The report of the NHS  Programme Directors, Act as One Programme and Acess to  Health and Care Programme, (Document “R”) provides an update on the transition of the Acute Provider Collaboration into Bradford District and Craven Act as One Programme, and the establishment of seven transformation programmes.

Members are asked to consider and comment on the information provided within the report.

(Mark Hindmarsh - 07984 291931 / Helen Farmer - 07932 946494)

The report of the NHS Programme Directors, Act as One Programme and Access to Health and Care Programme, (Document “R”) provided an update on the transition of the Acute Provider Collaboration into Bradford District and Craven Act as One Programme, and the establishment of seven transformation programmes.

For the benefit of those not involved in the work of the Committee during the 2019/2020 municipal year the report clarified that in September 2019 a presentation had been received setting out the planned work of the Acute Provider Collaboration (APC) between Airedale NHS Foundation Trust and Bradford Teaching Hospitals NHS Foundation Trust.

The achievements of the APC in bringing teams together was reported together with the rationale for the transition, in July 2020, into seven Act as One programmes. 

It was explained that the programmes brought together partners from across the health and care system around fewer mutually agreed priorities and focused on issues both within and outside of the acute hospitals. The programmes encouraged collaboration and partnerships between all sectors involved in the delivery and commissioning of health and care services. All programmes had a broad “end to end” scope, meaning that they covered the whole pathway of care from prevention of illness through to specialist hospital care. The current priority areas were reported as: -

Children & Young People’s Mental Health

Access to Health & Care

Diabetes

Respiratory

Ageing Well

Healthy Hearts

Better Births

The achievements of the APC; the rationale for that programme to be stopped and what had happened to the work planned to take place in the APC were reported. 

The Act as One priority programmes were presented together with the system governance arrangements around them; early achievements; areas of focus and challenges remaining for 2021.  Members were advised that challenges included: -

·         Support for the recovery of the health and care system from the COVID-19 pandemic and support the roll out of the vaccination programme where possible.

·         To Improve working with communities to understand and start to address the inequity in access to health and care services through stronger links with the VCS, grassroots GPs and Community Partnerships.

·         Innovate - there are unlikely to be significant funding increases into the health and care system in 2021, so improvements were likely to arise through innovation and improved working arrangements and relationships between partners.

The Chair thanked officers for a detailed presentation and acknowledged that the district had always worked well with partners. The joint work to encourage people to take up the flu vaccination was discussed and in response to questions it was confirmed that 25,000 more people had received the vaccine compared to the previous year.

A Member questioned why the governance arrangements included a member of the Bradford District Care Trust as Senior Responsible Officer for the Children and Young People Mental Health Programme as he believed the programmes were joint ventures between two acute hospital trusts.  It was explained that the appointment was in an endeavour to include a mixture of other partners on the board. 

It was queried if the Act as One Programmes would reduce the choices of provider or service available to residents. In response assurances were provided that it was not the aim of the programme to reduce choice or providers but to focus on common issues and to improve common outcomes.  Patients would still be offered a choice of provider particularly around out-patient services.  Members acknowledged that choice could be affected through collaboration but accepted that pathways of care could be beneficial if actions were more efficient. 

The report referred to the continuation of the digital super-rota providing access to specialist support seven days a week in the Ageing Well programme.  In response to questions it was clarified that it had been identified that there was a need to support care homes during the COVID pandemic and the rota included consultants, GPs, nurses and pharmacists to provide that support.    The provision of the rota was not a change to services but the provision of additional support. The care received may not be from consultants for the whole of the week but GPs involved would have enhanced experience in the care of the elderly.

Following questions about primary care involvement it was confirmed that the primary care providers were fully involved in all programmes.  GPs were also included and a member of the Local Medical Committee or Clinical Advisory Group was on all programmes.   Non-specialist ‘grass root’ GPs were also utilised to strengthen the programmes.

Significant impacts arising from the programmes included the increased take up of the flu vaccine; the addition of the super rota to support the elderly; support to COPD patients following discharge from hospital to manage and educate on their conditions.  Additional work around pathways of care for diabetics was reported and included a GP assist tool kit to allow patients to make better decisions about their condition and care. A major piece of work had also been conducted to allow patients to access appointments on line and partake in digital consultations.

A Member raised concerns about people having to travel to multiple locations for different treatments and that services were not co-ordinated.  It was explained that, whilst there was still some way to go, the Act as One approach was to ensure systems spoke to one another and that a co-ordinated approach to treatments be provided.  In response to that statement it was acknowledged that co-design was more than choice and choice was not required if people were involved in shaping their services. It was stated that Councillors support to enable connections to communities would be welcomed.  

Maternity Services were discussed and concern was expressed that data revealed that Bradford was ranked 122^nd out of 140 local authorities.  Members were assured that the district had two very good maternity units and that issues were not about hospital provision.  In the maternity work stream there was real work required with communities to educate people and ensure that women were fit for pregnancy. Members stressed that as a scrutiny committee they could help with engagement and emphasised that every baby deserved the best start in life.

A Member with experience as a medical doctor confirmed that issues he had seen arsing as a student, doctor, parent and grandparent remained the same.  He felt that perinatal mortality figures demonstrated that nationally maternity services were not moving forward.

A Member recited an email she had received from a resident asking if the programme had the right leadership and questioned how a team of non BAME leaders could understand poverty, discrimination and poor or non-existent services.  In response assurances were provided that those issues were at the forefront of the Programme Directors’ minds.  A new director responsible for communications had been appointed from the BAME community with fantastic experience and would provide a senior representative voice to the board.  Work had been undertaken with the Voluntary Community Sector (VCS) to build bridges and engage with communities.  Discussions had been held with Mosques and others to listen to communities and capture their insights.  Work being conducted by the CCG had identified a number of issues; work was being progressed and updates could be provided to Members. 

Key priorities for the Access to Health and Care programme included securing elective surgical recovery in partnership with the Independent Sector and the cost of that provision was questioned.  Members were advised that the provision was a national arrangement put in place to address a significant backlog of urgent procedures which could not be carried out at NHS hospitals due to the pandemic.  The Programme Directors did not have sight of the contract but believed that the Independent Sector could recoup their costs but not profit from the arrangements.  It was agreed to investigate the costs with the national team and report back to Members. 

In conclusion the report confirmed that the seven priority programmes were now well established and working relationships and engagement had improved significantly. It referred to supporting the health and care system from the COVID-19 pandemic and assurances were requested that support for staff would be included in that recovery. It was felt that staff on the front line were overstretched, exhausted and sick and the joined up thinking to restore internal staff was queried. Externally the mental health of working age adults was also raised and it was questioned if consideration would be given to the mental health of the nation.

In response it was reported that Occupational Health and Therapy were not included in the Act as One programmes.  Whilst those services were not explicitly included there would be a number of things being considered and assurances were provided that efforts would be made to reduce treatment waiting times.

It was explained that that rationale for selecting the seven programmes was in acknowledgement that issues were not being progressed as it was hoped.  There had been too much attempted with little focus.  In early 2020 the seven programmes had been selected to provide a focus on a smaller number of issues which could provide the biggest impact. Officers were aware that people often had a mix of physical and mental health issues.  Conversations were being held to try to break down the boundaries between physical and mental health and officers were keen to incorporate those measures in the programme this year. 

A Member with considerable experience in mental health acknowledged that mental and physical health had always been divided in the health system despite whole people suffering from both.  It was felt that a person with complex physical health needs would likely be suffering from some degree of anxiety or other mental health issue. He felt that a mental health crisis was looming and the importance of employers supporting the people they employed was crucial. It was believed that when looking at strategic plans it was easy to lose focus on mental health. 

Members were assured that the pressure on all staff had been recognised and bereavement and care support was provided.

It was agreed that a progress report be provided and it was requested that service user feedback be included. 

The Programme Directors explained that they had contacted the Better Births work stream lead who was happy to provide information for Members and the issues raised at the meeting around maternity services. 

The Respiratory work stream had been discussed at a previous meeting and it had been agreed that this would be the subject of an additional report.

Members felt it would also be more helpful to have a separate report discussing health inequalities and the Programme Directors agreed that they could provide a future report on the programme overall with individual details of all seven programmes.

Resolved –

That the NHS Programme Directors be requested to provide a progress report on the Act as One Transformation Programmes in 12 months time.

ACTION: Overview and Scrutiny Lead