An Introduction to the Staffordshire and Stoke-on-Trent Sustainability and Transformation Plan
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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
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.
44 6
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 STPs nationally across 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.
1.1m 542m
Our financial position is
Providing services to In four years’ time we
challenging — in four years’
time most organisations
estimate a funding gap of
across Staffordshire and
Stoke-on-Trent will be in
deficit, and we will have a
funding gap of £542m if we
don’t change things. people in Staffordshire for all organisations
and Stoke-on-Trent across Staffordshire
and Stoke-on-Trent, if
we don’t change things
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 Hospital
Stafford &
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
Staffordshire Tamworth
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
3 How things should be…
Everyone deserves difficulties, or a combination Health and care should be an
of all of these. equal partnership between
good quality, safe, you and the professionals
health and social care The services you use most of who support you. We believe
the time should be as close
services that make to where you live as possible,
that prevention is always
better than cure and that
the best possible use as long as this is safe and we all have a role to play in
of taxpayers’ money. the local health and care managing our own health and
system can afford this. For care — including planning and
These should be readily the vast majority of the time budgeting for our needs as
available to you regardless you should go home as soon we get older.
of your age, ethnicity, social as treatment is completed.
and employment status, More specialist care will
sexuality or where you live. be delivered in a centre of
excellence, so you may need
The standard of care should to travel a little further for
be the same whether you this — but rehabilitation
need physical, mental health and follow-up treatment/
or social care services, appointments will happen
support with conditions close to home.
associated with learning
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 in 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… 800 admitted to our
can be summarised local hospitals
[[ By 2021 the number of
as follows: people aged 65+ will rise every day
by 16% of these
1. We’re spending far too
much money and are 330 admissions
[[ 30% of health and care
building up a very big are unplanned
costs for those aged over
debt — £542million in five 65 years are spent on patients are
years if we don’t act now hospital care 60 readmitted
— 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 at any one
care, the latest technology exceed the average time could be
and equipment such as for injuries due to falls treated better
scanners, and training. in people aged 65+, elsewhere
It will also make it even Stoke-on-Trent was 30%
more difficult to attract above the national average. of acute bed
GPs, nurses and surgeons 30% occupancy is
to work here …with more complex by those with
health needs mental health
2. Our major hospitals are needs
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
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
death 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 rate 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.
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
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 and 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.
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 Simplified urgent and
planned care emergency 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
Reduced costs of services right support.
10 Together We’re BetterAffordable 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
and than hospitals. Reduce the your physical health, and provide access
community number and severity of to mental health professionals /support
care 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
and reduce duplication of tests follow up in the community so you only
efficient and concentrate experts and go to hospital once. Develop a dual care
planned specialised diagnostics in a approach addressing both physical and
care 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.
Simplified Increase community based Provide better access to more urgent care
urgent and urgent care and reduce 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.
Reduced 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.
Staffordshire and Stoke-on-Trent Sustainability and Transformation Plan 119 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
People currently view hospital
there
getting better quicker and
as the best — or only — place having a better quality of life, It is important to know that
for them when they’re ill but extra support is needed if hospitals will always be there
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 go to hospital only 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 the
need to ensure there are high centres and specially trained people that really need their
quality alternatives available pharmacists or developing specialist care, improving
elsewhere and that people centres of excellence that quality as a result as well as
know they exist and know 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 Better10 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
need to look not just at the symptoms but
ensure this happens in the future, at the root cause — and these aren’t always
many of us could take on more health related. Poor housing, social isolation
personal responsibility for our and a missing sense of community all
contribute to poor health, particularly mental
own health. This could be through health. We recognise that we need to treat
making better lifestyle choices to your mental health as equally as your physical
help us stay well, or by managing health. It 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.
Staffordshire and Stoke-on-Trent Sustainability and Transformation Plan 1314 Together We’re Better
11 What does the future
look like?
We certainly don’t These teams will work We believe that it will also be
closely together with patients less expensive as long as we
have all the answers as equal partners in the are all prepared to accept that
yet but local clinical management of their physical if we get this right the roles of
leaders have been and mental health, and people hospitals will change.
working on a new will be given the necessary
advice, support and resource This is likely to mean fewer
community ‘model to help them stay well for as hospital beds, less staff
of care’ in which a long as possible. working in a hospital setting
and more specialist services
number of health and When they are ill, they will in fewer hospitals. As part
care professionals be given the necessary of this we will look to move
with different skills knowledge and help to from three to two A&Es and
will work in small manage their own conditions one Urgent Care Centre and
wherever appropriate and an exploration of potential
teams (we call these possible, giving them more options, though no decisions
‘multi-disciplinary’), control over their lives. on the locations of these
which will both This kind of proactive
services has been made.
support and learn approach to care will Doing this well would mean
from one another. help us all work together our financial position would
to reduce the number of begin to improve in the
We think we would need times people need to be longer term and we would
around 23 teams based admitted to hospitals for both be able to meet the national
around local populations pre-planned and emergency standards for care within our
in Staffordshire and care, allowing people to major hospitals — something
Stoke-on-Trent of between remain independent, in control we have all struggled with in
30,000 — 70,000, many of and sleep in their recent years. This will mean
whom will need relatively own beds rather than on less queues in A&E, reduced
little support from the hospital wards. waits for operations, better
system most of the time. care and better patient
This will help to reduce a lot experience.
These teams will need to of the stress associated with
have the right information illness for patients and their We will have to make some
about their patients at their families, as well as being a investment in the short term
fingertips in order to help much more convenient, cost to make sure this works, and
identify those who may effective way of providing we have factored this into
need additional support, services. our plans as we know this
help and advice. will lead to savings in the
longer term.
They will focus on the overall
needs of the person rather
than dealing with a series of
individual symptoms, putting
the “jigsaw” together when it
comes to looking after people.
Staffordshire and Stoke-on-Trent Sustainability and Transformation Plan 1512 Public engagement
In partnership with [[How can we make
Healthwatch Staffordshire the best use of public
and Healthwatch Stoke- money?
on-Trent, throughout
November and December The events were held at:
2016 we held a number [[ Staffordshire Moorlands
of patient and public (Biddulph)
engagement events, [[ South Staffordshire
known as Conversation (Codsall)
Staffordshire and
[[ Stoke-on-Trent
Stoke-on-Trent. These (two events)
events were about local
people talking about [[ Stafford
the very real, very [[ Newcastle-under-Lyme
serious issues outlined
[[ Lichfield
in a Conversation
Staffordshire and [[ Tamworth
Stoke-on-Trent [[ Cannock
document through
an open, two-way [[ East Staffordshire (Burton)
discussion. These events offered the
opportunity to have frank and
We asked: open discussions with leaders from
[[Which services are the STP about the work we have
done so far, and difficult decisions
valued most? that may need to be made going
[[How can they be forward, as well as some of the
opportunities this will create.
shaped and improved? These were not full consultation
events, but the discussions may in
[[Where do patients the future inform the content of
need to access those any future consultations about any
services? major changes to health and care
services.
16 Together We’re BetterDuring the events we Many clinicians and health No decisions can or will
received feedback professionals have been be made until we have
involved in the work we have thoroughly engaged with
and ideas on:
done so far, but we now need you, our staff, politicians
[[ What you have seen that to get everybody involved. and voluntary sector
could be done better We need people who care organisations, and any
about their local services and major changes to service
[[ Where money could be who are interested in seeing have to go through a formal
better spent their local NHS not only consultation process.
survive the coming months
[[ What services mean the and years, but also begin to We are lucky to have a
most to you and how we thrive and improve as we National Health Service as
can improve them move towards 2020. well as the social care that
wraps around it. By getting
[[ If more of the care you We must also be realistic involved now, you can help
need were available close — with a population of well to make sure your local NHS
to where you live, how over one million people continues to provide high
far would be acceptable it’s unlikely we can please quality, easily accessible
to travel to receive everyone, and not all ideas healthcare to you, your
specialist care and proposals will be friends and your family
achievable. However, we for years to come.
[[ What we can do without will do our best to ensure
decisions made are in
[[ Whether it is right to
collaboration with the public.
expect people to budget
for their care needs as Local Scrutiny Committees,
well as their overall living your local MPs, councillors,
expenses in old age. the voluntary sector and
patient representatives
Healthwatch Staffordshire
will all have an important
and Healthwatch Stoke-on-
role to play in commenting
Trent will be providing a more
upon and challenging our
detailed report which will
plans. 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
changes to local services will to learn more so they can
be made without extensive share information with their
public consultation and communities.
feedback.
Staffordshire and Stoke-on-Trent Sustainability and Transformation Plan 1713 We need to make these big
decisions together
During our engagement You said:
events to date we have set There are lots about our current services
out a “direction of travel”, that you value highly, but you also gave
us examples of poor experiences, and
but there are a number of overall concerns that the current way we
big decisions that we need deliver care is not working as it should.
to make with you in 2017
We did:
and beyond: The plan is based on a new model of care
which will be more joined up, and bring
[[ How quickly, and in which locations,
care as close to home as possible, but also
should we deliver the new joined up help people take more control of their own
way of providing primary, community, health and care.
mental health and end of life care
services?
[[ How can we best use community You said:
hospitals and other estate (buildings You are worried about the pressures on
and land) to complement this? our A&E services, and there is confusion
about what services to use when.
[[ What is the most sensible and cost
effective way of providing elective
We did:
(planned) care? Should we centralise We recognise the need to simplify the
University Hospitals of North Midlands current system, and our proposals about
NHS Trust care services onto one site, redesign of urgent care are based on
and should we have fewer, high quality improving the service offered at local level.
centres of excellence? Where should These will be subject to consultation in the
summer.
these be?
[[ Improving urgent care in line with
national recommendations may You said:
reduce the need for A&E services. You understand and agree with our
Do we need the same number of A&Es ambition to provide care closer to
and if so where should they be? Our home, but you have real concerns that
current thinking is that we could move community services do not exist at
from three to two A&E sites and one present to make this happen.
Urgent Care Centre. This is something
we will hold a consultation about in We did:
summer 2017. We recognise that the development of
these locality teams will require investment
[[ Can we make further cost savings and transition funding. This is built into the
by sharing services or organising STP plan.
ourselves differently?
18 Together We’re BetterYou said: You said:
We need to recognise the differences The current system is fragmented,
there are between local areas, and the and care is often affected by lack of
different needs of local populations. communication between professionals.
We did: We did:
We agree and can reassure you that the The fundamental basis for the plan is
development of these new models will the development of integrated teams
be bottom up — driven locally. The most at locality levels who will deliver a more
likely form will either be multispecialty consistent service offer. These locality
community provider (MCP) or Primary teams will over time develop into new
and Acute Care System (PACS). A MCP models of care in line with the five
moves specialist care out of hospitals year vision for the NHS. This will mean
into the community, whilst a PACS joins professionals working together in teams
up GP, hospital, community and mental to give you a joined up service. These are
health services. The STP has not made any
the cornerstone of the STP.
statement about the format or geography
of these developments.
You said:
Are there any ways of slimming down
You said: your management costs or sharing
You are really concerned about the facilities?
future of the community hospitals in
Staffordshire and Stoke-on-Trent, and feel
in many places these are under-utillised; We listened:
you gave us lots of ideas about how we We recognise that reduction of cost is
could use these facilities better. important and we will look closely at
the way we work to see if there are any
sensible ways of joining up our services.
We did:
The STP is very clear that reduction in
beds will be supported by additional
investment in ‘out of hospital’ services You said:
including community, mental health, We have dedicated and committed staff
primary and social care. The CCGs will in our NHS and care services, and you
be consulting formally in the new year value highly their work.
about their plans for the future use of
community hospitals and we welcome
suggestions from local people. We listened:
We agree that our staff are fundamental
to delivering the plan and every
organisation is committed to supporting
their staff through the delivery of the
plan.
Staffordshire and Stoke-on-Trent Sustainability and Transformation Plan 1914 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 call the Communications and
Engagement Team at Midlands and
Lancashire Commissioning Support
Unit on 0333 150 1602.
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