To consider a report from Leeds City Council’s Head of Democratic Services introducing a report from the West Yorkshire and Harrogate Health and Care Partnership regarding the Improving Planned Care Programme.
The Joint Committee received a report from Leeds City Council’s Head of Democratic Services introducing a report from the West Yorkshire and Harrogate Health and Care Partnership on the Improving Planned Care Programme.
The report included a copy of the West Yorkshire and Harrogate Improving Planned Care and Reducing Variation programme (Elective Care and Standardisation of Commissioning policies) at Appendix 1, which focussed on reducing the health inequalities evident across the West Yorkshire and Harrogate system and specifically clinical thresholds, clinical pathways and prescribing.
The following were in attendance to present the report and support discussions:
- Dr Matt Walsh – Chief Officer, Calderdale Clinical Commissioning Group and Senior Responsible Officer, Improving Planned Care Programme
- Catherine Thompson – Director, Improving Planned Care Programme
In presenting the report, the following work streams within the Programme and matters were highlighted:
· Discussions on the complexities of culture, values, place and system within the Improving Planned Care (IPC) Programme were being held at ‘place’ level, however there was a desire for these to include the Joint Committee to provide assurance that the right discussions were being held.
· The Joint Committee of CCGs provided governance for the workplan elements of the IPC Programme. The workplan currently covered 2 high volume services – Eye Care and Musculoskeletal. Standardised clinical policies had been established for both areas, such as commissioning policies and thresholds.
· The Programme sought to create equitable care, service provision and access to services across WYH with fully evidenced high quality pathways. How to apply each pathway would be determined by place to shape the delivery of services.
In terms of Programme implementation, it was recognised that in some workstreams, such as workforce, WYH was the appropriate level, and not place. The Programme included a review of clinics to ensure best practice and efficiencies, and equity audits to better understand variations of practice and quality in cataract and knee/hip surgery. Consideration was also being given to the creation of a single prescribing committee.
In terms of workforce development, it was reported that funding had been secured to support the Eye Care Programme, as follows:
· To establish 20 places for a first year cohort of ‘First Contact’ practitioners, the aim being to train 50 in total.
· To provide enhanced skills training for 60 optometrists which will enable them to undertake ophthalmologist’s tasks
· To provide training to create Advanced Practice Nurses to enable nurses to undertake some eye care tasks where there is evidence that it is safe for them to do so.
The Joint Committee considered and discussed a range of matters relating to the Improving Planned Care Programme, including:
Pathways – The Joint Committee sought information relating to the monitoring of pathway delivery, whether pathways already established within WYH had been reviewed and how they were delivered for local needs. A Joint Committee member provided the meeting with his personal experience of receiving care for the same issue at both regional and local level.
In response, the Joint Committee received assurance that the IPC Programme leaders intended to include the Joint Committee in discussions on care pathway delivery and the shape of provision at a local level, noting that successful delivery was dependent on having the scale of workforce necessary and able to deliver it.
Additionally, the Joint Committee was informed that a quarterly working group had been established to discuss progress and failure against the implementation framework with each area represented in the group. The working group provided partners with the opportunity for mutual accountability rather than formal regulation additional to that already in place throughout the NHS to ensure clinical and delivery quality.
Timeframe – The Joint Committee noted comments relating to the timeframe for implementation, specifically noting that an individual patients’ care pathway may or may not fit within the designated timeframe for delivery of a specific aspect of care, depending on the complexity of their case.
Second wave of evidence base interventionspolicy– The Joint Committee noted that details had not yet been released, but would be subject to a national 8 week consultation period after the General Election 2019. The Joint Committee welcomed the offer to provide a link to the consultation, when available.
Equality of care – The challenge of achieving equality of care across WYH was recognised, acknowledging that different areas within WYH experienced different health challenges and risks; and not all partners wished to participate in the Programme. The Joint Committee expressed a desire to consider how equality could be achieved taking into account the differences that existed and how local Health and Wellbeing Boards will review care pathways to achieve equality.
The Joint Committee also requested the detail of the inequality data, noting with concern the reported 40% difference between the best and worst performing. The data would inform future discussions on the wider determinants of health and how to assist the IPC Programme. It was agreed that, following consultation with NHS England, appropriate data would be provided to Members of the Joint Committee.
Efficiencies – In response to discussions regarding the nature of the proposed system efficiencies and how these would impact on the workforce and patients, the Joint Committee noted that the efficiencies proposed would support the system processes, such as reviewing the best use of downtime between patient appointments and how some providers have designed their teams.
Progress – The Joint Committee identified that IPC Programme local plans had been drafted 18 months ago, and that development of the plans in response to system changes could be a matter where the Joint Committee provide an overview.
a) That the contents of the report and discussions held at the meeting be noted;
b) That the continuing development of the IPC Programme local plans be identified as an area where the Joint Committee could provide an overview;
c) That to support its ongoing work, the following details referenced during the discussion be made available to the Joint Committee :
· Inequality data that will inform future discussions on the wider determinants of health.
· The national consultation on the second wave of NHS Evidence Based Interventions Policy.
(During consideration of the item, Councillor G Latty left the meeting at 1.00 pm)