An Introduction to the Staffordshire and Stoke-on-Trent Sustainability and Transformation Plan Contents
1 Introduction 3
2 STP area map 4
3 How things should be… 5
4 How things really are… 6
5 The challenges facing our health and care system Health and Wellbeing 7
6 The challenges facing our health and care system Quality of care 8
7 The challenges facing our health and care system Finance and efficiency 9
8 How will we solve this? 10
9 Why hospital care isn’t always the best place for you when you’re ill? 12
10 We all need to take more responsibility for our own health, where appropriate 13
11 What does the future look like? 15
12 Public engagement 16
13 We need to make these big decisions together 18
14 Where can I find out more? 20
2 Together We’re Better Staffordshire and Stoke-on-Trent Sustainability and Transformation Plan 3 1 Introduction
STPs are about local leaders working together and with local people to join up and improve health and care within the budgets available to us.
There are 44 STPs and each has a ‘footprint’ – the area that it covers. Our footprint is Staffordshire and Stoke-on- Trent and we have named our Clinical plan ‘Together we’re Better’. Commissioning Groups We have two local authorities, six Clinical Commissioning 44STPs Nationally 6across Staffordshire Groups, who are responsible and Stoke-on-Trent area for buying healthcare for the area, and five NHS trusts providing services to 1.1 million people. In addition, Royal
Wolverhampton Trust runs Cannock Hospital.
Our population needs are changing as people live longer, often with more complex conditions. There is a life expectancy gap in some of our communities.
Our financial position is Providing services to In four years time we challenging - in four years time all organisations across estimate a funding gap of Staffordshire and Stoke-on- Trent will be in deficit, and we will have a funding gap of £542m if we don’t 542m change things. 1.1mpeople in Staffordshire for all organisations and Stoke-on-Trent across Staffordshire and Stoke-on-Trent, if we don’t change things
2 Together We’re Better Staffordshire and Stoke-on-Trent Sustainability and Transformation Plan 3 2 STP area map
Stoke-on-Trent CCG
North Staffordshire Stoke-on-Trent CCG City Council
Royal Stoke Leek University Moorlands Hospital Hospital Leek Haywood Bradwell Hospital Hospital
Cheadle Newcastle-under-Lyme Hospital North Stoke-on-Trent Staffordshire Cheadle Combined East Healthcare NHS Trust Staffordshire CCG University Stone Uttoxeter Hospitals of North Midlands Queen’s NHS Trust Stafford & Hospital Surrounds Samuel CCG Johnson Burton upon Trent Staffordshire and Stafford Hospital Stoke-on-Trent County Partnership NHS Hospital Trust Rugeley
Cannock Burton Hospitals Chase CCG NHS Foundation Cannock Trust Lichfield
South Tamworth Staffordshire Staffordshire and Shropshire County Healthcare NHS Foundation Council Trust South East Cannock Sir Robert Staffordshire Chase Peel and Seisdon Hospital Hospital Peninsula CCG
Not a geographical representation
4 Together We’re Better Staffordshire and Stoke-on-Trent Sustainability and Transformation Plan 5 3 How things should be…
Everyone deserves associated with learning Health and care should be an difficulties, or a combination equal partnership between good quality, safe, of all of these. you and the professionals health and social care who support you. We believe services that make The services you use most of that prevention is always the time should be as close better than cure and that the best possible use to where you live as possible, we all have a role to play in of taxpayer’s money. as long as this is safe and managing our own health and the local health and care care—including planning and These should be readily system can afford this. For budgeting for our needs as available to you regardless the vast majority of the time we get older. of your age, ethnicity, social you should go home as soon and employment status, as treatment is completed. sexuality or where you live. More specialist care will be delivered in a centre of The standard of care should excellence, so you may need be the same whether you to travel a little further for this need physical, mental health - but rehabilitation and follow or social care services, up treatment/appointments support with conditions will happen close to home.
4 Together We’re Better Staffordshire and Stoke-on-Trent Sustainability and Transformation Plan 5 4 How things really are…
There are many we often live longer with ill [[ A quarter of all patients health. Currently we treat admitted to hospital with reasons why we disease and conditions to a physical illness also have are not providing prolong life, but not always a mental health condition the standard of with people’s dignity that is most cases is not and quality of life as our treated whilst in hospital. care we have just priority. described. Our We are a growing, biggest challenges patients are ageing population… can be summarised 800 admitted to our local hospitals as follows: [[ By 2021 the number of people aged 65+ will rise every day by 16% 1. We’re spending far too of these 330 patients are much money and are [[ 30% of health and care unplanned building up a very big costs for those aged over debt — £542million in 65 years are spent on patients are five years if we don’t act hospital care 60 readmitted now—but we’re not seeing within 30 days enough improvements in [[ Half the local Clinical of discharge health and care as a result. Commissioning This matters because we Groups (CCGs), who of people in a won’t be able to make are responsible for buying 33% hospital bed at investments in improving local healthcare services, any one could be care, the latest technology exceed the average treated better and equipment such as for injuries due to falls elsewhere scanners, and training. in people aged 65+, It will also make it even Stoke-on-Trent was 30% of acute bed more difficult to attract above the national average. 30% occupancy is GPs, Nurses and Surgeons by those with to work here …with more complex mental health health needs needs 2. Our major hospitals are struggling to meet quality [[ People are living longer standards and demand — – this is good you’ve all heard the stories of long queues in A&E and [[ Many are living with cancelled operations complex long term conditions 3. We’re not always providing the right care at [[ Too many people end up the right time in the right in hospital, particularly way — and sometimes this A&E, when there are other, means we actually cause more appropriate and far you harm. The fact we are less expensive alternatives living longer means that
6 Together We’re Better Staffordshire and Stoke-on-Trent Sustainability and Transformation Plan 7 5 The challenges facing our health and care system Health and Wellbeing
Cancer Mental health Frail and elderly [[ Main cause of premature [[ 1 in 4 adults have [[ Injuries from falls deaths a mental health issue 30% higher than at any one time national average [[ Only 75% of patients seen within 62 days [[ Many cases of stress, [[ Reablement spend is anxiety and depression can 59% lower than national [[ Local CCGs have poor be treated at home with average. cancer detection rates. the right support.
Smoking Obesity [[ Higher rates of death [[ One in ten children aged due to smoking related four to five is obese illnesses [[ This rises to one in five [[ Need improved by age 11 education about health risks. [[ Two out of three adults have excess weight problems.
6 Together We’re Better Staffordshire and Stoke-on-Trent Sustainability and Transformation Plan 7 6 The challenges facing our health and care system Quality of care
Readmissions A & E Access and [[ Hip fracture readmissions [[ Poor performance locally wait times are up to 35% more likely against 4 hour wait targets [[ Large variation in the number of GPs per head [ [ [ Mental health unplanned [ 30% more attendances at of population readmissions worse than A&E than other areas national average. [[ Non-elective admissions, [ [ More education needed 62 week wait, all higher around alternatives. than national average
[[ Improvements here would make a real difference.
8 Together We’re Better Staffordshire and Stoke-on-Trent Sustainability and Transformation Plan 9 7 The challenges facing our health and care system Finance and efficiency
We face a significant financial challenge – £129million gap for 2015/16
This equates to:
[[ 8% of the total health spend
[[ 500 beds in acute hospitals
High levels of hospital Estates – Buildings [[ Over 3,000 NHS staff, admissions and land including Doctors and Nurses
[[ The six Staffordshire and = Stoke-on-Trent CCGs are currently forecast to end the year with a debt of £135million
[[ By 2020/21 the CCGs will receive 14.8% more money per year, but health costs will rise 20% in the same High costs of Duplication & period emergency care planned care [[ If we do nothing, the recurring deficit in 2020/21 is currently forecast to be £286 million
[[ Add in the cost pressures in social care, this forecast increases to £542 million by 2020/21.
8 Together We’re Better Staffordshire and Stoke-on-Trent Sustainability and Transformation Plan 9 8 How will we solve this?
Our draft plan puts together some ideas about how we can solve these problems based around five key areas:
We think there are two steps to achieving the care you deserve:
1. Affordable care (The next 1-5 years) We need to have honest and possibly difficult conversations about what Focused prevention Enhanced primary (i.e. GP) we can do without, do less and community care of, or do in a more effective way; but this may involve making some difficult decisions. For example: should we move from three A&E sites to two and turn the third into an urgent care centre? How would this work? How could we ensure the quality of care improved as a result? Would this adequately serve the needs of the local population? Effective and Efficient Simplify urgent & emergency Planned Care care system 2. Transforming Care (the next 3-10 years) This is the exciting bit. We want to work with you to plan the steps needed to transform the way that we will provide health and care services in the future £ so that these fit in with Mental health services the way that we live and (including learning work today. We need to disabilities) are a part of make sure that everyone is all of these areas treated fairly and gets the Reduce costs of services right support.
10 Together We’re Better Staffordshire and Stoke-on-Trent Sustainability and Transformation Plan 11
Affordable Care Transforming Care
Focused Reduce the number of people Work in new ways together to make Prevention with problems caused by prevention and wellbeing everyone’s alcohol, obesity and smoking. business. Tackle health inequalities by This will reduce expensive dealing with the social, economic and hospital admissions by twice environmental causes of ill health in as much as trying to prevent your community. Share with you the their admission once the responsibility for staying well. Develop problem is there. holistic approaches to support people with both mental and physical health needs.
Enhanced Increase the proportion of Improve access to care when you need Primary & care in the community rather it. Take your mental health as seriously as Community than hospitals. Reduce the your physical health, and provide access Care number and severity of to mental health professionals /support complications from long within these teams so you receive care term conditions. Develop a earlier, reducing barriers and stigma. Plan workforce plan to cope with your care with you if you have a long term the changes in training, roles condition. Share with you the responsibility and demand for different for managing your condition. Join up care kinds of professionals. and allow your medical records to travel with you.
Effective Reduce ineffective treatment, Perform more diagnostic tests and & Efficient reduce duplication of tests follow up in the community so you only Planned and concentrate experts and go to hospital once. Develop a dual care Care specialised diagnostics in a approach addressing both physical and few centres of excellence. mental health needs.
Provide quicker and less invasive treatments such as more physiotherapy and less surgery, more talking therapy and less drugs.
Simplify Increase community based Providing better access to more urgent Urgent & urgent care and reduce care nearer to your home. Make it easier for Emergency A&E attendances. Reduce you to know where to go for urgent advice Care emergency hospital and treatment. Provide safe alternatives to System admissions and readmissions. admission to hospital. Rapid 24/7 access to mental health care for those in A&E who need it; 24/7 home treatment for those in a mental crisis.
Reduce Review buildings, grounds and Involve you in all difficult decisions about Cost of bed capacity to ensure we what we can afford. Provide safe and Services are providing the right care in efficient environments for care, which are the right place. Increase the designed for 21st Century requirements. amount organisations work Maximise the use of technology to improve together to reduce excess communication, information, monitoring management costs. and problem solving.
10 Together We’re Better Staffordshire and Stoke-on-Trent Sustainability and Transformation Plan 11 9 Why hospital care isn’t always the best place for you when you’re ill?
If not hospital, then that treating people closer to When you need where? home through more localised hospital care, it will be services leads to them there People currently view getting better quicker and hospital as the best – or only having a better quality of life, It is important to know that – place for them when they’re but extra support is needed if hospitals will always be there ill because they either don’t we are to achieve this. when you need them, but by know about the alternatives, giving you better options for or those alternatives don’t Alternatives may include your health needs, it will help exist. If we are to encourage improved access to GPs with relieve some of the pressure people to only go to hospital a wider range of services the hospitals currently face, when it’s really necessary, we available; access to walk-in allowing them to focus on need to ensure there are high centres and specially trained the people that really need quality alternatives available pharmacists or developing their specialist can, improving elsewhere and that people centres of excellence that quality as a result as well as know they exist and known focus on specific health being able to better manage how and when to access needs, such as cancer or demand and wait times. them. Evidence suggests diabetes.
12 Together We’re Better Staffordshire and Stoke-on-Trent Sustainability and Transformation Plan 13 10 We all need to take more responsibility for our own health, where appropriate
NHS and social care services It’s not all about health should continue to be there We recognise that to truly tackle some of when we really need them, but to the health issues we face in our area, we ensure this happens in the future, need to look not just at the symptoms but at the root cause – and these aren’t always health many of us could take on more related. Poor housing, social isolation and a personal responsibility for our missing sense of community all contribute to poor health, particularly mental health. We own health. This could be through recognise that we need to treat your mental making better lifestyle choices to health as equally as your physical health. It help us stay well, or by managing makes absolute sense to engage with the voluntary and third sectors. It is clear that our own health better when we all need to work together to help improve we are ill. It could even involve health and social care across Staffordshire making use of new technology to and Stoke-on-Trent. monitor and maintain long-term conditions in the home.
12 Together We’re Better Staffordshire and Stoke-on-Trent Sustainability and Transformation Plan 13 14 Together We’re Better Staffordshire and Stoke-on-Trent Sustainability and Transformation Plan 15 11 What does the future look like?
We certainly don’t the “jigsaw” together when it We believe that it will also be have all the answers comes to looking after people. less expensive as long as we are all prepared to accept that yet but local clinical These teams will work closely if we get this right the roles of leaders have been together with patients hospitals will change. as equal partners in the working on a new management of their physical This is likely to mean fewer community ‘model and mental health, and people hospital beds, less staff of care’ in which a will be given the necessary working in a hospital setting number of health and advice, support and resource and more specialist services to help them stay well for as in fewer hospitals. As part of care professionals long as possible. this we will look to move from with different skills to three to two A&Es and When they are ill, they will will work in small one Urgent Care Centre and be given the necessary an exploration of potential teams (we call these knowledge and help to options, though no decisions ‘multi-disciplinary’), manage their own conditions on the locations of these which will both wherever appropriate and services has been made. possible, giving them more support and learn control over their lives. Doing this well would mean from one another. our financial position will This kind of proactive begin to improve in the longer approach to care will We think we would need term and we will be able to help us all work together around 23 teams based meet the national standards around local populations in to reduce the number of for care within our major Staffordshire and Stoke-on- times people need to be hospitals—something we have Trent of between 30,000 – admitted to hospitals for both all struggled with in recent 70,000, many of whom will pre-planned and emergency years. This will mean less need relatively little support care, allowing people to queues in A&E, reduced waits from the system most of the remain independent, in control for operations, better care and time. and sleep in their better patient experience. own beds rather than on These teams will need to hospital wards. We will have to make some have the right information investment in the short term about their patients at their This will help to reduce a lot to make sure this works, and fingertips in order to help of the stress associated with we have factored this into identify those who may illness for patients and their our plans as we know this need additional support, families, as well as being a will lead to savings in the help and advice. much more convenient, cost longer term. effective way of providing They will focus on the overall services. needs of the person rather than dealing with a series of individual symptoms, putting
14 Together We’re Better Staffordshire and Stoke-on-Trent Sustainability and Transformation Plan 15 12 Public engagement
In partnership with The events were held at: Healthwatch Staffordshire and Healthwatch Stoke- [[ Staffordshire Moorlands on-Trent, throughout (Biddulph) November and December [[ South Staffs (Codsall) 2016 we held a number of patient and public [[ Stoke-on-Trent (two events) engagement events, [[ Stafford known as Conversation Staffordshire and [[ Newcastle-under-Lyme Stoke-on-Trent. These [[ Lichfield events were about local people talking about [[ Tamworth the very real, very serious issues outlined [[ Cannock in a Conversation [[ East Staffordshire (Burton) Staffordshire and Stoke-on-Trent These events offered the opportunity to have frank and document through open discussions with leaders from an open, two-way the STP about the work we have discussion. done so far, and difficult decisions that may need to be made going We wanted to know forward, as well as some of the which services were opportunities this will create. valued most? How they These were not full consultation events, but the discussions may in can be shaped and the future inform the content of improved? Where do any future consultations about any patients need to access major changes to health and care those services? How can services. we make the best use of public money?
16 Together We’re Better Staffordshire and Stoke-on-Trent Sustainability and Transformation Plan 17 During the events we Many clinicians and health No decisions can or will received feedback and professionals have been be made until we have ideas on: involved in the work we have thoroughly engaged with done so far, but we now need you, our staff, politicians and [[ What you have seen that to get everybody involved. We voluntary sector organisations, could be done better need people who care about and any their local services and who major changes to service [[ Where money could be are interested in seeing their have to go through a formal better spent local NHS not only survive the consultation process. coming months and years, [[ What services mean the but also begin to thrive and We are lucky to have a most to you and how can improve as we move towards National Health Service as well we improve them 2020. as the social care that wraps around it. By getting involved [[ If more of the care you We must also be realistic – now, you can help to make need is available close to with a population of well over sure your local NHS continues where you live, how far is one million people it’s unlikely to provide high quality, easily it acceptable to travel to we can please everyone, and accessible healthcare to you, receive specialist care not all ideas and proposals your friends and your family will be achievable. However, for years to come. [[ What can we do without we will do our best to ensure decisions made are in [[ Is it right to expect people collaboration with the public. to budget for their care needs as well as their Local Scrutiny Committees, overall living expenses your local MPs, Councillors, in old age. the voluntary sector and patient representatives will Healthwatch Staffordshire all have an important role to and Healthwatch Stoke-on- play in commenting upon Trent will be providing a more and challenging our plans, detailed report which will and we have also set up be used to inform ongoing an Ambassador Training engagement. Programme for patients staff No decisions about major and local people who want to changes to local services will learn more about so that can be made without extensive share information with their public consultation and communities. feedback.
16 Together We’re Better Staffordshire and Stoke-on-Trent Sustainability and Transformation Plan 17 13 We need to make these big decisions together
During our engagement events to date we have set You said: You said: out a “direction of travel”, “There are lots about “You understand and our current services agree with our ambition but there are a number of that you value highly, to provide care closer big decisions that we need but you also gave to home, but you have to make with you in 2017 us examples of poor real concerns that and beyond: experiences, and overall community services do concerns that the not exist at present to [[ How quickly, and in which current way we deliver make this happen.” locations, should we care is not working as it should.” deliver the new joined up We did: way of providing primary, We recognise that the community, mental health We did: development of these and end of life care services? The plan is based on a locality teams will require new model of care which investment and transition [[ How can we best use will be more joined up, funding. This is built into community hospitals and and bring care as close the STP plan. other estate (buildings and to home as possible, but land) to complement this? also help people take more control of their own [[ What is the most sensible health and care. You said: and cost effective way of “We need to recognise providing elective (planned) the differences there care? Should we centralise are between local areas, UHNM planned care services You said: and the different needs onto one site, and should “You are worried about of local populations.” we have fewer, high quality the pressures on our centres of excellence? Where A&E services, and there is confusion about what We did: should these be? We agree and can services to use when.” [[ Improving urgent care reassure that the inline with national development of these new models will be recommendations may We did: bottom up – driven reduce the need for A&E We recognise the locally. The most likely services. Do we need the need to simplify the current system, and our form will either be same number of A&Es and multispecialty community if so where would they be? proposals about redesign of urgent care are based provider (MCP) or Our current thinking is that on improving the service Primary and Acute Care we could move from three offered at local level. Systems (PACS). A MCP to two A&E sites and one These will be subject moves specialist care Urgent Care Centre. This to consultation in the out of hospitals into is something we will hold summer. the community, whilst a consultation about in a PACS joins up GP, summer 2017. hospital, community and mental health services. [ [ Can we make further cost The STP has not made savings by sharing services any statement about the or organising ourselves format or geography of differently? these developments.
18 Together We’re Better Staffordshire and Stoke-on-Trent Sustainability and Transformation Plan 19 You said: You said: “You are really concerned about the “Are there any ways of slimming down future of the community hospitals in your management costs or sharing Staffordshire and Stoke-on-Trent, and feel facilities.” in many places these are under-utillised; you gave us lots of ideas about how we could use these facilities better.” We listened: We recognise that reduction of cost is important and we will look closely at We did: the way we work to see if there are any The STP is very clear that reduction in sensible ways of joining up our services. beds will be supported by additional investment in out of hospital services including community, mental health, primary and social care. The CCGs will You said: be consulting formally in the New Year We have dedicated and committed staff about their plans for the future use of in our NHS and care services, community hospitals and we welcome and you value highly their work. suggestions from local people.
We listened: We agree that our staff are fundamental You said: to delivering the plan and every “The current system is fragmented, organisation is committed to supporting and care is often affected by lack of their staff through the delivery of the communication between professionals.” plan.
We did: The fundamental basis for the plan is the development of integrated teams at locality levels who will deliver a more consistent service offer. These locality teams will over time develop into new models of care in line with the five year vision for the NHS. This will mean professionals working together in teams to give you a joined up service. These are the cornerstone of the STP.
18 Together We’re Better Staffordshire and Stoke-on-Trent Sustainability and Transformation Plan 19 14 Where can I find out more?
You can read the full STP submission here.
This will give you more detailed information about the work that is underway. It sets out our direction of travel but no decisions have been made yet – so there is plenty of time to have your say.
We want to know what you think, so if you have any comments on the draft plan or would like to get more involved please contact:
Or call the Communications and Engagement Team at Midlands and Lancashire Commissioning Support Unit on 0333 150 1602.