SOHS Redlines | Exeter City Council No Confidence Vote

SOHS Red Lines

No.15 – 17 December 2016

Exeter City Council No Confidence Vote

At the Full Council meeting meeting held on 13 December 2016, Exeter City Council considered a motion put by Cllr Chris Musgrave.

The motion said:

Exeter City Council notes that the Government requires 44 Footprint Areas across the UK to prepare NHS Sustainability and Transformation Plans for their area which will:-

i. Contribute to cuts of at least £2.5bn nationally this year, and £22bn within the next five years, to wipe out the NHS so-called financial deficit; and

ii. achieve this by implementing ‘new models of care’ that are set out in NHS England’s 5-Year Forward View (2014).

NHS bodies are severely limited in how they can oppose these cuts because they risk losing access to the £8bn NHS Transformation Fund.

However, local authorities are in an excellent position to make clear their complete opposition to the programme. 

Exeter City Council therefore calls on Devon County Council to join together with other Councils and campaign groups to widely publicise the details of all proposed cuts and changes to local NHS services.

We further call on Devon County Council to refuse to sign up to any STP, until the local proposals have been subject to a full and proper consultation.”

The motion was carried unanimously.

 

SOHS Redlines | DCC unanimous vote to ‘pause’ STP

SOHS Red Lines

No.15 – 17 December 2016

DCC unanimous vote to ‘pause’ STP

At its meeting on 08 December 2016, Devon County Council (DCC) voted unanimously in favour of two motions put by Cllr Brian Greenslade and Cllr Frank Biederman which, together, expressed the deep concern of the Council about the impact
of proposed cuts to Devon’s Health Services as indicated in the Sustainability and Transformation Plan (STP) for Devon; a claim for fairer funding of these services and the need for local MPs to lobby Government to this end.
Cllr Greenslade pointed out that Devon County Council is the largest local authority in the South West and, alongside Cllr
Biederman insisted that they will “speak up for the people of Devon who are terrified by the implications of this flawed process…”
The Save Our Hospital Services Devon (SOHS Devon) campaign has been instrumental in bringing this issue to the Council Chamber via lobbying at town and district level, the Health and Well-Being Scrutiny Committee, public meetings and the Red Line and Devon Sees Red demonstrations in Barnstaple and Exeter
.
In his address to the DCC on behalf of SOHS Devon Phillip Wearne said that the‘Success Regime’ and the STP process
headed by the same person in Angela Pedder, and operating with the same staff should be considered as one and the same. The ‘Success Regime’/NEW Devon Health Trust is “riddled with conflicts of interest and inherently unfair, especially for North Devon. In sum what is going on is an inside job.” He then explained where these conflicts of interest exist and added “ The SOHS Devon campaign is committed to preventing any cuts in our hospital ser vices.”
Liz Wood from the SOHS Devon campaign also addressed the Council and identified the threat to acute services at North Devon District Hospital (NDDH), saying “In June Ruth Carnall came to Barnstaple armed with her contradictory and contestable Case for Change document – the product of her own independent healthcare consultancy. . . she and her ‘
Success Regime/STP colleagues have stressed one thing: there are no red lines around any hospital services in Bar nstaple. . . nothing is ruled out, they warn in concert. That ‘nothing’ includes all our acute services – consultant-led maternity, paediatrics, neonatology and stroke.”
The full texts of both the above speeches are available on request.
On 05 December Oxford City Council also rejected this process, noting that the former Head of NHS England’s Commissioning Policy Unit, Julia Simon, has denounced the STP process as ’shameful’, ‘mad’, ‘ ridiculous’ and the plans as ‘full of lies’.

Exeter City Council | Motion on Wider Devon Sustainability and Transformation Plans

At its meeting held on 13 December 2016, Exeter City Council considered a Notice of Motion by Cllr Chris Musgrave under Standing Order No.6.

Minute 80 of the meeting notes:

Notice of Motion by Councillor Musgrave under Standing Order No.6

 

Councillor Musgrave , seconded by Councillor Morse, moved a Notice of Motion in the following terms:-

“Exeter City Council notes that the Government requires 44 Footprint Areas across the UK to prepare NHS Sustainability and Transformation Plans for their area which will:

i. Contribute to cuts of at least £2.5bn nationally this year, and £22bn within the next five years, to wipe out the NHS so-called financial deficit; and

ii. achievethis by implementing ‘new models of care’ that are set out in NHS England’s 5-Year Forward View (2014).

NHS bodies are severely limited in how they can oppose these cuts because they risk losing access to the £8bn NHS Transformation Fund.

However, local authorities are in an excellent position to make clear their complete opposition to the programme. 

Exeter City Council therefore calls on Devon County Council to join together with other Councils and campaign groups to widely publicise the details of all proposed cuts and changes to local NHS services.

We further call on Devon County Council to refuse to sign up to any STP, until the local proposals have been subject to a full and proper consultation.”

In presenting the Notice of Motion, Cllr Musgrave highlighted that he was proud that his party had created the NHS over 60 years ago and that the NHS was vital providing free health for the residents of this country. He hoped that he would get cross party support to resist the Sustainability and Transformation Plans. The NHS was no longer financially sustainable and the closure and relocation of some services in Exeter were affecting local residents and causing stress on local services. The City Council in supporting this motion would therefore assist the County Council in resisting the plan.

A Member [Cllr Andrew Leadbetter] stated that the County Council had passed a motion opposing these Government proposals and this motion would help the County Council in challenging theSustainability and Transformation Plan.

Another Member [Cllr Kevin Mitchell] stated that the provision of social and health care should be combined and all political parties should work together to find a solution to ensure the long term sustainability of the NHS.

All Members fully supported this motion.

The Notice of Motion was put to the vote and carried unanimously.

Devon County Council | Wider Devon Sustainability and Transformation Plans

At its meeting held on 08 December 2016, Devon County Council debated the Wider Devon Sustainability and Transformation Plans.

Minute 63 of the meeting notes:

Public Participation: Petitions, Questions and Representations
Petitions, Questions or Representations from Members of the public in line with the Council’s Petitions and Public Participation Schemes.

In accordance with the Council’s Public Participation Rules, the Council received and acknowledged oral representations made by a Mr Wearne and a Ms Wood on a matter relating to the functions of the Council, specifically on the impact of the Clinical Commissioning Group’s Sustainability & Transformation Plans (STP) for NHS services in Devon.

Speech made by Phillip Wearne:
Councillors, one of the motions before you today calls the Success regime now directing our NHS services in Devon flawed and calls for it to be halted until its independence is determined. I agree and trust you will too. You should consider the Sustainability and Transformation Plan process, the STP, headed by the same person in Angela Pedder and operating with the same staff part of the same critique.

In the brief time allowed me I will try and illustrate why what is going on here is not only open to serious accusations of pre-determination but riddled with conflicts of interest and inherently unfair, especially for North Devon. In sum what is going on is an inside job.

Firstly how can a healthcare trust running an acute service district hospital like North Devon District actually defend services when it proclaims itself part of a Success Regime that has made it clear that its services will be cut? How can our chief Executive Alison Diamond stand up for us North Devonians and represent the Success Regime at the same time? She can’t and she doesn’t – as consultants, staff and the public who have challenged her on this in Barnstaple have discovered.

Secondly, since this is all about money who is Alison Diamond, NDDH’s Chief Executive accountable to? She is married to Andy Robinson, now, having left her employ, the Chief Financial officer of the Success regime. So is she accountable to him or us, the residents of North Devon, where, incidently, she does not even live.

Third, in the clinical cabinet meetings in Exeter and Plymouth who represents North Devon? How many practising as opposed to managing clinicians – it’s an important distinction councillors — from North Devon are involved in the current clinical reviews and decision making? If any, and to date there have been very few, very occasionally, what weight is their opinion ever given?

In the coming weeks and months you will told repeatedly that all decisions on service cuts are being made on clinical grounds. Ask who those clinicians are councillors, where they work, what credentials they hold, what motives might impact their opinions. Money follows patients councillors, particularly in the acute sector. Both Derriford and RD&E have much bigger deficits than NDDH.
The Success Regime’s mantra is clinical and financial sustainability. They don’t say it but I will, councillors. NDDH is today on the very edge of clinical viability. Vacancies in essential areas are rife, staff covering for ghosts are run off their feet, interim, temporary appointments are the norm.

The very threat to our hospital imposed by the Success Regime’s threats to the services provided there has encouraged some staff to leave, others to refuse to come, still others to seek other jobs. Irony of ironies, councillors, the structures are so incestuous that NDDH has even lost two executives to the Success Regime. They are reinforced. We are weakened.

So ask yourselves who has made our hospital less clinically sustainable? Who is already cutting services? Who is weakening, co-opting or even recruiting our management? Ask yourselves whose interests might that be in if the leadership of the Success/STP Regime are determined to make the case for closing more services at NDDH. I say more because ENT and vascular surgery have already gone along with forty acute beds. Facts on the ground are being created councillors. You need to know those facts.

Medicine is an evidence based discipline councillors, and the evidence, points in one direction. Many of you have said to many of us wait for the various service reviews. But we know from bitter experience in Torrington, Ilfracombe, Bideford that will be too late: by then pre-determination will have become determination, and consultation will in fact be foregone conclusion.

By then much of the deliberately manufactured evidence on the clinical and financial viability of our hospital will be in their favour. And guess what, it’ll all be the product of the ultimate inside job. Well paid Success for them, disastrous failure for us. They move on, we in North Devon remain to live, and die, from the consequences.

Speech made by Liz Wood:
Councillors, as an active member of Save our Hospital Services (SOHS) in North Devon I am one of those who have lobbied you asking for your support for the two motions on your agenda as Item 15 today. Some of those exchanges have made it clear that there is little real understanding of what is happening or what is at stake here as regards health service provision in Devon in general, and where I come from in North Devon in particular.

Firstly, please understand that the Success Regime and the Sustainability and Transformation Plan process are now essentially one and the same. Both Ruth Carnall and Angela Pedder have made that clear in public and in private. Of course the latter includes Torbay and South Devon, the former did not, but the objectives of both, a reconfiguration and relocation of services to eliminate deficits based on the underfunding and defunding of our NHS — the subject of the motions before you today — are the same. For “Success Regime” in Cllr. Greenslade’s motion before you today you could and should read Success/STP Regime.

Secondly, many of you seem to think there is no defined threat to acute service provision at North Devon District Hospital. I do not understand how anyone following this issue can believe that. In June Ruth Carnall came to Barnstaple armed with her contradictory and contestable Case for Change document – the product of her own independent healthcare consultancy. Then and since then, she and her Success/STP Regime colleagues have stressed one thing: there are no red lines around any hospital services in Barnstaple. Anything could go, we should expect change, nothing is ruled out they warn in concert. That “nothing” includes all our acute services – consultant led maternity, paediatrics, neonatology, stroke.

You really need to understand one thing councillors. The basic STP template from NHS England allows for only two full service acute centers in each footprint, so technically just two in Wider Devon. As the acute service hospital catering to the smallest catchment population in Devon that makes NDDH particularly vulnerable. As the remotest acute service hospital in mainland England, that makes us, the people of North Devon, uniquely exposed to any acute service cuts.

Please read page 40 of the first draft of the STP, the one dated June 30th and leaked in mid-September, the one they did not expect the public or the politicians to see. It contrasts sharply with the second draft of the STP, the one sanitized for public and political consumption and published in October.

In the context of Derriford Hospital being the accepted primary fixed point for emergency care in Devon, the STP Draft One states: “Under a two site-option for maternity, paediatrics, neonatology and stroke, Royal Devon and Exeter Hospital would most probably be the second site rather than North Devon District Hospital….”

STP/Success Regime proponents and protagonists are not accountable to us councillors. But they are accountable to you and you are accountable to us, the residents and electors of this county. Please read what I have referred to, please listen to what they say, please question them, their assumptions, their statistics, and their evidence much more comprehensively than to date.

Above all please understand what is being proposed here – real, substantial cuts in provision and accessibility under the pretence of better care. Passing these motions today as I trust you will is just a start. The real work begins when you give them effect in both practice and spirit. Please ensure you do. Please make today a beginning, not an end.

The Chairman responded, thanking Mr Wearne and Ms Wood for their attendance and presentations, acknowledging representations made by them had been heard by the Members of the Council and would be taken into account, as necessary, at the appropriate stage of the Council’s proceedings (Minute 73 below refers).

Minute 73 of the meeting notes:

Cuts to Devon Health Services and the Success Regime (Minutes 55 and 56 of 6 October 2016)

To receive and consider the recommendations of the Cabinet relating to Councillors Biederman and Greenslade’s Notice of Motions.

The text of the original Notices of Motion, the Cabinet’s recommendations and any reasons therefor may be seen in full at Minute 104(e) of the Cabinet held on 9 November 2016 (Page 10 of 9 November 2016, Green Pages).

Pursuant to County Council Minutes 55 and 56 relating to the two Notices of Motion set out below as originally submitted and then formally moved and seconded by Councillors Biederman and Greenslade that:

Proposed Cuts to Devon Health Services and Impacts on Patients (Councillor Biederman)
‘This Council is deeply concerned about the impact the proposed cuts to Devon health services will have on patients – especially the loss of whole departments including maternity services at North Devon District Hospital – and massive reduction in acute and community hospital beds across Devon, as set out in the sustainable transformation plan.

This Council also recognises that Governments have deliberately not provided the NHS with the adequate level of funding and now calls on local MPs to lobby government ministers to urgently and significantly increase the level of funding to the NHS, in order to protect our precious health services for current and future generations’.

NHS Success Regime  (Councillor Greenslade)
County Council believes that the NHS Success Regime project for Devon is now seriously flawed and accordingly calls on the Secretary of State for Health and NHS England to cancel it forthwith. County Council further calls on Government and NHS England to firstly address the issue of fair funding for our area and to ensure the general election promise of an extra £8 billion of funding for the NHS is taken into account when assessing the claimed deficit for Devon NHS services.

Until funding issues are addressed it is not possible to decide whether or not there is a local NHS budget deficit to be addressed. Unnecessary cuts to local NHS budgets must be avoided!

Devon MP’s be asked to support this approach to protecting Devon NHS services and having had regard to the advice of the Health & Wellbeing  Scrutiny Committee and the subsequent views of the Cabinet set out in Minutes 29 and 104(e) of 8 and 9 November  2016, respectively, to accept the Notice of Motions in the name of Councillors Biederman and Greenslade as amended [highlighted below] for consideration by the County Council at its next meeting and to the further representations received (Minute 63 above refers).

Proposed Cuts to Devon Health Services and Impacts on Patients (Councillor Biederman)
‘This Council is deeply concerned about the impact the proposed cuts to Devon health services will have on patients – especially the loss of whole departments including maternity services at North Devon District Hospital – and massive reduction in acute and community hospital beds across Devon, as set out in the sustainable transformation plan.

This Council also recognises that Governments have [deliberately] not provided the NHS with a fair [the adequate]level of funding and now calls on local MPs to lobby government ministers to urgently and significantly increase the level of funding to the NHS, in order to protect our precious health services for current and future generations’.

NHS Success Regime  (Councillor Greenslade)

County Council believes that the NHS Success Regime project for Devon is now [seriously] flawed and accordingly asks [calls on] the Secretary of State for Health and NHS England toput the process on hold, until issues relating to the ‘independence’ of the Success Regime are investigated and for fair funding to be considered [cancel it forthwith]. County Council further calls on Government and NHS England to firstly address the issue of fair funding for our area and to ensure the general election promise of an extra £8 billion of funding for the NHS is taken into account when assessing the claimed deficit for Devon NHS services. Until funding issues are addressed it is not possible to decide whether or not there is a local NHS budget deficit to be addressed. Unnecessary cuts to local NHS budgets must be avoided! Devon MP’s be asked to support this approach to protecting Devon NHS services”

Members then formally moved and duly seconded the amendment(s) shown below and thereafter subsequently debated and determined.

Councillor Hart then MOVED and Councillor Clatworthy SECONDED that the Cabinet’s advice be accepted and in accordance with the views of the Health & Wellbeing Scrutiny Committee the Notices of Motion as set out hereunder be accepted:

Proposed Cuts to Devon Health Services and Impacts on Patients (Councillor Biederman)
‘This Council is deeply concerned about the impact the proposed cuts to Devon health services will have on patients – especially the loss of whole departments including maternity services at North Devon District Hospital – and massive reduction in acute and community hospital beds across Devon, as set out in the sustainable transformation plan.

This Council also recognises that Governments have not provided the NHS with a fair  level of funding and now calls on local MPs to lobby government ministers to urgently and significantly increase the level of funding to the NHS, in order to protect our precious health services for current and future generations’.

NHS Success Regime  (Councillor Greenslade)
County Council believes that the NHS Success Regime project for Devon is now flawed and accordingly asks the Secretary of State for Health and NHS England to put the process on hold, until issues relating to the ‘independence’ of the Success Regime are investigated and for fair funding to be considered]. County Council further calls on Government and NHS England to firstly address the issue of fair funding for our area and to ensure the general election promise of an extra £8 billion of funding for the NHS is taken into account when assessing the claimed deficit for Devon NHS services. Until funding issues are addressed it is not possible to decide whether or not there is a local NHS budget deficit to be addressed. Unnecessary cuts to local NHS budgets must be avoided! Devon MP’s be asked to support this approach to protecting Devon NHS services”

Councillor Boyd MOVED and Councillor Chugg SECONDED that in accordance with Standing Order 14(11) ‘The Question be Now Put’.

The Motion was put to the vote and declared CARRIED and immediately thereafter the mover of the amendment (Councillor Hart) and the movers of the original Notices of Motion (Councillors Biederman and Greenslade) exercised their right of reply to the debate.

Councillor Hart then MOVED and Councillor Hughes SECONDED that in accordance with Standing Order 32) the vote on the amendment in his name shall be by roll call.

The Motion was put to the vote and declared CARRIED.

The amendment in the name of Councillor Hart was then put to the vote and there being:
for the amendment, Councillors Ball, Barker, Berry, Biederman, Bowden, Boyd, Brazil, Channon, Chugg, Clarance, Clatworthy, Colthorpe, Connett, Croad, Davis, Dempster, Dewhirst, Dezart, Diviani, Eastman, Edgell, Edmunds, Foggin, Gilbert, Greenslade, Gribble, Hannan, Hannon, Hart, Hill, Hook, B Hughes, S Hughes, Julian, Knight, Leadbetter, McInnes, Mathews, Moulding, Owen, Parsons, Prowse, Radford, Randall Johnson, Rowe, Sanders, Sellis, Squires, Vint,  Way, Westlake, Wragg, Wright, against, or in abstention of, the amendment, none (Total: 0),
the amendment was declared CARRIED and subsequently thereafter also CARRIED as the substantive motion.

UNISON Report on the Sustainability and Transformation Plan for Devon

unison-report-on-stp-for-devon

Report on the Sustainability and Transformation Plan for Devon

Compiled: October 2016 for UNISON
Author: Richard Bourne

UNISON South West
UNISON House
Emperor Way
Exeter Business Park
EXETER
EX1 3QS

01392 442650
http://www.southwest.unison.org.uk

Report on the Sustainability and Transformation Plan for Devon

This paper is written on behalf of UNISON by Richard Bourne.

UNISON is the major trade union in health and social care and the largest public service union in the UK. UNISON represents more than 450,000 healthcare staff employed in the NHS, and by private contractors, the voluntary sector and general practitioners. In addition, UNISON represents over 300,000 members in social care. The union’s community and voluntary sector has an expanding membership of more than 60,000 and UNISON has a large retired membership of more than 165,000 with a particular interest in the future of health and social care. In addition, there is a wider interest among our total membership of more than 1.3 million people who use, or have family members who use, health and social care services.

Richard Bourne has conducted many reviews into major projects and programmes for UNISON.

He has also been part of over 70 Gateway Reviews, mostly in health, but also in local and central government. Until recently was a Gateway Programme Director at the Department of Health.

He has extensive knowledge and direct experience of the care system and has worked on policy development at local and national levels.

He has worked as a Consultant in the public sector for 15 years mostly on case preparation, evaluation and assurance of major and high risk projects. He has also held executive and non-executive posts within the NHS and DH at Board level. Richard has experience in local and central government working as a Consultant and was a Councillor for 13 years.

Summary

This report examines the Sustainability & Transformation Plan for Wider Devon (WDSTP) dated 30 June 2016 [01]. It is a strategy for improving the care system across Devon and for dealing with known issues especially the seriously deteriorating financial situation. Across England 43 other locality based STPs are being developed.

The WDSTP has not been developed after any formal public consultation and the document is not in the public domain. It is however fair to point out that across England practice over engagement about proposals and publication of STPs has varied and there is disagreement amongst stakeholders about the desirable level of openness. Guidance has recently been issued and more is expected.

Whatever the justification being claimed, developing major plans for the care system in secret without the openness and transparency promised for the NHS and without the active participation of the workforce is very poor practice and is leading inevitably to later conflict.

There is some tension already as currently (early October) there are active consultations into changes in both East and South Devon each of which set the path to closing community hospitals and reducing other acute beds.

A New Model of Care

The WDSTP sets out how a new approach to care delivery using new models of care can be developed and implemented: some of the changes are already taking place. It sets out to address the gulf between social care and health care (and address the cause of disputes) to make experience of care far better than many get from the current disjointed, dysfunctional and fragmented web of providers of care. It sets out the drivers already impacting on care – an ageing population; greater complexity in care needs; growing expectations; new drugs and technologies; common to every other STP. It highlights local issues such as with stroke care, paediatrics and maternity; and of course highlights the £600m gap in finances predicted for 20/21.

The model of care emphasizes the need for prevention and early intervention and building capacity in primary and community care to reduce the need for acute admissions and indeed to reduce lengths of stay in acute beds. As with many other similar models proposed over many years the model relies on out of hospital multi-disciplinary teams, proactive care planning and provision of a single point of contact and rapid responses when a patient requires help. None of this is new.

Only a draft version of the plan was made available to UNISON. This version is anyway not the final one, a lengthy period of validation and probably negotiation has to take place with the regulators and further information will have been required. It is expected that an agreed final version will be published late in October. There are also some references in the draft document to the need for further work to be carried out. It is accepted that some comments in this report will have already been acknowledged and will be resolved later.

The model of care being proposed in the WDSTP, and which has already been tested to some degree in South and North Devon, is desirable and should improve many aspects of care. It is achievable and may even offer better value for money in the long term. But it requires far longer to implement than is being allowed; it requires investment which is not obviously available; it requires system leadership capabilities that are not obvious; and it will not save money so financial balance is restored. Above all it requires the openness and transparency the NHS pretends to offer and genuine continuous engagement with the workforce representatives.

Acute Care

The model of care is strongly focused on substantial changes in primary and community care, to lessen the role of acute hospitals – care closer to home. This is an almost universal feature of STPs and in the 5YFV. There is general agreement that this can be beneficial for the experience of care; it is contested that the model produces better clinical outcomes and almost universally agree that the model does not cost less to operate. Closing hospital capacity especially A&E and maternity services is hugely unpopular and is contested everywhere it is tried.

Whilst the WDSTP signals some major changes in the provision of acute care out of the 4 hospitals (and closure of some Community Hospitals) there is no detail provided.

Consultation on Service Changes

It is strongly asserted by many experts that failure to develop proposals within any STP is contrary not just to the NHS Constitution and the often claimed openness and transparency principles within the NHS, it is actually in breach of statutory requirements.

It is commonly agreed, but very badly communicated, that any proposals for specific (significant) changes to how services are to be provided must be subject to proper formal public consultation. This is set out comprehensively in guidance from NHS England. Examples of such formal consultation on specific changes are visible already in regard to the proposed closures of

Community Hospitals.

Although the WDSTP may eventually set out a strategy that is agreed that does not alter in any way the responsibility placed on NHS bodies and local authorities when specific changes are proposed.

Filling the Gaps

The WDSTP does set out some thinking around improving children’s services, mental health and learning disability services which is to be welcomed but funding for these is a major issue that is not obviously resolved. It also appears these sections of the WDSTP were added to the main document rather than being an integral part of it.

Sadly the WDSTP does not deal with the chronic underfunding and increasing access restrictions in social care; the cuts in funding to public health; the demoralisation of the workforce and the issues in workforce education and training.

As a strategy it has some merit but as a plan it lacks even the most basic elements for credibility.

It is to be hoped later versions will fill in the many gaps.

Lack of Clarity

In other circumstances there would be a welcome for bringing together those charged with providing care in Devon to develop a clear strategy and plan to address the growing and changing demands for care, improve the quality of outcomes and experience and to address known weakness.

It remains unclear what exactly this plan is for. On the face of it the plan is about resolving identified issues in the care system in Devon and improving the quality and the experience ofcare; built on the foundation of a new model for care – with less reliance on hospital stays. But at another level the plan is simply about doing what is necessary to resolve the chronic financial problems facing both health and social care. It is clear that any plan which does not promise sustainable finances will not be acceptable.

Key Issues

Across England STP are being developed very fast and behind closed doors. In Devon and most other localities genuine desires to engage and consult are being subsumed into the rush to find ways to convince the regulators that financial balance will be restored after the NHS ran up its largest deficit in history last year despite increasing funding.

Whilst the aspirations in the plan are worthy of support the overwhelming impression is of a rather vague effort to work backwards from the need for financial balance in 20/21 and to make assumptions that are unrealistic but which allow the impression the books can be balanced.

As more details emerge and actual plans take shape the reality will become more obvious.

There is simply not enough funding in the system and the assumptions about efficiency gains in providing services and in allocating resources will not be anywhere near enough to fill the gap.

UNISON will support the changes that are clearly beneficial to patients and consider proposals for service reconfigurations on their merits.

UNISON has specific questions that address some of the issues that are already obvious.

Specific UNISON Questions

Having examined the WDSTP and as much related information that has been made public

UNISON will raise the following:

> Why are consultations about closing community hospitals going ahead before the overall strategy as set out in the WDSTP has been subject to proper consultation, let alone actually agreed?

> Why has the WDSTP not been published?

> What role have staff representatives played in development of the WDSTP and what role is planned for them in the ongoing governance?

> Whilst the WDSTP portrays a picture of what 2021 might be like for those receiving care when will there be a similar picture of what 2021 will be like for staff?

> How many new jobs will be created; how many existing jobs will be significantly changed and how many staff will be required to change location? Are any redundancies anticipated?

> Does the WDSTP assume that in 2021 all NHS organisations will be meeting their targets (A&E 4 hours, Cancer waits etc)?

> Does the WDSTP deliver seven day services – what is that taken to mean?

> Does the WDSTP assume that social care entitlement remains at “moderate”? Does this compromise the model of care?

> What will be done in the short term about the serious failures around commissioning? (NEW Devon CCG is in special measures and both Devon County Council and Plymouth City Council are struggling to commission Children’s Services.)

> What impact will differing levels of take up of personal independence payment, various forms of personal budgets and other monetary support have on directly provided support?

> What is the impact of reduced funding for public health; health education and training and social care?

> When will more details be available about the expected consolidation of acute services?

> How will non-public providers, such as Virgin, be bound into the WDSTP – through contract variations?

> Is it envisaged that implementation of new models of care will require tendering and market competition? How could this be avoided?

> UNISON request better links with the CCG to ensure that quality of service provision is maintained and the employment rights of staff are maintained throughout any transitional process.

The Wider Devon Sustainability and Transformation Plan (WDSTP)

It is accepted that the version that has been made available is not the final one and is incomplete. It is expected that by the end of October a more complete version will be agreed with regulators and that will then form the basis for all operational planning for all NHS bodies

in wider Devon for the next 2 years in detail and 5 years overall – to 20/21. At that stage it is expected that the WDSTP will be made public and form the basis for formal public consultation.

Background to WDSTP

This is a plan for improving care in “Wider” Devon, which covers the County as well as Plymouth and Torbay Districts, a total population of 1.3m. It covers two CCGs – NEW Devon and South Devon & Torbay. The stated objective is:-

Our aspiration is to achieve, by 2021, a fully aligned sense of place linking the benefit of health, education, housing and employment to economic and social wellbeing for our communities through joint working of statutory partners and the voluntary and charitable sectors.

This plan provides the overarching strategic framework within which people residing in wider Devon will experience sustainable, integrated, place-based support by 2021. It will drive delivery of a major programme of transformational change and improvement across wider Devon starting from 2016/17.

It would be hard to disagree with the aspiration, but the nature of any plan is to describe how the aspiration will be attained – at best the WDSTP sets out a strategy for a programme rather than a plan. Plans are subjected to a lot of prescriptive top down guidance over content and form. The current version from June will undergo formidable challenge and evaluation by the regulators (NHS England and NHS Improvement).

The new model for care, developed by a large team of clinicians, looks at how the need for care can be prevented; how care can be provided in the most appropriate setting – the closer to home the better; and how the services necessary to provide care and support can be joined up so the recipient (and their carers and family) are unaware of which organisation provides the different aspects of care. It relies on far better information shared across multiple organisations and systems; on retraining many staff and relocating where they work; it will need major changes in attitudes and development of many care professionals; removing decades long barriers between the competing empires of NHS and Las. Nevertheless this is all very desirable and in various permutations also the goal for STPs everywhere else.

None of this is new, all has been tried before and in Devon the new models are being established already in South. Various Vanguard projects in other parts of England have been trying new models of care since 2014. What is problematic is that little external evaluation has been done on the new models and evidence such as it is suggested that they do not bring financial savings – they are desirable and may be appreciated by users but they require investment to set up and do not significantly reduce costs – they shift costs around but a whole system approach shows little or no overall gains.

Background to STP Process

Sustainability and Transformation Plans [02] are the main method by which the Five Year Forward View for the NHS is to be taken forward. The 5 Year Forward View (5YFV) from 2014 set out the policy for the NHS within a context of the wider care system. It formed the basis for a funding settlement which applies until 2020/21. Whilst the 5YFV was focused strictly on the NHS, the STPs acknowledge the crucial interaction between the NHS and the wider system especially social care. It is clear that without attention to social care funding the 5YFV is not realistic.

Progress with the 5YFV is being developed through the 44 localities (footprints) of which wider Devon is one. In each locality the process has been to agree a leadership team; bring organisations together [03], crucially involving local authorities; agree on a broad approach to resolving long standing issues; and make submissions on progress in April and June to the regulators.

Wider Devon’s STP Contents – Some Key Points from the Document

The current version of the plan runs to 55 pages and appears to follow a template specified in general terms by guidance issued by NHS England. It is incomplete and will be subject to changes. There are however a few points from the actual document worth making clear.

Case for Change and Plan

The case for some change is clearly overwhelming as there is a projected deficit of £600m, some projections within the STP take it to around £772m. There are also changes required due to demographic changes and because some services are at present not sustainable, factors common to all parts of England. Specifically in relation to Devon is the over reliance on bed based care and issues around GP and other vacancies. The “plan” to make the change requires “recovery”; further financial improvements whilst planning for deployment of new models of care; then implementation of measures for prevention, early intervention, a new primary care strategy and reconfiguration of acute services. This leads to clinical and financial sustainability by April 2021.

Shared Vision

It would be hard for anyone to disagree with the statements provided:

We will operate as an aligned health and care system, to be a major force and trustworthy partners for the continual improvement of health and care for people living in Devon, Plymouth and Torbay.

 

The principles and design features in the STP will drive improvement in an integrated manner, delivering benefits of standardisation to reduce variation but tailored to the clinical needs of individuals and communities. This will drive improved achievement of national performance standards, patient and staff experience, safety, service line resilience and clinical effectiveness and outcomes.

Challenges to Address

The plan rightly suggests that it draws on not just responses during early engagement (imperfect though that was) but also from the Joint Strategic Needs Assessment (JSNA).

The Public Health and JSNA key considerations underpinning the plan

• An ageing and growing population

• Balancing access to services in both urban and rural localities

• Complex patterns of deprivation linked to earlier onset of health problems in more deprived areas (10-15 year gap)

• Housing issues (low incomes / high costs/ poor quality in private rental sector)

• Giving every child the best start in life and ensuring children are ready for school

• Poor mental health and wellbeing, contributed to by social isolation and loneliness

• Poor health outcomes caused by modifiable behaviours

• Pressures on services (especially unplanned care) caused by increasing long-term conditions, multi-morbidity, mental health and frailty.

• Unpaid care and associated health outcomes

• Shifting to a prevention and early intervention focus.

Drawing from these factors, the known weaknesses identified in current performance and the reality if the funding situation leads on to:

The principles and design features in the STP will drive improvement in an integrated manner, delivering benefits of standardisation to reduce variation but tailored to the clinical needs of individuals and communities. This will drive improved achievement of national performance standards, patient and staff experience, safety, service line resilience and clinical effectiveness and outcomes.

This means responding to what people need through reallocating resources to better meet the greatest needs of the population e.g through reducing the amount spent on expensive bed based care, improving efficiency and reinvesting in less expensive, more innovative, integrated care models including investing in community assets that do more to prevent ill health, keep people out of hospital, treat them effectively when needed and enable them to recover rapidly and to stay in their own homes for as long as possible.

Opportunities

The WDSTP document list over several pages a long and credible list of opportunities to make changes. These are changes which together allow the system to come into financial balance. As with so much else, these are not in themselves controversial but experience in many other places over many years shows that such changes are actually much harder to achieve than is claimed; require investment (human and financial); and rarely actually lead to cash releasing savings.

For those with time to spare there is an interesting Waterfall Chart which shows the miracle unfolding and financial balance restored.

The document does give some very limited information about how opportunities could be translated into priorities for action with a very small number of actual examples of the scale of change – one key claim being a 20% reduction in non-elective care.

As with other STPs there is almost universal agreement that the claims for this kind of level of financial improvement through such changes is unrealistic and not supported by any evidence.

Demand management has not been a success anywhere in terms of leading to savings; better and more responsive care and integrated working are desirable but tend to cost more in the short term and require investment to implement.

Priorities

In its final sections the WDSTP sets out a narrative about the priorities within the emerging plan.

These are important as they show where most effort will be applied. This sort of determination is exactly the sort of thing that should merit widespread public engagement. It is an obvious statement that little or any focus appears on changes in social care or public health. Many might argue these priorities are the NHS going through the usual motions.

􀁸 Promoting Health through Integration

o Huge societal changes are envisaged but there is no substance to how this can happen.

􀁸 Finances

o 13 specific opportunities for “savings” are identified.

􀁸 New Models of Care

o These are set out in more detail and much depends on multi-disciplinary teams,

hubs and networks – all of which are supported by a mixed evidence base.

􀁸 Mental Health

o The Devon priorities are set out and are intentions that might be thought to

address the parity of esteem ideas.

􀁸 Primary Care

o There is apparently an STP Primary Care Strategy and the headings are provided –

much of which links to the earlier success regime work.

􀁸 Acute and Specialist Services

o Little or no indication of which hospitals will be impacted.

􀁸 Children and Families

o This looks like an add-on with no signs of linkage to education and a model for integrated services which was tried (and failed) years ago in Essex.

Governance

This is a major area of concern for UNISON in Devon but also for others in most places. The notion of collaboration and whole system working does not yet appear to have translated into governance arrangements. In Devon the pre-existing Success Regime appears simply to have taken over the STP process.

It is all far to NHS centric and ultimately despite the assurance will still be biased to considerations around acute care which the public has the greatest interest in.

The impending publication of a later and better version of the WDSTP and its publication offer a huge opportunity to shift the whole approach of governance to make it open transparent and inclusive. There are no indications that this will happen.

Appendix

Evolution of STPs

The 5 Year Forward View (5YFV) from 2014 set out the policy for the NHS within a context of the wider care system. The 5YFV set out three key objectives to make the NHS sustainable over the medium term – a radical upgrade in prevention and investment in Public Health; greater control for patients; and breaking down the barriers around how care is delivered (it referenced explicitly the Wanless “Fully Engaged” approach).

It argued that if these objectives were pursued then by 2020 the NHS required additional funding of Åí30bn pa; which was to be met by £22bn of efficiency savings leaving £8bn for additional government funding. Key assumptions were that demand will grow at 3%pa (half through demography and half as quality improvement); provider efficiency will be at 2%pa rising to 3%pa in last 2 years; provider cost inflation at 3%pa. A key feature was “Transformation” with big changes to introduce a range of new care models – to be tried out initially in Vanguard projects across the country and with some funding specifically to support this transformation.

Based on the rationale of the 5YFV the Spending Review in 2015 agreed to a funding settlement for the NHS which did provide the £8bn increase in 2020 with a significant amount of front loading. This was widely promoted as being the government agreeing to fund the NHSs own plans for sustainability.

Investigations in particular by the Health Committee, Kings Fund and Nuffield Trust have all shown considerable scepticism over the reality of the assumptions behind the 5YFV and the progress so far has been limited. There was little confidence that the efficiency gains could be made even if funding was available for transformation. The Åí8bn promised turned out to be more like £5bn. In 2015/15 there was the biggest deficit in the history of the NHS with provider recurrent deficit at £3.7bn; made worse by the dreadful state of the social care system. Funding for social care has not had the same public attention but the concerns are even greater.

Progress with the 5YFV is being developed through 44 local Sustainability and Transformation Plans (STPs) which carry some funding for localities that agree on a broad approach to resolving long standing issues and meet stringent financial control targets. The STP process brings together local stakeholders, especially local authorities, and each STP has a Lead (variously from NHS and from LAs) as figurehead. STPs come in all shapes and sizes.

More recently details have been given about how the £22bn of savings will be divided – £7bn from national measures such as pay restraint; £9bn from provider efficiencies driven by reducing tariff paid to providers (£5bn of which is expected from changes identified in the Carter Review) and £5bn through service reconfigurations and system changes. It is this last £5bn or about . of the savings that comes through the STP process.

STPs have no actual statutory or other powers or duties and operate alongside the current legal frameworks and guidance. They are there to facilitate difficult change programmes which cross organisational boundaries. Key to sustainability is the new models of care brought about by transformation but most of the funding allocated for Transformation, to allow this significant reconfiguration of services, has had to be used to plug deficits in the acute sector.

There is a fear that details of the STPs are being kept secret. Such plans and summaries as have been prepared for the public show STPs rely on assumptions about moving care closer to home; reducing A&E attendances and emergency admissions; centralisation of some acute service; and making services better integrated – all changes to be welcomed but which have been shown to be very hard to deliver and very unlikely to produce any costs savings even in the longer term.

The plans appear to be simply an exercise in showing unrealistic paths which claim to bring financial sustainability.

The governance around STPs is opaque and there is little or no evidence of participation by staff representatives and patient groups, despite assurances from NHS England/NHS Improvement and even from Simon Stevens. An assurance has been given by Ministers that once the STPs have been agreed (expected to be in late October) then they will be published.

Alongside the 5YFV is the Better Care Fund which relies on funding from both the NHS and Local Authorities. By 2017 there has to be a plan for full integration between health and social care by 2020 – there are 150 Better Care Plans in line with authority boundaries. Again access to the “pooled” funding depends on approval of plans. It remains unclear how Better Care Plans align to STPs as they cover different footprints and are based on different assumptions.

A recent development has been what appears to be a Treasury led initiative, “the Reset”, which has the main aim of bringing the providers back into financial balance as soon as possible. Of special significance is the setting of control totals for both providers and commissioners with threats of severe consequences for those that do not meet the targets. This fits into a planning cycle which is also geared to delivery of the 5YFV and the STPs and the operation plans of the myriad NHS bodies.

The reset approach required specific attention to three areas; tackling pay bill growth, implementation of Lord Carter’s recommendations on back office cost reductions, and the consolidation of unsustainable services. This is backed by a wide-ranging seven-point set of actions being taken by NHS Improvement, NHS England with the support of the Department of

Health and the Care Quality Commission (5 separate autonomous bodies!!) which included the introduction of new intervention regimes of special measures which will be applied to both trusts and CCGs.

There is also, for no obvious reason, a new emphasis on involvement of the private sector.

Whilst the trend for slow but steady increases in private sector provision of NHS (clinical) services has continued most recent developments have been about failed procurements, failed contracts and poor delivery by private providers. The STPs appeared initially to rely on ignoring the previous enthusiasm for competition and market forces with instead moves to integrate, consolidate and collaborate.

In the real world no serious commentator (and no senior NHS manager) believes the NHS can deliver the current services, function safely, improve quality, move to 24/7 working and be financially sustainable. Something has to give and the current approach with an emphasis on finances implies service cuts and reductions in standards.

It is worth stating that STPs have neither powers nor duties and so all the duties placed on CCGs and Trusts remain – specifically around engagement and consultation on any service changes – the STPs offer no route to remove what will inevitably be resistance to what will inevitably be described as cutting services.

Cuts to capital spending, public health, social care and health education and training are all impediments to the delivery of the 5YFV. The first year of the plan has gone the wrong way. A reintroduction of a regime of targets and terror is just more bullying and counterproductive.

More use of the private sector will be a continuing disaster. Failure regimes will fail.

The local STPs are mostly wishful thinking and lack credibility even amongst those that contributed. Publication will lead to arguments and protests almost everywhere, and in some localities it is clear that no local agreement is going to be reached anyway.

The real problems are lack of funding – especially for social care; lack of coherence in the system; instability and fragmentation – all linked to a lack of morale and other growingworkforce issues. The 5YFV does not address the real issues so it will fail.

[01] Only a draft version of the plan was made available to UNISON. This version is anyway not the final one, a lengthy period of validation and probably negotiation has to take place with the regulators and further information will have been required. It is expected that an agreed final version will be published late in October. There are also some references in the draft document to the need for further work to be carried out. It is accepted that some comments in this report will have already been acknowledged and will be resolved later.

[02]  A more comprehensive explanation of the 5YFV and the STPs is provided later.

[03]  Organisations within footprint are NEW Devon CCG, South Devon and Torbay CCG, Plymouth Hospitals NHS Trust, Royal Devon and Exeter NHS Trust, Northern Devon Healthcare NHS Trust, Torbay and South Devon NHS Trust, South West Ambulance Service Trust, Devon Partnership NHS Trust, NHS England, Circa 160 GP practices, Virgin Care, Devon County Council, Plymouth City Council, Torbay Council, Livewell Southwest (formerly PCH) (CIC), Devon Doctors, Healthwatch (Devon, Plymouth and Torbay) and Care UK.

We Own It | It’s our NHS: Don’t Slash, Trash and Privatise

we-own-it-logo-header

 

 

 

 

It’s our NHS: Don’t Slash, Trash and Privatise

Dear councillors in England – the NHS needs you

The government wants local areas to deliver plans that will Slash, Trash and Privatise our NHS (and to deal with the crisis that follows). But if councils refuse to sign up to the plans, we have a chance of stopping them.

Sustainability and Transformation Plans (STPs) sound nice. In reality, ‘sustainability’ is code for cuts and ‘transformation’ is code for privatisation. There are 44 plans for ‘footprint’ areas across England. The plans – which are supposed to be signed off by Christmas – have mostly been kept secret and the ones that have been released often lack key information. What we do know is that they deliver deep cuts to NHS services and plenty of encouragement to the private sector to get involved.

Councils have to sign off these plans before they can be delivered. Councillors – please say no, don’t sign up to Slash, Trash and Privatise the NHS.

Don’t put lives at risk

The government wants councils to sign up to plans now and commit to drastic cuts that will put people’s lives at risk. The plans are expected to slash the number of A&Es in England from 140 to less than 70. A 38 Degrees investigation showed that the plans include huge shortfalls of millions of pounds – patients just can’t be cared for properly without more funding. Hammersmith and Fulham, Ealing and Sutton councils have refused to sign up to the plans. What does the plan look like for your area? Will it put lives at risk?

We condemn the Tory government for drawing up these plans. This is about closing hospitals and getting capital receipts. It’s a cynical rehash of earlier plans and is about the breaking up and selling off of the NHS. It will lead to a loss of vital services and will put lives at risk. Our job is to protect the NHS and this plan is about dismantling it. This document is an affront to the sensibilities of the people of north-west London.” Steve Cowan, leader of Hammersmith & Fulham council

 

We refused to sign up to the STP plans because we do not support the closure of Ealing and Charing Cross acute hospitals … We have made it abundantly clear that we will campaign until our last breath to save Ealing and Charing Cross hospitals. We do support some of the proposals for more integrated health and social care but we feel we will be punished for not signing up to these plans.” Julian Bell, leader of Ealing council

Warning bells are ringing

Most of the STPs haven’t yet been published.

Those that have been published often don’t include important financial information and evidence.

Julia Simon, the former head of NHS England commissioning, has denounced the STP process as ‘shameful’, ‘mad’, ‘ridiculous’ and the plans as full of lies.

Only 16% of NHS finance directors believe sustainable STPs are achievable by 2021.

The Royal College of Emergency Medicine has said “These plans that are emerging via different routes, if true, are potentially catastrophic and will put lives at risk” as almost a third of CCG leaders are considering closing emergency departments. How would your area deliver its plan? Is it realistic?

Defend our public NHS

Privatisation of our NHS is happening. Last week Virgin won contracts for 200 NHS services in Bath. STPs will increase the pressure to privatise, both by running down the NHS with cuts (so the private sector can swoop in to provide the solution) and through guidance that encourages a key role for private companies in planning and delivering services. An NHS England director has said STPs offer private companies ‘an enormous amount of opportunity’. Is that what people want in your area?

Privatisation wastes public money that could be spent on patient care. We already spend at least £4.5 billion on the NHS market. Private Finance Initiative deals have wasted £250 billion. We need to stop privatisation, not waste more money on it.

84% of the public support the NHS being publicly owned. The government knows privatising the NHS is hugely unpopular. That’s why they’re trying to devolve the decision making to local areas, taking the ‘N’ out of the NHS.

You’re on the frontline

This is it now – you’re on the frontline of saving our NHS. NHS England health plans assume partnership with local authorities and they imply shared responsibility for the (potentially very serious) consequences. That means councillors, council leaders and mayors can play a vital role by refusing to sign up to these plans. This is about local democracy. Please stand up for our NHS.

Don’t sign up to the plans – thank you!

Ask your councillors not to sign up to the plans to Slash, Trash and Privatise our NHS.

Read more on OurNHS: ‘Councillors must look before they leap into secret NHS cuts plans’.

Health Campaigns Together is calling for plans to be released and it has a guidance document for councillors here.

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STP – A briefing pack for councillors

We Own It have also sent an e-mail to councillors,

Dear Paul

The Government is trying to force local areas to Slash, Trash and Privatise our NHS through so-called ‘Sustainability and Transformation Plans’ (STPs). Ignore the silly words – these plans are about cuts and privatisation.

Some brave councils are taking a stand for our NHS. 20 councils have released the plans to the public, and Hammersmith and Fulham, Ealing and Sutton councils have refused to sign up to them. This is the right thing to do.

This is where the fight is at now for the NHS. If councils across the country start resisting the government’s plans, we could actually have a chance of pushing back privatisation of our NHS.

The government is dividing the NHS in England into 44 areas, each of which has an STP. The plans will leave local areas dealing with crisis – and private companies ever more ready to swoop in.

This is all happening behind closed doors. Only 15 of the 44 plans have been published. The government knows the public won’t go along with the plans, that’s why they are being kept secret. The plans are due to be signed off completely by Christmas – we need to see them and stop them NOW.

Say no to slashing, trashing and privatisation

Jeremy Hunt says the NHS needs to go on a 10-year diet. Now he wants to force councils to quietly sign up to an NHS that simply cannot meet people’s needs within the budget he has fixed.The government’s plans would mean an NHS that says ‘sorry, this hospital is closing, you need to travel further to have your baby or deal with your emergency’.Sound familiar? It’s the same old story. Privatisation is already wasting money that could be spent on patients – running the NHS as a market costs us at least £4.5 billion a year. And the cuts in turn are creating an NHS that is ever more vulnerable to the private sector.

“That’s the standard technique of privatisation: defund, make sure things don’t work, people get angry, you hand it over to private capital.”  Noam Chomsky

A few days ago Virgin Care won a contract to run 200 NHS services including adult social care in Bath. STPs will mean more of this. We know these plans are dangerous – they must be stopped across the country.

The NHA Party says that plans will mean reducing the number of A&E hospitals from 140 to less than 70 across England. That means fewer hospital beds, longer ambulance journeys for emergency care, longer waiting times for treatment. The plans also include selling off land and assets that belong to the NHS. And patients using vouchers and personal health budgets, as a form of ‘self-pay’.

A 38 Degrees investigation showed that the plans include huge shortfalls of millions of pounds – patients just can’t be cared for properly without more funding.

The NHS is ours. We don’t have to buy their story.

Let’s all work together to save the NHS we love and make sure people come before profit.

With best wishes

Cat, Matt, Biba and the We Own It team

PS You can read more here https://weownit.org.uk/blog/its-our-nhs-dont-slash-trash-and-privatise

Ask your councillors not to Slash, Trash and Privatise the NHS

[If you’re in England] Sign the 38 Degrees petition asking Jeremy Hunt to reveal the plans

if you’re in Scotland, Wales or Northern Ireland)

Ask your councillors to stand up for the NHS

Wider Devon Sustainability and Transformation Plan [STP]

Wider Devon Sustainability and Transformation Plan [STP]

The Wider Devon Sustainability and Transformation Plan was published as a draft submitted to NHS England in June 2016 and  sets out plans to improve health and care services for people across Devon in a way that is clinically and financially sustainable.

Health and care organisations as well as local authorities across Devon have been working together to create the shared five-year vision to meet the increasing health and care needs of the population – while ensuring services are sustainable and affordable.

The STP provides the framework within which detailed proposals for how services across Devon will develop – between now and 2020/21.

A key theme throughout the STP is an increased focus on preventing ill health and promoting peoples’ independence through the provision of more joined up services in or closer to peoples’ homes.

Seven priority areas have been identified as key programmes of work:

  1. Ill health prevention and early intervention
  2. Integrated care model
  3. Primary care
  4. Mental health and learning disabilities
  5. Acute hospital and specialist services
  6. Increasing service productivity
  7. Children and young people

The latest draft of the Wider Devon STP to reshape health and care services in Devon, Plymouth and Torbay by 2021 was released on 04 November 2016.

It is planned that the document will be presented to all partner organisation boards or equivalent bodies for consideration and endorsement over the next six to eight weeks.

Following this, the organisations involved will then undertake an engagement exercise involving citizens, patients, service users, their representatives and voluntary sector groups. Feedback will further help shape the plans.

The NHS and its partners will then use the STP framework to develop proposals to improve care.

One of the first organisations to consider the revised draft of the Wider Devon STP was Devon County Council’s Health and Wellbeing Scrutiny Committee, who met on Tuesday 08 November 2016, where the members considered a report by Jenny McNeill, Associate, NEW Devon CCG .

The minutes of the meeting note:

Councillors Brazil and Hawkins attended in accordance with Standing Order 25(2) and spoke to this item on the likely impact of service changes arising from the Plan (and subsequent consultations) on health service provision in their respective localities).

Dame Ruth Carnall, Ms A Pedder and Ms L Nicholas attended and spoke to this item at the invitation of the Committee.

The Committee considered the report of the Sustainability and Transformation Plan (STP) Team for wider Devon on the Plan which had been formally published on Friday 4 November (and circulated to all members of the Council). The STP was the local plan to achieve the NHS ‘Five Year Forward View’ published in October 2014 and designed to provide the overarching strategic framework to achieve safe, sustainable and integrated local support by 2021 and on closing the financial gap that existed,  recognising that doing nothing was not an option.  The report covered the timeline and the next steps.

The representatives also gave a presentation covering: the Sustainability and Transformation Plan (STP) and its footprint and the NHS organisations involved, and also included care quality and financial challenges, priority areas and aspirations.

The representatives responded to Members’ questions relating to:
· the role of local members in calling for additional resources from Government noting that the STP was developing within current resources
· the scope for additional one-off funding in respect of transition arrangements arising from changes
· challenges in delivering services as a result of changes
· information in the ‘Case for Change’ about comparative costs of acute beds vis a vis costs of care at home, which the representatives undertook to provide to members of the Committee.

It was MOVED by Councillor Westlake, SECONDED by Councillor Sellis and
RESOLVED that a special meeting of the Committee be arranged (for early December) to consider in detail the recently published Sustainability and Transformation Plan for wider Devon.

Further reading:
Devon-wide STP briefing document

Acute hospital services review