Cheshire & Merseyside Sustainability and Transformation Plan People and Services Fit for the Future 2 The Challenge for the NHS While on a day-to-day basis most We know that these issues require As a nation we are areas are running well, we are us to think more radically about fortunate to have seeing pressures in areas such as how best to address the problems hospital care, A&E, mental health we face together otherwise we a National Health and GP services. Some of this will fail to support the needs of Service that is free is being experienced in longer our communities into the future. waiting times and variable quality at the point of care, of care. In 2014, NHS England published delivering world a document entitled The Five There are several reasons why the Year Forward View (FYFV), class services. NHS is under pressure: which identified three priorities for the NHS to focus on in order to However, we also • People are living longer, but not improve services and the health know that the NHS always healthier, lives; of our country: • Care is not always joined up for 1. health and wellbeing – is facing some big patients, especially for the frail supporting people to stay well challenges and elderly and those with complex needs. As a result, too many 2. quality of care – providing there are clear signs people do not get the right care good services consistently in their homes or community, that it needs to wherever you live adapt and change which creates an over-reliance on hospital services; 3. NHS finances – maximising if it is to be fit for • We need to do more to support efficiency and reducing the future. children, young people and duplication in services. adults effectively with their mental health challenges; • At the same time, there is enormous pressure on health and social care budgets. There is also a growing financial challenge. The NHS will continue to receive a small year on year increase over the next five years, but this is not keeping pace with increasing costs and increasing demand for services. If we do nothing, the NHS faces a £30 billion funding gap by 2021. For Cheshire & Merseyside our share of this funding gap is £908m. 3 Cheshire & Merseyside Sustainability and Transformation Plan & Merseyside Sustainability and Transformation Cheshire 4 Cheshire & Merseyside in Partnership Although the NHS is a national public service it is made up of hundreds of organisations, including hospitals, community services, clinical commissioning groups and specialist services. In addition, public health and 2.5 30 social care are the million NHS responsibility of people organisations local authorities who work in collaboration with the NHS. Community and voluntary organisations also provide a great deal of support to complete this picture. It’s clear that the scale of the challenge is too big to be resolved by organisations making changes in 9 isolation. local authorities 5 For this reason NHS England has established 44 Sustain- ability and Transforma- tion (STP) ‘footprints’ across the country, bringing together NHS organisations, local author- ities and other partners to work together to deliver the priorities from the NHS Five year Forward View, by developing new ideas and proposals to improve health, improve quality and to ensure that the NHS remains financially sound. This is being backed up by additional investment over the next five years, above existing NHS budgets, to address these The role of the challenges. Sustainability and NHS organisations and local Transformation Plan authorities across Cheshire & Merseyside are working together (STP) for Cheshire and to develop ideas and proposals to share with the public about Merseyside is to how we can address our chal- lenges and come up with the co-ordinate our efforts, right solutions. These ideas have ensuring we promote the come together in the Cheshire and Merseyside Sustainability and best ideas and expertise Transformation Plan (STP). to provide for the needs Cheshire and Merseyside is a of the whole region now diverse region; with urban areas that have higher levels of poor and into the future. health and a greater concentra- tion of hospital services, alongside towns and rural areas that have different challenges, including Louise Shepherd physical access to services. Lead for the Cheshire and Merseyside STP and Chief Executive of Alder Hey Children’s NHS Foundation Trust Cheshire & Merseyside Sustainability and Transformation Plan & Merseyside Sustainability and Transformation Cheshire 6 Our Priorities Ideas and proposals have come of working, including sharing NHS organisations together in the Cheshire and Mer- electronic information across and local authorities seyside Sustainability and Transfor- all parts of the health and care mation Plan (STP), which has four system. have been working main priorities: together for the Improving Health 1. Support for people to last few months, live better quality lives and Wellbeing looking at examples by actively promoting We want to see significant what we know will have improvements in the of good practice and a positive effect on health health and wellbeing of improvements that and wellbeing. The way we live now is having a negative people living in Cheshire have delivered good impact on our health and and Merseyside. We results elsewhere. putting pressure on services. want people to be better Alcohol, smoking, poor diet informed and empowered Our core purpose and inactivity are increasing to make positive lifestyle demands on the NHS. We have choices and we want to is to ensure that to change this. the people of do more to prevent illness. 2. The NHS working together If we can support people Merseyside and with partners in local to stay well for longer we Cheshire continue to government and the will be able to improve voluntary sector to develop quality of life and reduce have access to safe, joined up care, with more of reliance on the NHS. good quality and that care offered outside of hospitals to give people the The plan identifies three Cheshire sustainable services, support they really need when and Merseyside-wide projects, and where they need it. which also means that will support reductions in alcohol abuse, blood pressure making the best use 3. Designing hospital services and antimicrobial resistance. of the funding we to meet modern clinical standards and reducing will receive over the variation in quality; people next five years. should be confident that they will receive similarly high standards of hospital care regardless of where they live. 4. Becoming more efficient by reducing costs, maximising value and using the latest technology; reducing unnecessary costs in managerial and administrative areas, maximising the value of our clinical support services and adopting innovative new ways 7 There is a strong health and business case for investing in schemes to prevent people becoming ill. This is the most effective way to make the NHS sustainable For example, tackling high blood in the longer term pressure is about encouraging more people to have checks, not only in traditional ways such as through their GPs, but also in everyday places in communities, Eileen O’Meara including pharmacies. If we in- Director of Public crease awareness and checks Health, Halton we can intervene to support the thousands of people who have undiagnosed high blood pressure, which often has no symptoms, and avoid deaths and instances of stroke and heart disease. Not only will these three schemes improve health, they will also reduce reliance on the NHS. Cheshire & Merseyside Sustainability and Transformation Plan & Merseyside Sustainability and Transformation Cheshire 8 Offering good Better Care Outside services closer Improving Hospital of Hospital to home will Services One of the most improve care Across Cheshire and far-reaching areas of Merseyside we will change we could make for the most undertake a review of is to establish integrated vulnerable clinical services across all services for better care in our our hospitals to identify in our communities. In where there are variations practice, this is about communities in quality and to look different parts of the and reduce at how we can establish NHS and social care admissions to consistently high clinical services working together standards. Our plans for seamlessly with a better hospital. This hospital services will lead focus on people’s needs. is good for to greater collaboration patients and for and sharing of expertise For example, in our communities and resources. The work GPs will work in integrated teams the NHS. with hospital specialists, district to review variation and nurses, mental health workers and standards is at a very early social workers to improve care for stage and will take some people with long-term conditions further time to deliver such as diabetes, elderly people impact. who are frail or children and adults with very specific needs. If In reviewing hospital services, we do this effectively we will keep we will be open about the more people well, improve quality issues we face that may lead of life and have fewer people to proposals to change how needing to be admitted and where some hospital to hospital. Jerry Hawker services are delivered. Accountable Officer, NHS Eastern Cheshire Clinical Commissioning Group 9 We will establish For example, there is evidence that for some specialist areas, consistently high clinical such as stroke services, it is better standards in all Cheshire to concentrate care in fewer centres as we know that this and Merseyside hospitals, will improve outcomes for so people can trust that patients. services will be good We also have a shortage of doctors and nurses in some regardless of their postcode. specialties, such as urgent and emergency care, which are making it difficult to provide good quality Dr Simon Constable services in every Medical Director, hospital.