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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 seven STPs in the South West region, with leads as follows:

  • Cornwall and the Isles of Scilly - Joyce Redfearn (Leadership Consultant) - plan published
  • Wider Devon - Angela Pedder OBE (Chief Executive, NEW Devon CCG) - plan published.
  • Somerset - Dr Matthew Dolman (Chair, Somerset CCG)- plan published.
  • Bristol, North Somerset, South Gloucestershire - Robert Woolley (Chief Executive, University Hospitals Bristol NHS Foundation Trust) - summary published
  • Bath and North East Somerset, Swindon and Wiltshire - James Scott (Chief Executive, Royal United Hospitals Bath NHS Foundation Trust) - plan published
  • Dorset - Tim Goodson (Chief Officer, Dorset CCG) - draft plan published
  • Gloucestershire - Mary Hutton (Accountable Officer, Gloucestershire CCG) - plan published.
Last year south west senior RCN officers wrote to the STP leads 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?

The STP leads have not been able to answer all of these questions in full, but as the plans are developed we will continue to press for answers.

The RCN and other staff side organisations have been lobbying the STP leads in the region to set up social partnership forums (SPFs) and these are now in varying stages of development. RCN senior officers are attending these meetings, as are many local RCN representatives across the region. Our senior RCN officers are currently negotiating seats on the STP Local Workforce Action Boards (LWABs) which will be looking at staffing structure relating to the STPs.

The STPs also have clinical work streams and our senior officers have requested lists of membership for the different groups so that they can develop links to nurses on those groups, to support and gather intelligence, or challenge where nursing does not have adequate representation.

STPs could see the biggest change to health care provision since the birth of the NHS. They will impact every service currently offered by the NHS so no matter who you are currently employed by, if you provide or commission an NHS service, the STP will have an impact. The early plans all highlight a desire for a strong prevention agenda, self-care, care closer to home, seven-day GP services, specialists working away from acute settings, a generic workforce, shared back-office functions and new patient care pathways.

What you can do

  • Be informed - follow the links above to read your local footprint plan.
  • Ask questions of your managers in your workplace setting:
    • How is your service linked in to the STP?
    • What is the vision for your service for the future?
    • Who from your service is working with the STP to advocate for your service and client group?
    • How can you share your experience and knowledge to influence change in the STP?
  • Link to your local RCN representative - to find out details please contact RCN Direct on 0345 772 6100 between 8:00 am and 8:00 pm, seven days a week.
  • Talk to your colleagues about STPs, encourage them to join the RCN or another trade union.

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 to NHS England by the end of 2016. The plans are in general early drafts, mainly aspirational with little detail. It is important that nurses influence the ongoing development of these plans where possible. 

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. 

Following strong lobbying by the RCN most STPs have established  STP partnership forums. We need to ensure that employers involve their staff sides in the development of the local operational plans. RCN senior officers will be in regular contact with the lead for each STP in their patch.

Now each NHS organisation is working to develop an operational plan for 2016/2017 to demonstrate how it will deliver what the STP has set out. These will be submitted to NHS England.

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.


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.