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) 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:
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
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:
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:
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.
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.
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.
More information about devolution is available via this link.
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:
Acute care collaboration vanguard sites:
For more information about vanguards, click here.