The Health of the Humber 2015 Report to the LEP Board, 13 th November 2015 Report from Lance Gardner, Board Member & Chief Executive, Care Plus Group 1. Summary 1.1. This paper explores the main challenges and opportunities for the health and social care sector in the Humber and identifies potential roles for the Humber LEP in supporting the future sustainability of the sector. 2. Recommendation 2.1. The paper identifies that Humber LEP could take action to: 2.1.1. Ensure that training provision for health and care professionals meets the needs of local providers and communities 2.1.2. Ensure that the impact on health and social care provision is taken into consideration in planning infrastructure investments, in particular the role of transport infrastructure in enabling access to care and its impact on future demand for health and care services. 2.1.3. Ensure that the region takes advantage of emerging opportunities, including accessing EU funding to develop social enterprises and the implementation of telecare and other technology driven solutions 2.1.4. Facilitate joint working between health leaders to enable collective, strategic leadership across various delivery organisations. 2.2. It is recommended that the LEP Board consider: 2.2.1. Asking the Employment and Skills Board to consider training provision for the health and social care sector 2.2.2. Asking the Infrastructure and Regulation Board to explore ways of joining up long term planning for transport infrastructure and health and care. 2.2.3. Facilitating the establishment of high level health leaders group to enable strategic leadership. 2.2.4. Creating LEP advisory group to a) advise ESB and I&R Boards as appropriate and b) drive forward work on innovation opportunities identified in this paper. 1
3. Roles for the Humber LEP in Health and Social Care 3.1. The health and wellbeing of the local populace is fundamental to the economic sustainability and growth of the Humber region. Health and social care provision is the second highest employer in the Humber region, and the second highest fiscal turnover. 3.2. Increasingly, decisions about the future are being taken in partnership, and across traditional boundaries. The Healthy Lives Healthy Futures initiative is becoming the lynchpin for enabling people to speak the unspeakable and have really imaginative discussions across a widening geographical footprint, including not just the Humber, but much further afield. 3.3. The table below provides an overview of the challenges and opportunities facing the health and social care sector in the Humber region and identifies potential roles for the Humber LEP in addressing these issues. Detailed examination of the challenges and opportunities for the region can be found in sections 5 and 6. Skills and Recruitment Issue Number of training places and funding for nurses is determined at national level and may not reflect local employment need. Lack of nurse training provision in N and NE Lincs. LEP Role Consider local control over allocations of funding in future Freedoms and Flexibilities requests. Influence/lobbying on changes to structure of training and funding. Use local influence to try secure accreditation for South Humber FE Colleges. Challenges of recruiting staff PR and marketing role raising awareness of the positive aspects of health and social care provision in Humber plus quality of life opportunities Business Issue Opportunities for the further development of health and social care social enterprises, building on existing local strengths and best practice. Impact on businesses of loss of productivity due to staff ill health LEP Role Raise awareness of opportunities in the sector for social enterprises. Support the development of business support and incubator projects for potential ERDF and Growth Deal funding. Use to generate business interest in the issue. Raise awareness of how the health 2
service and businesses can work together to maximise staff wellbeing, e.g. smoking cessation, health screening. Infrastructure Issue Transport infrastructure investments can alter the shape of future demand for health services. Changes in health care provision (i.e. people travelling further for higher quality care) alter requirements for transport infrastructure. No overarching structure for planning strategic use of public assets in health service and local authority ownership. LEP Role Increase co-ordination between health and transport authorities facilitate sharing of data and long term investment plans Possible LEP-led project: assessment of current assets leading to strategic plan for disposal/investment. Innovation Issue Lack of awareness of the Humber s regional research and innovation strengths in health, care and life sciences. Lack of co-ordinated approach to project development and project prioritisation for application of digital technology, linked with Smart Cities and IoT agendas, telecare and integration of systems. LEP Role Use Life Sciences Proposition for UKTI Northern Powerhouse to raise awareness of Humber assets Leadership/co-ordination role bringing together relevant partners and identifying pipeline of projects Ensure optimisation of EAFRD broadband investments to benefit local communities Other Issue Impact of devolution on funding for specialist services in the Humber e.g. cardiology, oncology Impact of increasing austerity cuts on social care and the potential LEP Role Ensure impact on health and social care is discussed in devolution negotiations Lobby for effective safe funding of social care 3
repercussions within health delivery Limited structures in place to enable collective, strategic leadership across various delivery organisations. Facilitate joint working between health leaders 4. Health and Social Care in the Humber the current landscape 4.1. The socio-demographics of the Humber populace are atypical when compared to the rest of England, and this trend is only likely to be enhanced during the next 50 years, with higher than average growth in the numbers of people over 80 years of age, and a smaller than average number of children. 4.2. Health outcomes in the Humber are worse than the national average across a number of key measures. An adult is 30% more likely to die of respiratory disease in Hull than they are in the rest of England and Wales. Mortality rates for strokes and cancer are also higher than national average. Further details are provided at Appendix 1. 4.3. The structure of health and social care delivery in England is complex, comprising a broad range of organisations delivering separate but interrelated services. 4.4. This diagram shows some of the main delivery organisations. 4
4.5. Regional health care providers have faced criticisms for the quality of care and access to care they provide. Hull Royal Infirmary [HRI] was in the worst 10 hospitals for access to A&E last winter. In 2013 Northern Lincolnshire and Goole NHS Foundation Trust [NLAG] was also deemed to be failing and was one of the Keogh 14 which were the 14 hospitals deemed to be most failing by the NHS and were personally supervised by the Chief Medical Officer Sir Bruce Keogh. However, NLAG have come out of that process as a stronger and more dynamic organisation. This is demonstrated by the fact that in the recent friends and family test 94% of staff said they would be happy for their friends and family to be cared for by the organisation. 4.6. There are limited structures to enable collective, strategic leadership across various delivery organisations. The Humber LEP could play a key role in facilitating joint working between health leaders to enable collective, strategic leadership across various delivery organisations. 5. Risks and challenges 5.1. The Humber health economy is facing a number of risks which, if not managed carefully could have devastating effect on the socio-economic wellbeing of the area as a whole. Recruitment 5.1. The Humber is facing a recruitment crisis in health and social care. A third of all GP posts are vacant, and another third of GP are over 65 and desperate to retire. For the past nine years there has been a persistent fall in the number of new doctors, at a time when workload and demand have soared. [BMJ 2014]. None of the local hospitals have been fully staffed for more than 12 years, and the recruitment of Consultants is increasingly difficult. It is not unusual for a Consultant or GP post to be vacant in excess of 5 years. 5.2. Recruitment issues are common across the health and social care sector. By 2020 there will be 19,000 nurse vacancies across England. Earlier this year the overall nurse vacancy rate was calculated at 10 per cent (12,566.35 FTE) i.e. posts not permanently occupied. The vacancy rates across therapies, technicians and social workers are even worse than those in nursing. 5.3. The causes of this crisis are deep rooted and complex. The policy of concentrating services in a small number of specialist centres has the knock on effect that these centres are more attractive to prospective employees, which exacerbates recruitment problems for general regional facilities. The poor image of region (and historically poor reputation of some healthcare institutions) also affects recruitment. 5
5.4. The Humber LEP already works closely with Bondholders and other partners to improve the image of the region. It would be beneficial for the LEP and partners to assess whether appropriate marketing materials are well used by health and social care sector employers and whether additional work could be undertaken to support recruitment in the sector. Access to Training 5.5. Recruitment challenges in North and North East Lincolnshire are worsened by the fact that local people cannot train for a care profession locally. Nursing and clinical professions now require academic qualification delivered or accredited by Universities. The absence of accredited courses in North and North East Lincolnshire means that students leave the area to attend university and many do not subsequently return to the area to work. Moves to establish an accredited course on the south bank have faced some difficulties. 5.6. The LEP could play a role in facilitating negotiations to secure an accredited centre on for the south bank. 5.7. The number of training places and funding for nurse training is determined at national level and may not reflect local employment need. 5.8. The LEP could use its lobbying and influencing role LEP influence/lobbying to secure changes to the structure of training and funding or more local control over allocations of funding through future Growth Deals. Access to Care 5.9. The Humber faces significant challenges in terms of access to care, with many residents travelling long distances to meet their care needs. A resident of Sheffield can access 99% of their care needs within 10 miles A resident of Leeds can access 97% of their care needs within 10 miles A resident of Hull can access 80-85% of their care needs within 10 miles A resident of North East Lincs can access 60-65% of their care needs within 10 miles A resident of North Lincs can access 30-35% of their care needs within 10 miles. 5.10. The challenge of access to services is compounded by below average levels of car ownership in Hull and North East Lincolnshire and poor public transport links in some areas. See Appendix 2 for details. 5.11. Reduced availability of services locally is partly due to the national policy of centralising services to places where highly skilled specialists undertake sufficient numbers of procedures to assure their ongoing competence and effectiveness. Whilst this is excellent for maintaining quality of services, it can have a devastating impact on accessibility to services. 6
5.12. There is now an assumed norm that it is only possible to offer a full range of services to a population in excess of 3 million people. Children s heart surgery, for example, is only undertaken in 6 locations nationally. 5.13. In reality this leads to a very small number of fully equipped specialist services across the nation, and a multitude of communities who only have access to a district general hospital offering a first line resuscitation service before transfer to a major centre, and a fairly routine set of hospital based services. 5.14. This is already the case south of the Humber and is increasingly become an issue in the North Humber area. When these decisions are made, the potential secondary impact on local commerciality and regeneration is not considered. 5.15. The LEP could use its role as an advocate for local industry to remind health decision makers of the negative impact that shrinking local public services can have on the attractiveness of the area economically. Transport 5.16. The availability of specialist services and the ease of transport means that south Humber residents prefer to travel west to South Yorkshire to access specialist care rather than across the bridge to Hull. There is very little travel for care between North East and North Lincolnshire, and virtually none south from the north Humber area. 5.17. The Humber LEP and local authority partners should ensure that access to health care services is taken into consideration when planning future transport investments. 5.18. Investments in transport infrastructure have considerable impact on future demand for health services. For example, investments in infrastructure in North East Lincolnshire have improved transport links in to Diana Princess of Wales Hospital in Grimsby, which will result in residents choosing to access services in Grimsby in preference to other regional centres. This is not currently accounted for in long term investment plans for the hospital. 5.19. The Humber LEP should work to increase co-ordination between health and transport authorities by facilitating the sharing of data and long term investment plans Finances 5.20. The graph below demonstrates very clearly the major crisis which is facing the local area a huge financial shortfall. 7
5.21. This graph covers North and North East Lincolnshire only; across the whole of the Humber the shortfall by 2018/19 is likely to be 250 million. Both health economies are currently taking out loans with the Department of Health to manage current deficits. 5.22. There is widespread recognition that if the local care economy is to survive there will is a requirement for fundamental change on an unprecedented scale. It is also reasonable to expect that the current level of provision will not be maintained on all sites. 6. Assets and opportunities 6.1. Despite the considerable challenges facing the sector, the Humber can point to significant successes and assets: The best public single point of access in England The lowest lengths of hospital stay for people over 85 years The cardiology service at Hull is one of the best in the UK 3 of the leading social enterprises in the UK for providing care are in the Humber area (Care Plus Group, City Healthcare Partnership, Navigo Health and Social Care CIC) We have the only care academy in England, with another soon to open in Hull (The Academy Grimsby) The NHS friends and family test results are some of the best in the UK There are in increasing number of local care providers breaking into the Times 100 best employers to work for We have state of the art cardiology and cancer facilities at Castle Hill. 8
Local care providers have won numerous regional and national awards and accolades. Northern Lincolnshire and Goole Foundation Trust and Humber Foundation Trust are highly respected and improving their quality faster than most other trusts 6.2. By building on these assets, the Humber LEP has an opportunity to drive the development of innovative practice in health and social care provision. Social Enterprise 6.3. The Humber is home to the UK s first health social enterprise (City Healthcare Partnership in Hull), the first acute mental health social enterprise (Navigo in Grimsby) and the first independent social work practice (Focus in Grimsby) as well as an extensive network of smaller social enterprise and VCS providers. 6.4. The region has the opportunity to build on local expertise in delivering health and care services through a social enterprise model by: 6.4.1. Supporting the development of successful and sustainable social enterprises. Work is underway to investigate accessing European funds to delivery this activity. 6.4.2. Develop best practice and trialling innovative delivery models Innovation 6.5. The Humber an area which is renowned for being innovative, and we are using IT and digital technology in ways most of the country can only dream about. We must be one of the few areas in the public sector where we love our IT services not despise them. KC are also bringing forward developments which can only enhance digital utilisation in care locally. 6.6. The Humber LEP has a role to play in supporting the development of local partnerships to secure funding for innovative telehealth, Smart Cities and Internet of Things projects. Lance Gardner Chief Executive Care Plus Group 9
Appendix 1: Demographics The socio-demographics of the Humber populace is often very atypical when compared to the rest of England, and this trend is only likely to be enhanced during the next 50 years, with higher than average growth in the numbers of people over 80 years of age, and a smaller than average number of children. An adult is 30% more likely to die of respiratory disease in Hull than they are in the rest of England and Wales. 10
Appendix 2: Car ownership across the Humber region Authority area No cars 1 car 2 cars 3 cars 4 or more cars Hull 40.6 42.3 14.2 2.3 0.6 North East Lincs North Lincs 30.8 43.5 20.8 3.8 1.1 20.7 43.5 27.5 6.3 2.0 East Riding 17.6 43.9 29.6 6.6 2.3 England 25.8 42.2 24.7 5.5 1.9 11