AGM 2017 - Q&A session


Key questions and answers that patients asked at our recent AGM

September 2017

To view some of the key questions and answers people asked at the AGM please see below:


Q. Of 450 hospital clinicians surveyed by Hospital Consultants and Specialists Association 42% believe that STP will have a “Negative Impact” on Patients Care. Furthermore 77% believe, STP is another way of making cuts to NHS and 56% are of the opinion this will result in job losses and understaffing.

West Leicestershire Clinical Commissioning Group too is expected to make savings whilst implementing STP. In the light of all expert view stated above and expected saving to be made by WLCCG, will there be cuts to the services and if it is, where are the cuts going to be?

A. Given by Professor Mayur Lakhani:
This survey was a national survey undertaken by the Hospital Consultants and Specialists Association with their 41,000 consultants. 450 replied to this questionnaire.

If we didn’t have an STP or BCT we’d probably have to invent one. Some patients do seek help in our acute hospitals when their condition would be better treated elsewhere. The current model of care is not right for modern health care and is too hospital centric. This problem is nation-wide.

Patients are quite often treated in the wrong setting of care, where it can be more expensive to treat patients. For example the cost of an outpatient’s appointment can be about £220; the cost of GP care for a whole year is about £125. An admission can range from about £400 to £3000.

We haven’t got the luxury of as much money as we would like to do the things that we need to do, but even if that was the case I strongly believe that as a clinician, unless you reform the model of care, you won’t get better outcomes. I believe that this is not about cost cutting or about reducing services; this is about better quality and reforming the model of care.

Now within that there are a lot of choices to be made, and it will take time, but I want to assure people that please keep an open mind about the STP, I understand your reservations, your questioning, perhaps your cynicism and I can understand why this group voted or said that this is all part of a cost cutting drive.

For us, it is about using what we call the LLR pound, so we don’t spend the pound according to what benefits the West, or the East or the hospitals, but what is best for you in LLR and how we do that, and that’s why we’re having the debate and working together..

A. Spencer Gay added:
It’s our job to try, as best we can to improve the health care of people within West Leicestershire and Leicestershire as a whole. So when we talk about the STP, within a constrained financial budget, it’s not about just balancing the budget, it is also about ensuring we get both cost effective and clinically effective services for patients.

Having said that, I did talk earlier about the fact that there is a significant financial challenge for us as an organisation, and for all organisations within our STP. But the amount of money that is actually being spent is increasing year on year, so it’s not about cuts and taking services down, it’s about trying to get better value for the money that is spent on those services, as we spend more and more.

I think the other thing I’d say is that this was a national survey. In LLR we’ve got a clinical leadership group, which is key to the decisions that we’re making around STP. Mayur actually chairs that group, which focuses on delivering the right things for patients and trying to be more efficient at the same time, rather than making drastic cuts.

Mayur added:
Just to emphasise that these proposals are supported by the doctors and nurses, including the general practitioners, we’ve got a very strong clinical engagement model with many people involved in planning and developing services, so that’s where we are with that.

Q. Why has the Sustainability Transformation Partnership (STP) Public Patient Involvement Group been asked to sign confidentiality agreements if they want to continue as members of the group and see STP papers? This means they are cut off from the public and can no longer be considered representatives of the public. Why is the STP obsessed with secrecy? The public are entitled to know what plans are being made for the health service at a time when key decisions are being made. We use and pay for the NHS.
A Given by Toby Sanders:

Firstly it’s a very understandable question, I think if I look back to the last 12 months we published a draft sustainability and transformation plan last Autumn and I think there has been not enough communications from the NHS publically about the status of that plan and where it is at, and I think that in the absence of that people understandably become anxious and fill the spaces with their own thoughts about what might be going on. But we are refreshing the plan and will publish again later this year.

It might be helpful to explain for other people in the room about the patient and public involvement group. I chair something called the System Leadership Team, which is a group that brings together execs and clinicians made up of medical directors from the Leicester hospitals and others to look at our overall system plans, and we have a patient public involvement groups which feeds thoughts, patient experience, patient views into that.

Much of the information that the system leadership team looks at is work in progress. We’re looking at regularly updated versions of financial plans, where we are on some of the modelling around community hospitals or the reconfiguration of the acute estate. So a lot of the work that the group looks at, month in month out is work in progress and because of that, it is work that is not put into the public domain at that stage. It will be put into the public domain this side of Christmas in terms of an updated version of the plan and next April/Spring time as we get into formal consultation.

But as the chair of SLT, there is a really tricky dynamic here, because although it’s not material that’s in the public domain, I really want the PPI group to have an insight into the discussions we have, from a patient public perspective at the earliest opportunity.
So we have a chair of the patient public involvement group, who also happens to be a member of the HealthWatch in our area. He sits on that group and participates in the discussions and we’ve agreed with the members of the patient group that we share information with them. But actually at their request, they’ve signed confidentiality agreements, because they felt it was more helpful for us to be confident that we could share material with them even though often it is a work in progress .
So it’s about trying to do the opposite of being secret, it is about getting meaningful patient views from the room, but on things that are inevitably still evolving.

Q. Why is the CCG tabling a paper at this month's governing body meeting (Tues 12th September 2017) to approve the move towards the creation of an Accountable Care System for LLR when this idea has never had any public scrutiny or public debate?
A. Given by Toby Sanders
We’ve got a paper tomorrow which is going to be in our public board discussion from West Leicestershire. It’s the same paper that was discussed last week at Leicester Hospitals trust board, and it’s also a paper that is going to be discussed in the other partner organisations, which are NHS organisations locally. I just talked about, that System Leadership Team doing what we want it to do, which is not making decisions, but actually working out the thinking and ideas to improve the way our system operates and then routing that into the public meetings, like our trust boards, like our CCG boards, so that those discussions happen in public.

So this is really early stage thinking paper. It’s not there asking for anyone to agree or sign up to details of anything, it’s there to put an idea out there. It is an idea that has been worked up by a number of people across our organisations.

Unfortunately the term ‘accountable care system’ mirrors American language. America operates a very different health care system; in their accountable care systems they have a much stronger private ethos and a much stronger profit ethos.

One of the areas that is really interesting is the way that they’ve grown in parts of the states and in other parts of the world such as New Zealand and Canada. They’ve found a way to get organisations to work together around a common goal, and they try to reduce some of the fragmentation that you get between organisations. When you get one organisation issuing an agenda or a priority and another one has a slightly different variation on the theme - all that does is waste time and resource and often leads to poorer services for patients. So we need to understand how to get NHS publically funded organisations in Leicester, Leicestershire and Rutland, so I’m talking about the three CCGs, the hospital trust and Leicester Partnership Trust, working around that LLR pound which Mayur made reference to, focusing on what we can do for our population.

What it is absolutely not, is about us saying how can we replicate a profitised American model or any other system that brings that model in.

So we’ll be having a debate for anyone who wants to join us tomorrow in our board publically about this, I think that’s the right thing for us to be doing, opening up these discussions for board meetings and it isn’t something we’re going to practically decide on tomorrow. But what it won’t be is a new organisation; we’re not going to set up a new superstructure. We are not going to set up anything that takes over the responsibility of individual organisations.
We all ultimately have the same NHS logo, and that’s what we’re all here for, whether we’re provider, commissioner or any of our other local NHS