Do you have a burning question about the Shaping Our Future programme? You may find the answer you’re looking for here.
What is an STP?
In October 2014, the NHS published its Five Year Forward View
to set out the need for health and social care services to become sustainable over a five year period. Locally, NHS organisations (commissioners and providers of services) have been asked to work together with local authorities to produce Sustainability and Transformation Plans (STPs). These STP partners are working together to develop the plan so it describes exactly how they will respond to the Five Year Forward View.
There are 44 STP Partnerships across England. Our plan for Cornwall and the Isles of Scilly is called Shaping our Future. Shaping our Future is a live project and will develop as our ideas develop by listening to local people.
Why do we need to do this?
As with all large organisations there is a need to respond to changes in society and to review current systems/provisions and make them more efficient where we can. We need to build services fit for the 21st century that focus on prevention and meet the demands of an increasing and ageing and increasingly able to use new technologies.
Every year the number of people that need support from NHS and care services is growing and new (often initially expensive) treatments come on the market at a rate that is greater than the amount of money we have to spend. To keep up with these changes commissioners and providers of services need to work with local people and the experts that provide health and social care to develop new ways of helping people stay well and develop services in line with best practice to ensure everyone receives the most appropriate treatment in the right place at the right time in the most effective and efficient ways based on the money we have to spend and the availability of suitably qualified staff.
The work that local partners are doing for Shaping our Future would be happening to a certain extent anyway. The only difference is that it would be happening within individual commissioning and provider organisations rather than all organisations in the health and social care system working together on a common plan. The Shaping our Future programme has given us a once in a lifetime opportunity to do this more effectively and efficiently by providing a foundation for partners from different organisations to work together in new ways as one team working on a set of shared priorities.
Everyone is quick to criticise the NHS. Shouldn't we be saying how good it is?
Absolutely, health and care professionals see more people and provide increasingly better outcomes every year. These plans are all about sustaining and preserving the NHS that we all value for future generations.
We aim to support staff by working with them and the people they provide support to in order to ensure any service changes that Shaping Our Future recommends are those most likely to relieve some of the pressure that services are under, focus resources where they are most needed and (most importantly) provide our populations with the best possible outcomes in ways that are sustainable and able to meet increasing demand.
How many of the 44 regions have accepted the STP?
Each area is at a different stage in their development journey. For example, Devon has already completed some formal consultation about the future shape of some services as their plans under the Success regime are slightly further ahead in their detailed planning than we currently are.
Commissioners and providers of NHS services have a legal duty to ‘formally’ consult relevant local authority health and social care overview and scrutiny committees (OSCs) when considering any proposal that is a substantial development or variation of health and social care. OSCs then formally scrutinise proposals and may invite comment from interested parties, including Local Healthwatch before making a decision.
In exceptional circumstances they can make reports and recommendations to NHS England and the Secretary of State for Health if they are not satisfied that public engagement and consultation has been adequate or when they consider a proposal would not be in the interests of the local health and/or social care service. OSC meetings are open to the public and you can view when they are meeting and what is on their agendas on your local council website.
- Information about Cornwall’s Health and Social Care Overview and Scrutiny Committee can be found here.
- Information about Isles of Scilly Health Overview and Scrutiny can be found here.
What is the STP in Cornwall and the Isles of Scilly trying to achieve?
The STP plan for Cornwall and the Isles of Scilly, Shaping Our Future, is about three things:
- Improving health and wellbeing of the local population;
- Improving quality of services; and
- Delivering financial stability.
We are considering lots of ways we can achieve this by preventing people from getting sick through public health and other initiatives; by preventing illnesses from becoming more serious by intervening sooner; and by providing care and support that is based on current best practice.
By ensuring people are treated in the right way at the right time in the right place we hope to achieve greater financial stability and create health and care services that can keep up with growing demand for years to come.
Why isn’t NHS spending controlled like that of councils, which cannot spend money they do not have?
Each NHS organisation is supposed to live within the financial resources allocated to it. NHS Kernow Clinical Commissioning Group
(CCG) is currently not complying with its statutory duties as it is overspending its allocated budget. This means that elsewhere in the country other CCGs have to underspend to offset our deficit. The councils have more flexibility and are, for example, able to raise income and also set thresholds for services which the NHS is not able to do so easily. For example we can’t stop people attending the emergency department if they believe they need that level of care.
Will the STP close services across Cornwall and the Isles of Scilly?
There are no current plans to close services, but the way in which these services are delivered, and the location that some services are provided from, may need to change. We will keep sharing more information as the detail of our plans develops.
Haven't you already made up your minds/submitted plans?
No, this is very much the start of a five year programme of work and we cannot progress without help from local people. So far we have completed two phases of public engagement (spring 2016 and winter 2016/2017) to establish our priorities and early views on the outline plans. This enabled us to agree an outline business case.
We are currently using what people told us and are completing a lot of further local engagement with a variety of clinical and professional staff as well as colleagues from councils and expert lay representatives during the co-production phase of our plans’. This will help us develop more detailed ideas into a list of options for how services and pathways could be transformed and agree how different options will be assessed to help us identify which services and care pathways will be prioritised for development and which can be implemented straightaway. We have just started the next phase of our co-production workshops.
Our plan is to hold a further round of co-production sessions in May and to then test out our current thinking with the wider public over the summer. This will inform our final options. Any potential major service changes this process identifies will then be the subject of formal public consultation across the whole of Cornwall and the Isles of Scilly.
How will you decide on which services to change?
Commissioners and providers use the following types of things to help them identify which services should be prioritised for improvement:
- Expected benefits to patients (services where reconfiguration could realise significant improvements to patient outcomes and experience will be prioritised over those where only minor benefits could be expected; strong evidence base of expected improvements to clinical outcomes);
- Expected benefits to the health economy (services where large scale savings could be made will be prioritised over services where fewer savings could be realised for the same effort);
- Expected benefits to clinical teams (such as shared rotas across different providers have been found to reduce pressure on staff, support competencies by enabling staff to see a greater range of cases, reduce occasional practice and concentrate key resources where they are of the most benefit);
- Access (waiting and travel times; range and quality of patient transport services);
- Ability to address staffing and recruitment difficulties (including the development of new and innovative roles. For example things like an active programme of research and development and the ability to see a wider range of cases make vacancies more attractive to applicants);
- Demand and capacity (having the right care in the right place at the right time can help to address waiting times, length of stay and avoiding people being stranded in a hospital bed unnecessarily);
- Quality and safety performance (performance against quality and safety targets and national and international averages);
- Equity (adherence to the Equality Act 2010); and
- Joint Strategic Needs Assessment (JSNA) overseen by the Cornwall and Isles of Scilly Health and Wellbeing Boards.
During the coproduction phase of our engagement we will be working with the people most affected by any potential service changes to develop options and agree how to weight different criteria to help us select the best of any options that are coproduced.
How is NHS Property Services involved?
The Shaping Our Future estates work stream brings together the estates leads from Cornwall Council and NHS organisations as well as NHS Property Services
and Community Health Partnerships. The estates workstream is led by NHS Kernow Clinical Commissioning Group.
Are the councils and NHS talking to each other and parish councils about how important things like housing, domestic abuse and homelessness is to health?
Yes, we are working with colleagues in community networks to inform the continual development of Shaping Our Future, particularly the workstreams focused on prevention, including housing. Each network includes elected councillors and representatives from town and parish councils within the community network area. The networks can also invite local organisations’ and service providers, like the police, housing and health services, to join them at their meetings. Some of the issues that community networks deal with include anti-social behaviour, economic development, the environment, community planning, regeneration, conservation, community safety, and transport and highway issues.
Where will you get the extra GPs you need to deliver more things in the community from?
We are working with GP practices to develop plans for how the primary care services they provide could be delivered more effectively and efficiently. For example, some success has already been seen locally by GP practices working together to provide clinical services ‘at scale’ (where savings by sharing resources across different teams or buildings to enable individual organisations to do more than they can when they work alone) and some are starting to share non-clinical staff and other resources.
We also know that larger GP surgeries or those working together can be more attractive to newly qualified medical staff than smaller ones so are more likely to recruit. However, relieving the pressure that GPs are under is not just about recruiting more of them, but also looking at ways that primary care can be delivered differently. For example, some GP surgeries have freed up GPs’ time by conducting telephone triage to reduce the number of patients coming in to see them for something that could safely and more appropriately be treated by a pharmacist or a minor injuries service. Further GP time has been saved elsewhere by implementing video conferencing for regular (non-urgent) follow up appointments for some groups of patients with long term conditions and we know from the public engagement we’ve already carried out that some local people would like to see this option available more widely. Nevertheless we realise there won’t be a one size fits all solution. Better use of technology in an area we know has broadband problems or an ageing population that isn’t confident about using technology is not going to be acceptable to all. Consequently we will closely consider all the options that GPs and pharmacists suggest before making any recommendations.
How are you engaging with the voluntary sector?
More intense engagement with the voluntary sector is included in the coproduction phase of the engagement plan which is currently being developed.
How can people with mental health problems who are receiving care out of county be brought back to a suitable facility that is achievable within budget?
We are working hard with our local mental health services provider to ensure that only when absolutely necessary will people be cared for outside of Cornwall and the Isles of Scilly. Sometimes this is necessary to access very specialist skills that are not available locally, but we will always work to return people home as quickly as possible. This work will look at services we could develop in the community to allow some people who are currently in local beds not to be admitted in the future to free up local beds for some people whose needs are greater. However, we realise there will still be further work we can do to make improvements at a local level such as initiatives to promote mental wellbeing and to identify problems and intervene much sooner to prevent people from needing the kind of specialist care that is only available outside of the region.
Are you working with Patient Participation Groups (PPGs)?
We have a Citizens Advisory Panel (CAP) that acts as a critical friend and advisory body to Shaping Our Future to ensure health and care services are planned and developed with local people. Many of the lay members on CAP are already working with community networks and Patient Participation Groups
. More information about community networks can be found at www.cornwall.gov.uk/CommunityNetworks
We would like to strengthen and widen our links with patient participation groups and are currently revising the way that CAP works to formally support our ability to do so.
Will there be increased use of private services?
There are many NHS services across England, including GP practices and pharmacies which have been provided by private and charitable providers for years. All current providers of health and social care services are being consulted, including any that come from the private and voluntary sectors.
Commissioning organisations are bound by laws that relate to competition and the procurement (selection and purchase) of public services. These ensure that any provider (be they private, charitable or NHS) that wishes to provide an NHS service must go through the same rigorous selection process as any NHS providers that bid to deliver a service. All procurements must include patient representatives in their selection panels which further ensures the selection process is fair and objective.
We don’t know what sector a provider will come from until we have completed a formal procurement process so we do not yet know whether Shaping our Future will lead to an increase or decrease in privately run services. We can however assure people that once a provider has been contracted to provide a given service, commissioners are then responsible for ensuring that all service providers are performance managed against the same targets and quality standards regardless of whether those services are provided by the NHS, a charity or a private company.
Prevention programs require initial investment and take 20 years to pay off. How will that achieve short term savings?
Although the health benefits of some public health initiatives aimed at smoking cessation and weight loss take time before they show up as reductions in the number of people needing services we can forecast how much can be saved by reviewing changes in the number of people who give up smoking and join weight loss programmes or have bariatric surgery (gastric bypass and gastric bands).
The Shaping our Future plan talks about £20m for prevention. Where will the £20m for prevention come from?
Additional investment in prevention programmes in Cornwall and the Isles of Scilly to help people live well and stay well will need to come from a variety of sources. Some funding is available from national NHS Transformation Funds, other government departments (such as Department for Energy and Climate Change and Department for Communities and Local Government), Sport England and via European Social Investment Funds and our Devolution Deal. We have also applied to grant making bodies such as The Big Lottery Fund. Working in partnership we also have the opportunity to influence NHS and public sector workforce and spending to ensure we promote health – not just treat ill health. In the longer term we expect some shift in resources to prevention as the new models of care are put in place.
What is Shaping Our Future doing with schools and parents to get messages across, eg the increase in diabetes from increased sugar intake?
We have a separate plan under the umbrella of Shaping Our Future for all children’s services called One Vision. This sets out the detail of our work with all ages of children and their families and carers. A copy of the plan and more information about One Vision is available at www.cornwall.gov.uk/onevision
How much is Cornwall and the Isles of Scilly working with other STPs?
People from Cornwall and the Isles of Scilly regularly and routinely travel into Devon for health services and further afield for some ‘specialised’ services. Consequently, we have regular meetings with the STP team in Devon as well as specialised commissioners in the South West to ensure their plans take into account what is best for our population. Devon colleagues are very aware of their responsibilities to reflect the needs of patients who live in north and east Cornwall.
How long do you think it will be before we can realistically look at joined up IT?
As with any IT system there is significant investment required to enable very large numbers of different organisations to connect to the same system. There are other options which are much cheaper that will enable professionals to access the same information regardless of where they are in Cornwall and the Isles of Scilly. There are strict information governance rules regarding what information can be shared and under what circumstances that need to be adhered to. Linked to our Shaping Our Future plan is a Local Digital Roadmap which sets out our ambitions for the development of the enabling technology.
Cornwall has a high number of retired people who come here from outside of the county, which costs us money. Do we have reciprocal arrangements in place?
Yes, the same funding rules apply everywhere in England. If people retire to live in Cornwall or the Isles of Scilly, population based funding will follow them. If they holiday locally, and become unwell, the local NHS also receives funding.
If you don’t have a car and are too ill to walk or get the bus how will you manage?
It will depend on what service people need to attend and where they live. For example, people currently travel to appointments via ambulance, hospital car services, air ambulance and taxis if they have a medical need for transport or use public transport.
The Department of Health Leaflet, HC11: Help with NHS Costs sets out what support people can access to help with their travel costs.
As our plans develop we will be looking at travel times and travel options for people who may need to travel for services. One advantage locally is the Devolution Deal for Cornwall which gives us more control over local transport services.
What is a Community Hub?
A Community Hub is a term that has been developed locally to describe a single point for information, services and facilities. The hubs will aim to foster greater local community activity and bring residents, the local business community, and smaller organisations together to improve the quality of life in their local area.
Are you factoring new housing and town developments into your plans?
One aim of Shaping Our Future is to ensure health and care services can cope with expected increases in demand. Consequently, local authority partners are helping the Shaping Our Future team calculate future demand as accurately as we are able. The housing workstream is also working with a variety of local partners to ensure by 2020/21, residents of Cornwall and the Isles of Scilly with particular health and care needs will have improved housing options with a better supply, mix and choice of homes. They are working to ensure this range of provision will be shaped to meet the requirements of vulnerable adults who require housing with care and support. Homes will be of good quality and will be in individuals’ preferred neighborhoods. With access to good support, advice and financing models, an increasing number of people with care and support needs will be attracted to the improved housing offer and able to take advantage of it.
The priority between acute services and community services has drifted over time to favour acute services. How will the STP ensure a more balanced approach in future?
Everyone involved in health and care in the community and in hospitals is working together to plan services for the future as equal partners. The plan is to focus resources where needed to ensure people receive the right care in the right place at the right time. This will result in more resources being focused on community provision to enable patients to remain fit and independent in their own homes and so require less acute (and more costly) services.
How can you stop bed-blocking when there are too few packages of care available and too few carers who themselves have too little time available at clients homes?
What the media refers to as ‘bed blockers’ are actually people who no longer need the level of care (such as hospital care) where they are, but are unable to leave hospital because the appropriate provision is not yet in place. We are working with commissioners and providers of health and care as well as seeking the views of those who rely on these services to help us develop this part of the plan to ensure we focus resources where they can achieve the greatest benefits. Please be assured that no changes will be made until we are confident that all parts of the care pathway are sufficiently robust and in place.
Commissioners are working carefully with providers to ensure the right care is available at the right time in the right place. Alongside this, the system is working to maximise the ability to work with patients to help people recover and regain their independence, which reduces the need for any long term packages of care.
If Cornwall and Isles of Scilly had no tourists, would the local NHS be considered to be well funded?
NHS Kernow gets more funding than other parts of England when comparing current resource limit (budget) with national target funding. Although we do need to have sufficient services in place to cope with the annual influx of visitors, the costs of any hospital care provided to tourists are charged back to the areas where they normally live, rather than falling on Cornwall and the Isles of Scilly itself.
How do I make sure I’m kept informed as work on the plan progresses?
The Shaping our Future website will be updated with all the latest news stories and developments regarding the plans and any engagement events.
How are you involving pharmacists in this work?
NHS England in the South West has employed a team of expert pharmacists who are working with commissioners, local pharmacists and those that purchase medications for large provider organisations to ensure we are getting the best prices. NHS Kernow CCG also employs groups of pharmacists and technicians to ensure medicines usage is optimised.
Within local communities we are encouraging all professionals to get involved in planning for local people. This will include the extended role that pharmacists could play in things like care homes medicines management the management of minor ailments as well as the fantastic opportunity they have every day to reinforce public health messages.
How does this plan differ from the work we did years ago to help plan more joined up services?
This is the first time that all local health and care organisations have been asked to sign up to a single plan for the geographic area. In the past each organisation has developed and submitted a plan in isolation as these often contained contradicting aims and ambitions. Shaping Our Future gives us a great opportunity to join up acute and other community services across a large number of organisations and commissioning teams so we can jointly review and redesign whole pathways of care from prevention through to acute services that people might access from their local acute hospital or a specialised centre further afield.
If the majority of public feedback is negative will you scrap the plan?
The Shaping Our Future plan will develop in line with what all local stakeholders, including the public, tell us if it is clinically safe, appropriate and financially sustainable. We cannot however scrap the plan and do nothing because we know that health and care services are not delivering the best possible outcomes for local people and are not sustainable in the long term unless we adapt to meet increases in demand and changes to best practice and clinical standards. Consequently, doing nothing would not be in the best interests of the people for whom we provide services.
Is there a team working on this?
Yes, there are lots of people across all of the local health and care organisations that are working on this and we are currently reviewing the workforce needed to deliver the plan to ensure we have no gaps in the support available to the different priority work stream groups.
We are committed to ensuring that the large amount of work needed to be able to provide the public with a range of options about how we could meet each of the priorities set out in the Outline Business case is completed properly and this necessarily takes time. As soon as we have completed that work with our lay ‘experts by experience’ members we will be able to tell the wider public the pros and cons of different options so they can help us choose which ones we implement and we will share that information with people in a variety of ways. Experts by experience are people who have received support from the service or pathway being considered for transformation either as the recipients or the loved ones of those who have received care.
How will budgets integrate when they come from different sources?
We will need to work through how we integrate budgets to ensure that each organisation complies with any statutory requirements. We already have experience of pooled budgets between health commissioners and the Councils through mental health and learning disability services and the Better Care Fund. However, we will aim to provide seamless services to people regardless of whether the budgets are formally pooled or not
How will staff be fully involved in any proposed reforms?
It is vital that we involve our staff in all service redesign work. The work stream groups currently developing the plans are already identifying key stakeholders to engage with. We are in the process of a system-wide engagement strategy to ensure members of our staff and the wider community will be involved in the co-design of new services.