Gap 2: Care and Quality Outcomes

·        Gap 3: Financial Gap

Consideration was given to the proposals in respect of the financial gap, with a forecast financial deficit of £44.1m for 2017/18. It was acknowledged that there was a need for the CCG and its partners to plan for a different way for the population to access services and for changes in the organisation and delivery of services.  The deficit had to be addressed and the costs of services better aligned to the CCG allocation of funding. Details of the financial recovery plans had been included in the document.  An updated financial plan had also been circulated.

Board Members attention was drawn to the medium term strategy detailed in the plan.  They were also informed of the six key priorities contained within the plan. Work had already started on four overarching areas and Board Members were asked to consider how they could be involved in developing these programmes of work.

The Director of Public Health stated that she welcomed the scale of the ambition reflected in the plan but asked how confident the CCG was in its ability to deliver the plan taking into account the need to deliver savings and in the context of cuts to budgets.  The Accountable Officer, NHS Vale of York CCG, gave details of recent discussions that had taken place regarding shared responsibilities and stated that he was optimistic that this would lead to a new approach.  He outlined some of the ways in which this could take place and care and support be provided in a different way. He acknowledged that the CCG did not have a good track record for delivering efficiencies but explained that an agenda programme which the CCG had agreed and developed with the Foundation Trust was making impressive progress.

The Locality Manager (North) NHS England explained the national context and informed Board Members that the planning had been brought forward by five months and that there would be further submissions. 

Councillor Cannon stated that she was pleased to note that citizens would be involved in the process but expressed concern that this had not happened sooner and that the plan was not easily accessible.  She suggested that there was a need for it to be simplified and that there was greater clarity and reality when references were made to collaborative approaches.  The Accountable Officer, NHS Vale of York CCG, stated that he accepted the comments that had been made but that the plan that had been presented was not the version that would be prepared for the public.  Healthwatch York had been asked to support the CCG in preparing an engagement programme and a summary document would be prepared to present the information in a more accessible format.  He stated that he was optimistic that there was a new and better relationship between the Local Authority and the CCG and that this joint working would help achieve the ambitions that had been set. 

David Booker, NHS CCG, stated that this was a period of unprecedented pressures and there was a need to do things differently.  There was a real opportunity to work together and move forward.

In response to questions from Board Members, details were given of the Accountable Care System (ACS).  It was noted that although there was no formal governance in place at present, it was a developing mechanism by which organisations were working together with a focus on locality populations and how services could be delivered in these areas.  Bill Scott stated that North Yorkshire Police would hope to be one of the agencies that were included.

The CYC Corporate Director – Health, Housing and Adult Social Care, stated that he believed that there had been a missed opportunity to take a real joined-up approach.  The systems that were in place did not enable agencies to work together and share information in the way they would wish.  There was an added issue in the Vale of York because there were three Local Authorities.  The HWBB should ask for these issues to be raised as there was a need to look at a whole system approach.  The challenge to the system was enormous and demands were increasing.

The Manager of Healthwatch York, stated that she was looking forward to receiving and sharing the simplified plan and being involved in the engagement activities.  Conversations were taking place with groups which it was hoped would use services differently but there were some suspicions and concerns regarding the impact on these services.

Jane Hustwit, York CVS, expressed concern that some groups may not be able to continue and that there was a lack of information on this issue.

Wendy Scott, York Hospital NHS Foundation Trust, stated that she accepted the comments that had been made regarding the way in which the document had been presented but it was important that the HWBB supported the delivery of the plan and supported the CCG in whatever way it could.

The Chair acknowledged that there was a willingness to work together but stated that unfortunately this had not happened previously.  She requested that the wording in the plan be amended to reflect that, although there was a commitment to working together moving forward, this had not happened previously.  Whilst it was the intention of everyone to support the plan, this could not happen unless formal and informal discussions took place.  The Chair expressed her regret that the plan had been published by the CCG on its website before it had been forwarded to the Council who should have been involved throughout the process.  The Chair requested that the plan be brought back to the HWBB once it had been approved by NHS England.¹

The representatives from the CCG explained that, prior to publication, the plan had been shared with the Chairs of the HWBBs for their comments.   Unfortunately the timescale for submission had been very tight.  The plan was being presented at the meeting for discussion by the HWBB.

Resolved:  (i)      That the unapproved two year CCG Operational

                             Plan be received.

                   (ii)      That, when approved by NHS England, the plan

                             be brought back to the HWBB.

Reason:     For information and engagement while awaiting full approval from NHSE.