[Dr Helen Hibbs, Senior Responsible Officer for the Black Country and West Birmingham Sustainability and Transformation Partnership (STP) to present report]

Dr Helen Hibbs, the Chief Officer for Wolverhampton CCG / Black Country STP Senior Responsible Officer gave a presentation on the Black Country Sustainability and Transformation Plan, a copy of which is attached to the signed minutes.  The presentation outlined the STP progress to date.  It also detailed the initial work around the Black Country Clinical Strategy, key areas of integrated working between health and social care, and the ongoing development of primary care.  It also highlighted some of the main challenges, risks and drivers for delivering integrated care in the future. 

The Chief Officer for Wolverhampton CCG / Black Country STP Senior Responsible Officer stated that the Clinical Strategy would make a difference to local patients by reducing unwarranted variation and duplication across health and care services.  It would also help to improve people’s health, improve the quality of services and deliver financial stability.  The strategy had 12 priority areas.  The current areas of focus were cancer, mental health, learning disability services, maternity and neonates and primary care.  Over the next few months they would be engaging local clinicians and communicating with patients and the public before launching the strategy in November 2018.  Integrated work with Adult Social Care was a component of the STP Plan. 

The Chief Officer for Wolverhampton CCG / Black Country STP Senior Responsible Officer remarked that primary care was at the heart of the place based plans and was integral to delivering improved health and wellbeing.  There were some challenges and risks which she highlighted as follows: -

·       Collaboration across the 18 partner organisations

·       Unwarranted clinical variation

·       Recruitment and retention of clinical workforce

·       Financial sustainability

·       Development of population health management

·       Digital innovation

·       Primary and community care estates

·       Wider determinants of health

She stated that the STP would work collaboratively with its health and care partners to move towards an Integrated Care System (ICS). 

The Chief Executive of the RWHT stated there was now agreement to merge pathology Services across the Black Country, Sandwell and West Birmingham.  On the 1 October he would inherit 21 Consultant vacancies in Pathology and he estimated it would take at least two years to recruit to them.  Russells Hall only had one Consultant in post, when their establishment was 6.5 posts.  He did not want the manpower situation to worsen in other services.  The work force problem was a serious issue across health organisations in the Black Country, which became a problem for the RWHT when they had to take on responsibility for services, such as pathology.  He was also concerned about the financial position of neighbouring Trusts and the wider national finances of the NHS. 

The Chief Executive of the RWHT stated that there was a large amount of issues taking place near to the Wolverhampton border which would impact the RWHT.  At a meeting in Dudley in the previous week the CQC had wanted to close an A&E Department at nights and at weekends.  This had been prevented.  On the 27 September, the Board at Shrewsbury and Telford was expected to make a decision to close the A&E Department at Telford at nights. There was also an issue with Paediatrics.  Those decisions would clearly have an impact on the RWHT.  He would have preferred the issue to have been dealt with earlier in the year in May, when the problem had been foreseen, as there was now little lead in time to the Winter.  He and Anthony Marsh at West Midlands Ambulance Service had real concerns on how the issue could be dealt with. 

The Chief Executive of the RWHT stated that Shrewsbury and Telford Hospitals had been losing consultants for a long time.  They had two A&E Departments to cover with only three A&E consultants.  They had been asking him and other hospitals such as Stoke, which had 28 A&E Consultants, to send A&E consultants to assist.  The problem he faced was that medical personnel did not wish to work in departments where they felt frightened.  There was also an issue that when people finished their training they wanted to work in a major trauma centre rather than a standard A&E Department. This had been the direction of travel for approximately the last fifteen years. 

The Chief Executive of the RWHT commented that there would soon be no choice but to close the A&E Department at Telford during the evenings.  He was of the view that if consultants were sent from the RWHT to Shrewsbury and Telford, that they would resign their position.  There were currently 400 A&E consultant vacancies in the country. Consultants wanted to work in large teams and have a reasonable assurance that they would be able to return home at the end of their shift and not have to stay over for many hours.  There had been a report approximately twelve years ago which had recommended that there should be a reduction in the amount of A&E Departments in England to seventeen.  This had not been implemented by the politicians, but he thought ultimately this is what would have to happen in the future, due to the resourcing issues being faced nationwide.