Agenda and minutes

Members are asked to declare the existence and nature of any Disclosable Pecuniary Interests in respect of any item of business to be considered at the meeting.

No declarations of interest were made by councillors regarding items on the Agenda.

Andrew Demetriades, Joint Programme Director, will in attendance and update the Panel on the establishment of a commissioner led programme to review and develop the clinical case for change and potential solutions identified in the work undertaken to date by the hospital trust.

Mr. Andrew Demetriades, Joint Programme Director for the Acute Sustainability Programme established by Surrey Downs, Sutton and Merton Clinical Commissioning Groups, addressed the Panel.

Epsom and St. Helier University Hospitals NHS Trust faced significant challenges in terms of the sustainability of its buildings and how its acute services were organised.  The Trust recently set out its own views on these challenges and how to respond to them, running a public engagement exercise and producing a Strategic Outline Case for investment in its acute services.  The key challenges going forward were threefold: clinical, financial and estates.  In particular, Mr. Demetriades highlighted the challenge faced in relation to the Trust’s estates.

The decision to change service arrangements locally could only be taken by the three CCGs and the Acute Sustainability Programme would be looking in detail at the challenges faced by the Trust and how the CCGs could best ensure that the hospitals continued to deliver quality, safe and sustainable services for the area going forward.

There was a complex regulatory process that needed to be followed, particularly in terms of financing any proposals, but the importance of engaging more widely in the potential future configuration of services was recognised.  The Trust had set out its preferred scenario of consolidating its major acute services onto a single site either at Epsom, St. Helier or on the Sutton Hospital Site where a new build would be required.  In the Sutton scenario, land had been retained by the Trust in order that a new facility could be co-located on with the Marsden site. Should the Sutton site not be the way forward, the land would be sold to the London Borough of Sutton for housing purposes.

The programme would consider the best overall clinical model going forward in terms of the configuration of Major Acute services as well as other local health and care services.  Major Acute services were identified as Emergency Department, Acute Medicine, Paediatrics, Emergency General Surgery, Obstetrics and Intensive Care.  Any changes to the configuration of services needed to have clinical support based on good evidence but Mr. Demetriades stressed that the CCGs had reaffirmed their commitment to the requirement for two hospitals.

In order to achieve this, it was important that the governance process was sound.  An independently chaired Programme Board had been established with commissioner, provider and regulator representation. The Board would provide strategic oversight of the programme and make recommendations to the Committees in Common.

Mr. Demetriades outlined the programme’s journey so far, in particular highlighting that testing of the clinical model and case for change had begun and a dedicated Stakeholder Reference Group was about to be established to help shape the programme. The indicative programme timeline envisaged the programme being delivered through 5 phases, working on the assumption that a formal consultation would be required. The programme was currently in the phase of reconfirming the case for change and reviewing the clinical service models & impacts these may have, in particular whether deprivation might  ...  view the full minutes text for item 9.

Dr. Russell Hills, Clinical Chair, will be in attendance and will update the Panel on the work of the Clinical Commissioning Group, including its work undertaken as part of the Surrey Heartlands Health and Care Partnership.

Dr. Russell Hills, Clinical Chair, was in attendance and updated the Panel on the work of Surrey Downs Clinical Commissioning Group (CCG).

The Panel was reminded that Surrey Downs CCG was made up of 31 GP membership practices across three localities (Epsom, Dorking and East Elmbridge), 19 of the practices in the Epsom locality.  The CCG planned and bought healthcare for just over 305,000 people living in an area that crossed four local authority areas (Epsom & Ewell, Elmbridge, Mole Valley and Reigate & Banstead).  The CCG procured health care from a range of different organisations and one of the CCGs largest contracts was with Epsom & St. Helier University Hospitals NHS Trust.  The CCG was part of the Surrey Heartlands Health and Care Partnership (formerly the Sustainable Transformation Partnership) which involved eleven organisations and covered a population of around 850,000.

In terms of the population and local health needs in the CCGs catchment area, it was an ageing population and the CCG faced a number of challenges around issues such as obesity, smoking and skin cancer.  New care pathways had been launched across a range of areas with more services available in the community, closer to home.  The CCG has recently won a Health Service Journal Award for the success of a skin care intitiative aimed at preventing/catching problems early and targeting intervention.  The majority of patients in the Surrey Downs area were now benefiting from better access to primary care with extended GP opening hours, including weekends, via the hub system, which was proving extremely popular.

Dr. Hills highlighted that Surrey Downs CCG has also started working more closely with Guildford and Waverley and North West Surrey CCGs.  To reflect closer working across the three CCGs, a new Joint Executive Team had been established.  The three CCGs remained separate statutory organisations but were increasingly aligning their plans and priorities.  He was also pleased to announce, hot off the press, the new provider for adult community services in the Surrey Downs area from the 1 October 2018.  The new service was to be delivered through a partnership with Epsom & St Helier University Hospitals Trust, CSH Surrey, GP Health Partners, Dorking Healthcare and Surrey Medical Network.  The partnership was to be known as the Integrated Dorking, Epsom & East Elmbridge Alliance (IDEEA).

In terms of the CCGs current focus, it was currently finalising its commissioning plans and priorities for 2018/19, aligned through the Surrey Health and Wellbeing Board.  The need to live within financial means was recognised and there was a continued programme of efficiency savings, looking for opportunities to improve care and reduce variation.  The CCG was also actively supporting the progression of the Epsom and St. Helier Acute Sustainability Programme.

Dr. Hills then went on to talk about the Surrey Heartlands Health and Care Partnership working across health and social care  He explained that across England there were 44 of these partnerships with local NHS organisations and Councils drawing up proposals to improve health and care in the areas they served.  ...  view the full minutes text for item 10.

Daniel Elkeles, Chief Executive Epsom & St Helier University Hospitals NHS Trust, and Dr Hilary Floyd, Medical Director, GP Health Partners Ltd, will be in attendance and will update the Panel on the local delivery of services.

Daniel Elkeles, Chief Executive Epsom & St Helier University Hospitals NHS Trust, Dr Hilary Floyd, Medical Director, GP Health Partners Ltd and Sonya Sellar Area Director, Adult Social Care, Surrey County Council were in attendance and presented an update to the Panel on the local delivery of services.

The Trust had seen no increase in elderly care admissions to Epsom and the length of stay of those admitted had come down by a day because of the work of Epsom Health and Care Alliance.  Resulting from the local NHS’s shared vision to work more closely together, the alliances from Dorking, Epsom & East Elmbridge, led by the Trust, had been successful in bidding for a contract to provide adult community services.  The principle behind the successful bid was the division of the Surrey Downs area into six GP lead localities, bringing community services into these localities with the aim of proactively preventing hospital admissions.  It was about to become one of the most integrated health and care systems in the country with the support of Surrey County Council and Mr. Elkeles was keen to stress that there was also a role for the District/Borough Council’s in shaping this exciting model of delivery.

From the GP federations perspective, Dr. Floyd confirmed their desire to improve services for their patients by integrating services in the community and gave an example of how the model might work with the allocation of a key worker, determined by their particular need, who could co-ordinate a patient’s care for the overall wellbeing of that individual.  The model also aspired to motivate and energise the work force via a much more rewarding work environment leading to greater job satisfaction and staff retention, sentiment echoed by Sonya Sellar.

The proportion of spend of Council Tax on Adult Social Care was decided by Surrey County Council’s cabinet but it was acknowledged that the service was stretched even with the extra 3% recently ring fenced.  However, the County Council did not work in isolation.  It was as much about providing signposting and advice as direct services.  Mr. Elkeles held up the Longmead Centre as a good example of the delivery of preventative agenda.  The Panel Chairman echoed the Council’s desire to expedite this local approach to a national problem of a health service overwhelmed by an ageing population. He referenced the emerging Action Plan being drawn up by Epsom and Ewell Borough Council that aimed to bring all the strands together and coordinate its activity with other providers to help people stay out of hospital.  Councillor Turner also provided some examples of initiatives undertaken in Reigate and Banstead, in particular tapping into voluntary sector resources.

Dr. Floyd summed up by stressing how important it was to work together now on planning how to prevent a repeat of the stresses placed on acute services last winter, at least in the local NHS.

The Panel is asked to confirm as a true record the Minutes of the meeting of the Health Liaison Panel held on 4 July 2017 and 14 December 2017 (to follow) and to authorise the Chairman to sign them.

The Minutes of the meeting of the Health Liaison Panel held on 4 July 2017 were agreed as a true record and signed by the Chairman.  The Minutes of the meeting held on 14 December 2017 would be presented to the next meeting.

The Chairman will present a report on the work of the Health Liaison Panel in 2017/18.

Presentation of the Annual Report was deferred.