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RCN South West Region

Integrated care in England: South West region

Integrated care

Integrated care has become a key focus of reform in England as a response to a need to deliver further efficiency savings. Sustainability and transformation plans (STPs) and devolution are part of a number of wide range of new initiatives to develop and deliver integrated care. 

Read the RCN's policy briefing 'Integrated Health and Social Care in England: update', published in April 2015.

Sustainability and transformation plans (STPs)

Sustainability and transformation plans (STPs) were announced in the NHS England 2016/17 Planning Guidance, published in December 2015 as part of the Five Year Forward View. They aim to ‘bring local health and care leaders, organisations and communities together to develop local blueprints for improved health, care and finances over the next five years’.

Across England there are 44 STPs, known as footprints.

Each STP has a named ‘leader’ who is responsible for ensuring the final plans are written in partnership with community input. These plans, rather than being based around institutions, are locality based, reflecting the needs of the community rather than what an institution wants to provide. The STPs are backed by £560 billion of NHS funding, with the first wave of funding being awarded to the most credible and compelling plans.

There are six STPs in the South West region, with leads as follows:

  • Cornwall and the Isles of Scilly - Joyce Redfearn (Leadership Consultant)
  • Devon - Angela Pedder OBE (Chief Executive, NEW Devon CCG)
  • Somerset - Dr Matthew Dolman (Chair, Somerset CCG)
  • Bristol, North Somerset, South Gloucestershire - Robert Woolley (Chief Executive, University Hospitals Bristol NHS Foundation Trust)
  • Bath, Swindon and Wiltshire - James Scott (Chief Executive, Royal United Hospitals Bath NHS Foundation Trust)
  • Dorset - Tim Goodson (Chief Officer, Dorset CCG)
  • Gloucestershire - Mary Hutton (Accountable Officer, Gloucestershire CCG).
South West senior RCN officers have written to STP leads for the areas they cover to request meetings and to ask for responses to the questions:
  • Who is the nurse leader for the STP?
  • How has the health of the locality been scrutinised to establish priorities?
  • Is there a plan to increase mental health investment? If so where will this be released from and if not how will mental health targets be met?
  • What new models of care are planned and how will these be commissioned?
  • Has an equality and diversity group been established or planned to be established?
  • Are there plans to reduce the number of organisations, functions or service delivery in order to release funds?

There is a regional STP board that meets monthly. Each STP needed to submit their draft plans to the regional STP board at the end of June 2016 and their final three-year implementation plan will need to be submitted by October. 

Each NHS organisation must then produce an operational plan for 2016/2017 to demonstrate how it will deliver what the STP has set out.

The nine ‘must dos’ for 2016/2017 within the operational plans:

  • Develop a high quality and agreed STP.
  • Aggregate financial balance.
  • Address and sustain quality in general practice.
  • Ensure access standards for A&E and ambulance waits are met.
  • Ensure no more than an 18-week wait from referral to treatment at hospital.
  • Deliver the 62-day cancer wait standard.
  • Achieve the two mental health access standards.
  • Transform care for learning disabilities.
  • Make improvements in quality while maintaining affordability.

The STPs must provide details about:

  • How health is going to be radically improved to address the health and wellbeing gap; this will include for example how to prevent the causes of ill health such as diabetes and obesity, how to engage with the population to encourage them to take care of their own health.
  • How the new models of care will improve quality, what new models are to be rolled out across the locality, how digital health care will be rolled out? By changing the way that care is delivered how the quality of all services will be improved
  • How the finance and efficiency gap will be closed. How workforce productivity will be increased through initiatives such as e-rostering and what will be done to improve the use of the NHS estate.

The pace of change is fast and the intention is that it will increase. STPs all have three work streams established to address the three gaps from the Five Year Forward View: care models, finance and workforce. Changes to care models will impact on workforce in terms of the numbers of staff and the skills needed. 

However as yet little involvement has been put in place by South West STPs for staff side representation on workforce work streams. It has been agreed with employers at the Regional Social Partnership Forum that this must be addressed. Going forward there must be discussion at SPF for the regional overview, a partnership forum at STP level for each STP area and at local staff side for the individual providers. 

STPs will be discussed further by unions at the SW Health Officers’ Forum (HOF) and also at the joint staff side meetings. Meantime RCN senior officers will be in regular contact the lead for each STP in their patch.


Cornwall devolution

The Case for Cornwall and the Deal for Cornwall were both approved by the Cabinet on 14 July 2015. They set out a commitment to achieve greater integration of health and social care and present opportunities for greater devolution of powers from Westminster.  Cornwall is the first rural authority to agree a Devolution Deal with the Government. The Cornwall Devolution Deal outlines the powers that will be devolved to Cornwall for transport, energy, health and social care, and heritage.

Devolution within Cornwall 

As well as having powers devolved to Cornwall from London, Cornwall Council is also devolving services and assets to local councils, groups and organisations within Cornwall.

Latest update

Currently Cornwall are not proceeding with health involvement in the devolution plan.  However we expect movement on this as the STP moves forward with its plan. Meanwhile the various health providers are coming together in a consortium. These include Cornwall's acute hospital (Royal Cornwall Hospitals NHS Trust in Treliske), mental health hospitals (Cornwall Partnership NHS Foundation Trust), community hospitals (formerly Peninsula Community CIC) and Cornwall GPs (Kernow Health). This new arrangement will take some time to settle down operationally and will be exacerbated by the need to resolve the varying degrees of financial deficit within the component bodies.

Other plans in the South West

West of England (Bristol area) - This bid is approved.

Further South West devolution bids also awaiting approval have been submitted from:
There is currently no evidence of health organisations being involved in devolution in the Dorset or Wiltshire plans.

More information about devolution is available via this link.

Vanguard sites

The South West has three vanguard sites piloting new models of care in different areas and health care settings. Follow the links for information about each one:

Integrated primary and acute care systems – joining up GP, hospital, community and mental health service:

South Somerset Symphony Programme

Urgent and emergency care – new approaches to improve the coordination of services and reduce pressure on A&E departments:

South Devon and Torbay System Resilience Group 

Acute care collaboration vanguard sites:

Developing One NHS in Dorset 

For more information about vanguards, click here.

Integrated care in England

Find out more about the three ways integrated health and social care is set to be delivered in England and what it all means for you.