Toby Sanders has a big job. As chief executive of Northamptonshire’s two NHS clinical commissioning groups he has responsibility for an annual budget just shy of £1bn and it’s his role to make sure the health services in the county are performing well and meeting the needs of our ever growing and ever ageing population.
Appointed in November last year after a successful seven years in the same role in West Leicestershire, the new chief executive has plans to shake up the county’s healthcare system in line with the NHS’s new 10-year plan that was published earlier this year.
A merger for the two clinical commissioning groups – which are both rated as good by NHS England – is on the cards and his team is also in the process of reviewing the current primary care infrastructure in Northants, mapping out what is needed by way of GP surgeries, dental practices, health clinics and hospital extensions to make sure the county’s health care provision is where it needs to be as thousands more homes and new patients are added in each year.
Add on top of that a move towards an integrated care system – where health, local government and voluntary groups join up their services – all amid the reorganisation of local government in the county in which two new super councils will replace the eight existing ones and it is fair to say that success in creating a new system fit for the future is something that will require a great deal of skill, diplomacy and successful partnership working.
One of the first tasks on his long to-do list is to assess and then plan for new health infrastructure.
With Northamptonshire’s population due to rise from 741,000 to 803,000 by 2028 it is clear there will need to be investment in more services. This is something that has been lacking in recent years.
Mr Sanders, who was a town planner before his move into health, says the county is the only one in the past three years not to have received any capital funding from central government.
He said: “There is not a strategy for GP for growth and expansion and that is what we are on the case of and what we are putting right.
I think we have missed a trick in some areas and that it is something that I have really grabbed hold of since I have been here. We will have that clearer plan as we go into the summer.
“There is a particular need in terms of the strain and pressure on general practice and we know that is something where we can do things to support.
“I’ve met with a number of MPs on this issue and a number of leaders of councils. The NHS is a people business not a buildings business but if you have not got the right buildings and there is not enough space then you are always going to struggle.
“I think there are more opportunities that we could realise if we had a clearer plan.
We are doing a specific piece of work at the moment with our practices looking at the primary care estate. It is heavily linked into my very strong push for this organisation to be more successful in securing capital funding, nationally, in particular to be able to support some of the building work that we know are going to be needed going forward.
You need to look at the buildings that we have got. Look at the capacity and the number of patients in the surrounding area; where we have got areas with poor quality buildings and where we have areas that have scope for expansion, put that into a prioritised list and then over the next few years gradually just work our way systematically through that list. That is my ask of this organisation.”
Some of the investment will come from contributions from housing developers, but the chief executive says a new hospital in either the south or north of the county or even a new large hospital in the middle of the county is out of the question in today’s financial climate.
Instead the two hospitals will start to work more closely together and there are some upgrades coming soon to Kettering General Hospital’s accident and emergency department.
As well as the hospitals working closer together local government, which looks after adult social care and health, will work together. This is a move towards an integrated health system.
Mr Sanders said: “Moving forward the policy agenda talks more about the sustainability and transformation partnerships (STPs) becoming integrated care systems and the NHS long term plan was pub in January and sets out an expectation that all STPs do that by April 2021.
“In practice what this is about is expecting NHS and relevant areas, local government, to work together in a more joined up way and to plan things more sensibly together; to make more use of our resources together and to look at the NHS pound and the local government pound that we have – how do we make best use of that resource to improve health outcomes and make sure there is care where people need it.”
The STP – which is called the Northamptonshire Health and Care Partnership – has set out four target areas to focus on this year where it thinks it could do better.
The chief executive said: “Looking at how much of our annual £983m gets spent on different service areas allows us to look and see where there might be opportunities to improve, quality, outcomes or use of resources, and the four areas that are our transformation priorities this year are frailty, respiratory conditions, musculoskeletal conditions and urology.
“When we have asked ourselves where could we do better for local people these areas consistently come up as areas where we either lag behind other areas in terms of health outcomes; because we spend on many cases a disproportionate amount of our funding and perhaps still don’t get the outcomes we want to see, or maybe we know these are areas where we have issues around access or quality of service provision.
“So if we look at frailty, we know across so many different markers that we could do more to support patients at that earlier stage of their condition. Our services don’t currently join up well enough too many people end up being admitted into hospitals. Not because that is appropriate, but because there aren’t the other services there to support them.
“There is so much more we could do by working better together across health, social care and also the voluntary sector and we need to join that up in a more co-ordinated approach to planning people’s care.”
And also coming ahead is a change in the way GP surgeries work. As dictated by the NHS 10-year plan, Primary Care networks are being set up across the country which will see GP surgeries link together and a more enhanced role for pharmacists and a new role of social prescribers. These people will link people to voluntary organisations, such as walking groups, who can help improve their health.
So with all that Toby Sanders may possibly have the longest to-do list of anyone in the county. But hopefully with proven success in Leicestershire the county’s health future is in safe hands.
What is a Clinical Commissioning Group?
Clinical commissioning groups (CCGs) are clinically-led statutory bodies that have a legal duty to plan and commission most of the hospital and community NHS services in the local areas for which they are responsible. CCGs are led by a Governing Body made up of GPs, other clinicians including a nurse and a secondary care consultant, and lay members.
They were established as part of the Health and Social Care Act in 2012 and replaced primary care trusts in April 2013.
Northamptonshire has two CCGs – Nene and Corby – which have a combined budget of £983m. There are plans to merge the two CCGS by next April.
The current facts and figures about Northamptonshire’s health infrastructure
There are 104 GP premises in the county
There are two acute hospitals (in Kettering and Northampton) and 3 community hospitals (In Wellingborough, Corby and Daventry
There are two mental health in-patient facilities
There are 133 pharmacies and 150 dental practices