|STP Footprint Name||Spreadsheet update||Analysis: what will the plans mean for frontline services and patients?||Final Draft Submission (October)||Link to plan||Transformation funding requested in submission||Predicted size of the deficit in 2021 (based on April or June submission)||Predicted 2021 Deficit (based on October submission)||Do Something deficit||STP outlines plan involving service reconfiguration and/or bed closure||Service affected||Specific reference as outlined in STP submission||Maternity||Mental Health||GPs (Primary care)||Pathology||Diabetes||Learning Disabilities||Cancer||Dementia||Estates|
|Bath, Swindon and Wiltshire||w/c 19 December 16||By 2021, the health and social care system in Bath, Swindon and Wiltshire is projected to be £290m short of the funds it needs to balance its books while maintaining the same level of care for patients. The plan is short of important detail on how it'll close the funding gap without cuts or closures to services but makes clear that over £200m of the required savings over the five year period will have to come through "transforming clinical services".||Emergent plan||http://www.bathandnortheastsomersetccg.nhs.uk/assets/uploads/2016/04/BSW-STP-Final-14-12-16.pdf||£490.49 million||£290 million||Yes||Beds||"We will model the number of beds required across the footprint to understand whether we require a similar or reduced number of hospital beds in the future."||"There is increased focus on maternity services via the Improvement and Assessment Framework and the|
four key areas of focus for this group are:
- Neonatal and still birth
-Maternal smoking at time of delivery
- Women’s experience
- Choice in maternity services
In addition to these areas of focus, the forum is also taking the opportunity to evaluate the services provided across the STP more generally to identify ways to work together across the footprint to improve maternity services. There is a range of local and national drivers for change which have highlighted areas of inconsistency in service provision and practice across maternity services. The next stage of this work will include engagement of local people in some early evaluation work which has already been undertaken."
|"To improve patient experience, we will move from reactive responses to crisis, to an integrated social, mental and physical health care service in the community that prevents crisis and creates parity of esteem between physical and mental health."||"There is likely to be collaboration across the three CCGs at STP level around the provision of commissioning support for primary care in 2017/18."||"All back office functions will be looked at to scope the potential to share services."||Priorities: |
" - Embed prevention and self-management along identified LTC pathways, including
diabetes, recognising the needs of people with multi-morbidities, and drawing on the
support of ‘expert’ peers within the voluntary sector.
- Diabetes Prevention Programme – statement of intent to work together across the STP.
- Collective campaigns for flu and pneumococcal vaccinations using social marketing to
achieve behaviour change."
|"The strategic aim is to deliver the National Directives of Transforming Care by:|
- Working in partnership to reduce the need for people with learning disabilities to be admitted to
specialist hospital placements outside of the area
- Ensuring equal access to the health, mental health and social care services available within the
- Developing integrated training programmes to ensure all providers of care are operating to the
same excellent standards including friends, family and carers
- Developing a skilled workforce across all healthcare provision"
|"The footprint has a long-establish Cancer Forum that has now expanded to include all BSW stakeholders. This group will operate as a sub-group of the STP Board and will have representation on the SWAG Cancer Alliance Board. The footprint has significant cancer flows (and working relationships) into Wessex and Thames Valley alliance footprints and our planning assumption is that these flows will remain. The clinical and commissioning leads for the STP are already engaged with SWAG over the production of our work plan in line with the Ops Planning guidance."||"Infrastructure: Development of estates to maximise potential that are elderly/dementia user friendly (access/facilities/location)"||"Along with the opportunity to develop integrated clinical models, we can improve efficiency by rationalising all of our estates/buildings, sharing our clinical and non-clinical information, and harnessing our purchasing power (as set out in the Carter Review)."|
|"We expect that we will need to deliver over £200 million savings over the five year period, through transforming clinical services: through planned care, urgent and emergency care, as well as through preventative and proactive care approaches."||"Mental health, social care, community and hospital professionals will work more closely together, providing reliable services that are designed with input from patients and available closer to home. This will be achieved by planning at neighbourhood level, with GPs coordinating a range of care services"||"We believe local engagement and ownership of clinical models will be critical if we are to meet the long term needs of our local populations. As a result, the development of community models of care will continue to be very much locality focused with sharing across localities on model design. Our plan is to continue to have separate contracts within each locality."||"Pockets of technological innovation exist to support people with long term conditions. These innovations should be adopted at scale to address the growing needs of people with dementia, and their carers. Further opportunities exist to pool our analytics capability to provide a systems view, improving population-based planning and system capacity and demand."||"From a funding perspective, we will simply not have the resource to maintain all our existing sites, invest in new buildings and invest in assistive technology and preventative support and services. Our priority is therefore to work with clinical teams and local citizens to design the care model for their area and to then target our investment to deliver a physical infrastructure that enables delivery of that care model."|
|"BSW STP leaders recognise that sustainability and transformation present an opportunity to address the holistic health and care needs of our populations, including mental health and wellbeing. Current mental health service commissioning arrangements result in variable access, varying service specification, waiting times and treatment outcomes across three CCGs. We have not yet developed fully integrated social, mental and physical healthcare, focussed in the community and pro-actively delivered at the earliest opportunity. There are fragmented care pathways, with both duplication and gaps in provision."||"Similar to the future model for community services, bespoke models of sustainable primary care provision will be developed in the three locality areas with sharing on learning and implementation across the STP to accelerate delivery."|
|Birmingham and Solihull||w/c 24 October 2016||By 2021, the health and social care system in Birmingham and Solihul is projected to be £712m short of the funds it needs to balance its books while maintaining the same level of care for patients. However, the plan is short of important detail on how it'll close the funding gap without cuts or closures to services.||Full Draft Published||B'Ham & Solihull STP - Full Draft Plan - October 2016||£712 million (includes NHS and Social Care)||"There is currently no expectation that the current acute bed base in the system will reduce"||"Deliver a consistent world class holistic service that empowers women and families to make informed choices and who can access high quality care from a range of providers most suited to their personal choice and clinical need. The workstream will deliver BUMP (Birmingham and Solihull Maternity Pathway)" "Benefits will be realised through a variety of activity shifts. At this stage our financial insight is fairly limited and we have focused on potential savings from a move to more home births and midwifery led births. We are exploring other areas around estate and rates of surgical intervention and induction of labour but this is in the early stages"||The plan expresses the footprint's strategic objectives for mental health. Over the next 5 years the area wants to: |
"provide better help for people who are suffering from, or who are at severe risk of, mental health problems” and "ensure that mental health is considered as important as physical health". The plan states this "will be delivered through the following objectives:
1. Prevent– preventing mental health problems and getting help earlier, for people starting to suffer poor mental wellbeing
2. Protect– protecting, those who are most vulnerable from the adverse effects of mental health problems including management of the relationship between mental and physical health and ensuring parity of esteem
3. Manage– preventing mental health crises and managing them better when they do occur
4. Recover– helping people with mental health problems to recover back into everyday life".
|Plan notes that the overarching objective is to co-ordinate, oversee, guide and monitor the implementation of an Enhanced General Medical Services strategy, which will: |
• "Improve sustainability and resilience of GP through new support team
• Support delivery of the GP Forward View
• Offer an enhanced 8 till 8 service to support patients and improve accessibility
• Development of universal offer and Practice of the Future
• Model based on 29 ‘natural communities" The plan indicates that the "key focus is to develop an enhanced general medical practice offer which is aligned to long term conditions (LTC) priorities and preventative interventions (initially focussing on Frailty, Respiratory, Diabetes, End of Life and Dementia pathways) to deliver the place based integrated community model"
|"develop a single integrated laboratory model across Birmingham and Solihull that will deliver a high quality pathology service"||Plan indicates that diabetes prevalence in STP footprint is higher than national average. Diabetes is identified as one of the key disease areas for the "enhanced general medical practice" offer to focus on||Planning on developing "prime provider models across a range of key specialised services" - including adult teriary care including cancer - to "reduce the non-specialist demand on tertiary providers" and "ensure that the capacity that is released is used in order to manage the increased demand for tertiary access. The prime provider models will ultimately support the standardisation of care, address quality issues and improve access and utilisation for specialised services both within the BSol STP"||To create an estate footprint that is fit-for-future purpose and flexible enough to adapt to and support changes in clinical service models, without the need for additional significant capital investment. This will be achieved by: Initial disposal of unused, poor condition, and/or surplus estate to fund estate change programme; Reduce the known areas of estate void (e.g. in LIFT buildings) and implementation of other innovative opportunities to repurpose existing buildings enabling the delivery of high quality place based clinical services within the natural communities; Ongoing oversight of estate utilisation across Birmingham and Solihull and planned use on a footprint-wide basis to realise additional benefits and optimised estates utilization.|
|Bristol, North Somerset, South Gloucestershire||w/c 21 November 2016||NHS leaders in Bristol, North Somerset and South Gloucestershire have requested more money. However, the plan is short of important detail on how it'll close the funding gap without cuts or closures to service. By 2021, Bristol, North Somerset and South Gloucestershire is projected to be over £300m short of the funds it needs to balance its books while maintaining the same level of care for patients.||Full Draft Published||BNSSG STP - Full Draft Plan - November 2016||£60m||£305.5 million (unclear if NHS only or includes social care)||Yes||district hospital||Ongoing plans to reconfigure Weston Area Health Trust to make it financially viable: 'Although increased use of Weston elective facilities could be part of the solution, we will still need to take significant costs out of the system to make this programme a success'||"Improve resilience of local primary care services: Primary care services organised around meaningful, minimum population clusters of 30,000-50,000, A seven day operating model that reduces reliance on acute hospital services"||Organisational savings in pathology cited as one of the measures to reach help reduce the footprint's deficit|
|Integrated primary and community care||Anticipated outcomes from integrating pirmary and community care include "savings in consolidating and reducing premises"|
|Buckinghamshire, Oxfordshire and Berkshire West||w/c 14 November 2016||By 2021, the health and social care system in Buckinghamshire, Oxfordshire and Berkshire West is projected to be £479m short of the funds it needs to balance its books while maintaining the same level of care for patients. The plan, leaked by Reading Council, gives important details such as plans to use "general support workers" rather than nurses to save money. There are also plans for consultations on reductions in acute beds and changes to Horton hospital.||Full Draft Published||BOB STP Plan||£200 million||£479 million||£11 million surplus (including £106 million STF funding)||N/A||Workforce||£34 million workforce savings from (among other things) - "Skill mix changes to support a more flexible workforce– use of generic support workers (across health and social care), reduction of nursing grade input, increased use of healthcare assistants and physicians associates and more flexible uses of ECPs and ANPs."||"Maternity services across BOB will need to make changes both locally and across the STP footprint to deliver the recommendations in the national maternity review, ‘Better Births: Improving outcomes of maternity services in England; A Five Year Forward View for maternity care’, February 2016."||Savings include £4 million in mental health from "The use of outcomes based contracts in mental health and moving to lead provider contracting arrangements for forensic services is estimated to save £4m across the BOB footprint."||"The proposed changes to the Horton Hospital and the development of community hubs based around GP populations and bed based services across Oxfordshire and Buckinghamshire will mean patients have reliable and sustainable access to high quality evidence based services closer to home which will lead to improved patient outcomes."||Planned savings include: "Collaborative working on clinical support services, particularly pathology and radiology. The development of a collaborative interventional radiology service is an early priority. The AHSN imaging clinical network is progressing the development of improved image sharing across the network."||"The development of community hubs based around GP populations across Oxfordshire"||"Potential changes to specialised commissioning pathways for specialised services, such as cancer and cardiology treatment."||"By January 2016, all six memory clinics with which the Oxford AHSN worked had been accredited by the Royal College of Psychiatrists (RCP) Memory Services National Accreditation Programme (MSNAP), with three of them receiving the highest ‘excellent’ rating. This work was led by the AHSN, building on the excellence in West Berkshire."||The vision, design and implementation of cross organisational efficiency opportunities such as back office integration, shared use of estates and workforce initiatives.|
|Yes||reduction in hospital beds||Savings in Buckinghamshire include - "shifting spend on bed-based care into prevention and care at home"||"More effective use of mental health specialist commissioning budgets to improve pathways, starting with secure services. Outcomes based contract across BOB for MH & LD"||"Support the transformation of primary care to deliver high quality care through working at scale and coproduction of improved quality of care across the healthcare system though the development of new ways or working and integrated systems of care."||"Rollout of the diabetes prevention programme across BOB from its current implementation in Berks West"||"Establishment of an STP wide planning and commissioning function for services such as cancer, stroke, ambulance and 111, through a joint CCG Commissioning Executive."|
|reduction in hospital beds||There are plans for a "Consultation on bed closures at OUHFT", "New roles for Oxfordshire community hospitals",|
|reduction in hospital beds||Oxfordshire transformatinon programme includes - "Reductions in acute bed based care across Oxfordshire" and "Service changes at the Horton Hospital in Banbury (part of Oxford University Hospitals Foundation Trust)"|
|Cambridgeshire and Peterborough||w/c 21 November 2016||By 2021, the NHS in Cambridgeshire and Peterborough is projected to be £504m short of the funds it needs to balance its books while maintaining the same level of care for patients. To plug this gap, the area is considering "rationalising" NHS buildings - this may mean selling NHS properties and closing services. The area's STP also confirmed that health leaders in the area are "considering delivering all bed-based stroke and neurological rehabilitation on a single site".||Full draft plan||http://www.fitforfuture.org.uk/wp-content/uploads/2016/11/Cambridgeshire-and-Peterborough-Sustainability-and-Transformation-Plan-October-2016.pdf||£250 million||£504 million (includes specialised services and ambulance services but excludes social care)||"We have explored all possible opportunities to improve our financial position and return it to balance by 2020/21. Through the use of top-down analysis, and by quantifying local opportunities, we have been able to turn the projected £504m NHS deficit into a small projected NHS surplus of £1.3m. We have refined these numbers by modelling future activity and costs and we have used this information to underpin our plans and to ensure that our solutions have a long-term impact"||Stroke services||On changes to stroke services across the STP footprint, the plan states "we are considering delivering all bed-based stroke and neurological rehabilitation on a single site". On changes to stroke services, the STP also states "The creation of dedicated hospital and community based rehab teams will lead to increased staffing specialisation and better outcomes for patients. In addition, there will be financial benefits around volume of staff required and average length of stay reductions. We expect to consult with the public on these proposals in 2017. We have also considered whether we need one or two hyperacute stroke units in Cambridgeshire and Peterborough and have concluded that at present we should retain two hyperacute stroke units"||Plan outlines an approach to develop "Neighbourhood care hubs" to releive the pressure on general practice. In the context of mental health, one of pillars is to "As part of our system-wide mental health strategy we are considering how to integrate our community and mental health teams further to ensure the psychological needs of people with long-term conditions, and the physical health needs of patients with severe mental illness, are uniformly met. Work is already underway to provide enhanced primary mental health care that supports GPs in identifying psychological needs and primary care led interventions. This, together with support from ‘recovery coaches’, will facilitate users to step down from secondary mental health and address a commonly held ‘fear of a cliff edge’ among users and carers"||Plan indicates that developing a "pathology hub" could deliver a "saving opportunity" of around £7 million. Plan does not provide further information about what a pathology hub is.||"Learning disabilities: We have been working closely with the councils to implement ‘Transforming Lives’ for people with a learning disability. In the past year alone we have reduced the number of people in a bed by half. Further, the Collaboration for Leadership in Applied Health Research and Care (CLAHRC), which is hosted by CPFT, is evaluating the use of integrated personal health and care budgets for people with learning disabilities which, if successful, may be rolled out more widely"||On cancer, the STP states: "We are working to implement the recommendations of the ‘Cancer Taskforce Strategy’ and to achieve world class cancer outcomes. The establishment of ‘Cancer Alliances’ is crucial to this. We are reviewing cancer pathways and focusing in particular on prostate, lung, ovarian, colorectal, oesophageal, and gastric cancers. We are working to improve the percentage of patients diagnosed at stage one and two and targeting our interventions at patients most likely to benefit. With Public Health England and Cancer Research UK we want to ensure that our screening programmes, in particular for breast and bowel screening, are appropriately targeted and optimally utilised. Where uptake could be improved we will work with specific GP practices and promote screening as part of health checks. We have already implemented a new two week wait referral proforma which lowers the referral threshold in line with new National Institute for Health and Care Excellence (NICE) guidance and we are working with trusts to redesign pathways to enable earlier diagnosis by, for example, reviewing access to diagnostics"||On dementia, the plan states, "Our neighbourhood teams, primary care, and social care will work with the voluntary and community sector (VCS) to identify those at risk of poor or deteriorating health. They will deploy community-based workers to support those with a severe mental illness or dementia and to support migrant workers, travellers, and our wide range of diverse communities who may need a different blend and style of intervention that is more socially attuned"||On estates the plan states: "We have many community estate sites, some of which are poorly utilised. This provides us with the opportunity to rationalise the numbers of buildings used and potentially develop new primary and community care facilities on the larger freehold sites. This rationalisation will also promote co-location and shared working spaces which can bring teams together and foster integrated care delivery across health and social care agencies"|
|reduction in bed numbers||community beds||Plan states:"We currently have 213 health and social care community beds where patients experience variable levels of rehabilitation and care and with variable lengths of stay. Evidence suggests there is no correlation between longer length of stay and improved patient outcomes. By better defining clinical models of care in community beds, investing in therapeutic input and domiciliary care, and standardising discharge protocols we believe we can make a transition to more effective and patient-centred models of care. This transition would result in a reduction from the current total community bed stock by 2018, releasing funds for reinvestment in home-based services for local people, as part of our own contribution to transformation funding and commitment to improved patient care"||Plan also outlines an approach to improve mental health provision in the context of Responsive urgent and expert emergency care. In this context the appraoch is to "We are investing £2m of Urgent and Emergency Care Vanguard money in 2016/17 in an evidence-based, community first response service which provides urgent out of hours assessment and support to people in mental health crisis. We are enhancing our model of liaison psychiatry services in our two emergency centres. Too many people experiencing a mental health crisis previously ended up in police custody, and so we have partnered with the local police force and embedded four mental health workers in the police control room to ensure that people are only detained under section 136 when there is no alternative. This is already having a significant impact, saving the police force money and providing a better experience and appropriate care for patients in the community"||Plan outlines a vision for "ageing well": "We must improve independence and wellbeing in older age and prevent health and care needs from escalating. To achieve this, we will focus on physical activity and reducing falls, holistic approaches, and care for older people’s mental health, and strengthening place-based approaches to healthy ageing. We have already begun to make progress in falls prevention, caring for people with dementia, tackling social isolation, loneliness and malnutrition in the community, and prevention of urinary tract infections and incontinence. Increasingly, all council and NHS staff will act as ‘eyes and ears’, spotting indicators that someone is becoming more vulnerable and referring them to appropriate support"||Plan indicates that developing a "single plan for estates and workforce" could deliver a "saving opportunity" of around £29 million|
|On Minor Injury Unit (MIU)'s, the STP states: "we are now working with local stakeholders to develop the details behind a number of options including the development of three rural urgent primary care hubs which will initially focus on integrating local primary, MIU, and community services, but will move on to include development of point-of-care testing and consultant support via telemedicine links. These hubs will deal with minor injuries as well as extended scope minor illness and urgent care".||"Specialised mental health: We provide limited specialised mental health locally: a small number of low secure beds and limited CAMHS tier 4 services. The East of England region has been identified as one of three areas without a mother and baby unit for those with severe mental health problems following childbirth. We aim to address this, and our mental health strategy also prioritises the development of perinatal mental health services in the community"|
|acute service consolidation||On Acute consolidation, the plan states that a "A Full Business Case (FBC) setting out how patients in Huntingdonshire, Greater Peterborough, and South Lincolnshire will benefit from the services provided by staff working in one single hospital foundation trust, based on three hospital sites, (Hinchingbrooke, Peterborough, and Stamford Hospitals), was approved by the boards of both PSHFT and HHCT at the end of September 2016 (subject to consideration of feedback from the independent local Clinical Senate on the integration of clinical services, and staff and public engagement sessions held in October and November 2016). The FBC has been referred to NHSI for review and the boards of both trusts will meet again, separately, at the end of November 2016 to review all feedback to ensure it is reflected in the FBC and the accompanying implementation plan. They are then expected to ratify the FBC in readiness for the merger to take place on 1 April 2017. In the interim, both trusts are working together to provide safe services, particularly in areas identified as being fragile. Some benefits will be achieved by April 2017, with full benefits delivered by autumn 2020"|
Plan does not specific whether merger of PSHFT and HHCT is primarily a organisational merger, or if any services/sites will be affected (downgraded/shut) as a result. In the FBC submitted, it states: "It does not recommend changing services at any one of the three hospital sites"
|reconfigure some clinical pathways||specialist services - orthopedics, stroke and others||Plan states "Clinical networking will help us to deliver the savings opportunities identified through pathway changes that shift care to lower cost settings where appropriate, align referral and treatment thresholds, and reduce costs of care". Specific clinical areas for redesign include: orthopedics, stroke and |
On Orthopedic services, the plan states: "We are considering centralising specialised orthopaedic trauma services (such as fragility fractures) at PSHFT and CUHFT" . Plan also indicates changes to other orthopedic services are being considred, "We are also investigating the case for reconfiguring planned orthopaedic services, by increasing the number of low-complex procedures at HHCT and centralising high-complexity orthopaedics at PSHFT and CUHFT. These reconfigurations are expected to improve the quality and sustainability of services at all three sites. We expect to consult with the public on these proposals in 2017". On these changes, the plans states that proposals have been developed "following extensive engagement with clinicians across all provider organisations"
|Cheshire and Merseyside||w/c 31 October 2016||The plan states that the current set up of acute services is unsustainable in this footprint area. This may well lead to cuts in A&E services. By 2021, the health system in Cheshire and Merseyside, excluding social care, is projected to be over £900m short of the funds it needs to balance its books while maintaining the same level of care for patients.||Full Draft Published||Cheshire & Merseyside Draft STP submission - October 2016||£908 million (does not include social care)||£1.9m (assuming roughly £190m of STF funding)||YES||Acute||CM plan indicated there is "a need for C&M to undertake an STP wide review of clinical services, to reduce variation and determine future options for hospital configuration. Through taking a pan-C&M approach we can reduce unwarranted variation and improve quality". Plan goes on to say "A first step will be to identify how acute care is performing under its current configuration"||The Alliance LDS has a Maternity Services Review work stream where "Alignment with Vanguard Proposals for a single service" will be delivered||"A C&M Mental Health Programme Board will be established to oversee nine work streams to facilitate delivery" of key objectives||"Investment in improving the resilience of services delivered outside of hospital settings (primary care, social care, community care, mental health) is essential for us to transform our system and move towards both lower cost and higher quality care delivery."||The Cheshire and Wirral LDS has a project called - "Development of common approach to IPC (inc. management of multi drug resistant organisms) and medicines management/ creation of single pathology service/ creation of single radiology service/ cessation of procedures of limited clinical value"||The Cheshire and Wirral LDS has a diabetes programme that aims to "Implement at scale a national evidence-based diabetes prevention programme capable of reducing not only the incidence of Type 2 diabetes but also the incidence of complications associated with Type 2 diabetes; heart, stroke, kidney, eye and foot problems."||The Cheshire and Wirral plan includes a Cheshire and Wirral Cancer Strategy. The strategy includes "reconfiguration of complex surgical and non-surgical cancer services" and "reconfiguration and rationalisation of the number and function of MDTs."||One of the objectives of the STP mental health section is to "Maintain a dementia diagnosis rate of at least two thirds of estimated local prevalence, and have due regard to the forthcoming NHS implementation guidance on dementia focusing on post-diagnostic care and support."|
|Cheshire & Wirral plans propose "Remapping of ECT elective and emergency care models" including "ED [Macclesfield Hospital’s A&E] downgraded to MIIU staffed by GPs" (MIIU = minor injury and illness unit)||Primary care transformation project - "Transformation of primary care aligned to the GP Forward View and forming an essential component of the Community Model of Care"||One of the mental health projects is Dementia Care - "Increase dementia diagnosis rates & create dementia-friendly health & care settings"|
|"We recognise the current acute configuration within this footprint is unsustainable"|
|The North Mersey LDS discusses the leaked plans to merge up to four hospitals (see BBC story - http://www.bbc.co.uk/news/uk-england-merseyside-37339549). The plan doesn't go into more detail than already reported (including "site rationalisation across 4 to 5 hospital sites in the city") but does lay out a five year time line|
|Some elements of the plan are not finalised and present options. For example the Alliance LDS lays out three potential options for Urgent Care, ranging from 3 trusts with a Type 1 24 hours A&E to 1 trust with a 24 hour A&E.|
|By the end of November 2016 the Cheshire and Wirral LDS plan to have "Confirmation of preferred hospital and service reconfiguration option"|
|Elective services||"Ward closures based on reductions in DTOC" (Delayed transfer of care)|
|Paediatric||The Alliance LDS lays out options for paediatric services including - "Move from 3x level 2 units to: 2x high acuity units & 1 lower acuity unit or 1x high acuity units & 2 lower acuity unit or Higher and Lower levels of Acuity"|
|Cornwall and the Isles of Scilly||W/c 5/12/16||By 2021, the health system in Cornwall and the Isles of Scilly, is projected to be £264m short of the funds it needs to balance its books while maintaining the same level of care for patients. The plans provide little detail, but says that the number of community hospitals may be reduced.||Final plan||Final plan||£277 million||£264 million||Yes||Beds||"Better community and home care should mean less need for community hospital beds and sites so we may reduce these over time, particularly if they need major financial investment."||"For adults, we want to increase access to psychological therapies; expand job opportunities for people with mental health problems, learning disabilities or long term conditions; join forces with employers to create healthy workplaces; and vitally build more aff ordable homes alongside making homes warmer and safer."||"We want joined up care teams in the community, linked to GP practices. Alongside this we want to expand the roles of community pharmacists, practice nurses, health care assistants, therapists and other primary care practitioners to enable GPs to use their expertise in the most eff ective way."||"We want to implement a national prevention programme for diabetes patients, standardise care across GP practices to avoid complications and use technology more to review patients and avoid the need for outpatient appointments."||"Care professionals will work together on a range of conditions from mental health and learning disabilities to frailty, stroke and end of life care."||"Early and eff ective intervention on conditions such as diabetes, heart disease, stroke, cancer, joint problems and dementia - including better use of technology."||"Early and eff ective intervention on conditions such as diabetes, heart disease, stroke, cancer, joint problems and dementia - including better use of technology."||"Rationalise our estate to make best use of the sites we have and releasing money where we can for direct patient care."|
|http://www.cornwallfoundationtrust.nhs.uk/DocumentsLibrary/CornwallFoundationTrust/AboutTheTrust/ConsultationAndInvolvement/CornwallAndIslesOfScillySTPAprilSubmission.pdf||community hospitals||"To support GPs and community teams we want to adapt community hospitals so that they become community hubs which offer multiple services and prevent or reduce acute hospital visits. This may mean a reduction in sites and concentrating services in better locations because we expect changes in community services to reduce the need for community hospital beds."||"Better support and opportunities for people with mental health problems and long term conditions."||"We want to have one plan for our public sector estate to use our buildings and sites in the most cost eff ective and eff icient way that will enhance care. Some of our buildings are old, tired and not fit for purpose or in other cases new, expensive and underused."|
|Coventry and Warwickshire||W/C 12 December 2016||By 2021, the health system in Coventry and Warwickshire, is projected to be £300m short of the funds it needs to balance its books while maintaining the same level of care for patients. The plans provide little detail, but says that maternity services will be reconfigured to "realise financial savings" and that acute services may be reconfigured. In the past in the NHS reconfiguration has meant cuts.||Final draft plan||Final plan||£300 million (£267 million NHS only)||Small surplus||Yes||Acute services||"Review land and site utilisation for University Hospitals Coventry & Warwickshire, South Warwickshire FT and George Elliot sites for potential reconfiguration and rationalisation"||"Service reconfiguration to meet national/local review recommendations and bring ongoing sustainability" and "Realise financial savings"||"Embed public health and mental health within all our transformation programmes"||"A primary care development workstream will focus on developing GP services at scale and pace closely aligned to other STP activity to facilitate transfer activity from hospitals into care closer to home."||"Potential targets for consolidation include pharmacy and pathology (building on existing work)"||"STP partners have submitted an expression of interest for the 2017 roll out of the National Diabetes Prevention Programme – decision awaited from NHS England"||"Build on previous and current Better Care Fund activity on improving the situation for citizens with learning disabilities, particularly in moving those who are receiving care out of the area into appropriate care closer to their family and friends."||"Given its significance, we are going to treat Cancer services as a completely separate wave of clinical pathway review from other specialties. This will mean that we can start to make improvements in our cancer services earlier than otherwise."||Examples / case studies - "Implemented a care navigator programme in south Warwickshire for older people and those with dementia, to support and empower patients and their carers to take more control and enable better understanding of services available in the health and care system"||"Consolidation of estate and making best use of existing estate"|
|Acute services||"Lack of sufficient capital to respond to agreed changes (e.g. right-sizing of UHCW A&E)"||"We consider public health and mental health to be key parts of our “people focussed” transformation workstreams (Proactive & Preventative Care, Urgent & Emergency Care, Planned Care, Maternity & Paediatrics)."||"Integrated Neighbourhood teams established in Coventry, city wide, to support frailty patients aligned to GP clusters, involving MDT working (Primary Care, 3rd Sector, Mental Health and Community services)"|
|Acute services||"Standardised single point of access with timely redirection to most appropriate care"|
|Acute services||"Challenges associated with acute provider network development and potential reconfiguration decisions"|
|Derbyshire||w/c 14 November 2016||The plan states that by 2021 Derbyshire will be £355m short of the money it needs to balance its books while maintaining the same level of care for patients. To meet this challenge, there are ambitious plans to shift care into the community allowing the region to close up to 12 fewer acute wards in Derbyshire (nearly 500 acute beds); 4-5 fewer community wards; 1-2 fewer specialist Mental Health wards and one fewer dementia care wards.||Full Draft Published||Derbyshire STP||£355 million (specific wording in STP: "by 2021 there will be a £219m financial gap for Derbyshire’s health system – with an extra £136m gap for local authority care costs if organisations carry on working as they do currently, and people use services as they do today")||Urgent care||STP identifies transforming urgent care as one of its 5 priorities: "Transforming urgent care provides our single greatest opportunity to address fragmentation and unwarranted variation". Plan also indicates that by 2020 there will be a "Reconfiguration of ‘front doors’ to the hospitals"||As part of plans to "develop a coordinated Urgent Care Network across Derbyshire" plan states that for Mental Health Urgent Care "Effective Place of Safety is delivered through the Mental Health Urgent Care Hubs that are staffed 24/7, located at acute hospital sites with appropriate areas for assessment located within the UCCs. Rapid assessment and diagnosis by the MH Liaison team (RAID) and dementia rapid response team, alongside crisis and home treatment services prevent unnecessary admissions to hospital."||As part of plans to "develop a coordinated Urgent Care Network across Derbyshire" STP states that "Groups of local practices and other providers collaborate within ‘place’ to deliver improved ‘in-hours’ and extended access, with the appropriate balance of pre-bookable, same day and urgent appointments to meet local urgent care needs, thus improving urgent access to primary care"||Plan states: "We know our health system is inefficient in a number of ways, and therefore improved efficiency must be a key part of our plan" - with resepct to pathology specifically, the plan states the area can " Align and optimise clinical support services with a specific focus of diagnostics and pathology"||Plan states "transformation work is also underway in a number of other areas that will make a vital contribution to our overall reshaping of the system". In the context of cancer transformation, the STP states the following but does not give any specific details:|
"• Development of integrated clinical care pathways
• Redesign access to the Acute Oncology Service in line with Urgent Care redesign
• Redesign access to primary and community care in place
• Develop integrated services for palliative and end of life care
• Development diagnostic capability and capacity
• To attract, develop and train a workforce to address capacity deficits"
|Plan states "The development of place-based care and the greater integration of services and organisations will require - l ess bed-based care: c.12 fewer acute wards in Derbyshire; c.4-5 fewer community wards; 1-2 fewer specialist MH & 1 fewer dementia care wards"||"Estates and facilities management" listed under the section on "System Efficiency". Specific interventions include: |
• Community hospital/facility rationalisation
• Acute hospital (incl. PFI) optimisation
• CCG offices
• Technology to support agile working
• Shared estate functions
• Shared procurement of revenue/capital items"
|Plan states that delivering the STP will help the area to "significanlty change the 'shape of the system", which includes a "£247m more care delivered through Place (growing from 30% to 39% of all care delivered) and a reduction in care delivered in specialist settings"||Redesign Access to Primary Care – including to deliver the aims and key elements of the ‘GP Forward View’: |
• Deliver primary care at scale
• Support and grow the primary care workforce
• Improve access to general practice in and out of hours
• Transform the way technology is deployed and infrastructure utilised • Better manage workload and redesign how care is provided
|Rationalise and optimise estate|
|reduction in hospital beds||Derbyshire STP states that: "Investing in place-based care will enable us to reduce our bed-based care significantly". Timeline changes appears to be: |
• March 2018: 200 fewer beds - Acute 130; 2 RDH + 2 CRH; MH - 20 dementia care); community beds - 50 BCCH)
• March 19: 300 fewer beds: Acute (+ 50; 1 RDH + 1 other); MH (+33 Adult MH); community beds (+20 South)
•2021: c.400 fewer acute NEL (RDH 188, CRH 112, out of area 100), c. 85 fewer community hospital, c. 50 fewer MH
Derbyshire STP also outlines rational for bed reductions, largely that many inpatient beds could be better utilised in alternative settings, including:
"• Acute NEL(non-elective) bed reduction against baseline = 30%; evidence suggests c.50% of acute NEL bed days could be treated in alternative settings
• Community hospital bed reduction against baseline = 40%; evidence suggests c.60% of community hospital bed days could be treated in alternative settings
• Adult mental health bed reduction against baseline = 18%; evidence suggests c.33% of adult mental health bed days could be treated in alternative settings
• OP/Dementia bed reduction against baseline = 40%; evidence suggests c.75% of dementia bed days could be treated in an alternative setting"
|"Inefficient use of estate. The fragmentation of our services and organisations means that our estate is under-utilised. This means that building costs are higher than they need to be, opportunities for improving efficiency through effective co-location are missed, and some services could be provided much closer to patients if our building utilisation were coordinated centrally around people’s needs"|
|urgent care||Plan states: "Our redesigned Urgent Care network will be fully integrated with place-based care. Urgent Care pathways across acute, community and mental health settings will interface with place-based care through a 24/7 clinical assessment, advice and treatment hub. An enhanced directory of service and 111 service will support patients to access the most appropriate urgent and on the day care delivered 7 days a week. Our local interventions are focussed around the following seven initiatives"|
Some of the initiatives include:
|acute services||"Across Derbyshire we plan to invest in place based care to deliver joint health and social care reactive integrated care services which are integrated with our acute urgent care services". One of the impacts of reforms to urgent care services is that by 2021 there will be"482 fewer health care beds required"|
|With respect to "Physical configuration of services" the STP states that the "developmentof place-based care and the greater integration of services and organisations" will require: |
• The development of place-based ‘community hubs / networks’ – aligned to local service needs (e.g. urban/rural) – fully integrated with Primary Care.
This will mean, in some places, the reconfiguration / redevelopment of community (health and LA) and primary care facilities, and that MIUs/WICs will not exist as standalone services.
• Less bed-based care: c.12 fewer acute wards in Derbyshire; c.4-5 fewer community wards; 1-2 fewer specialist MH & 1 fewer dementia care wards).
• Some of the community hospital sites may not be required; others will play a key role within community hubs.
• The development of co-located Urgent Care centres at ED sites.
• Rationalisation of back-office facilities"
|Devon||w/c 31 October 2016||The Devon STP suggests that there may need to be service reconfiguration affecting maternity services and hospital beds. Historically, in the NHS 'reconfiguration' has meant closures. Devon's STP indicates that "maternity [services] are not clinically or financially sustainable in the long term without changes to the way they are delivered". This could mean maternity services will be cut or downgraded||Full Draft Published||Devon STP submission - October 2016||£384 million||Yes||mental health, acute and specialist services||"Engage, design and consult on reconfigured new models of care for mental health, acute and specialist services to secure clinically sustainable services, reduce duplication and variation and improve user experience"||Devon STP indicates that "maternity [services] are not clinically or financially sustainable in the longterm without changes to the way they are delivered across Wider Devon"||Mental health and learning disabilities is identified as one of Devon STP's priority area. Plan indicates that the "The initial proposals below will be further developed and extended over time to make sure they achieve our key objectives". On mental health and learning disabilities specifically the plan states: Ensure our services meet local needs; Maximise the effectiveness of mental health spending to achieve better outcomes; improve mental illness prevention in primary care; Improve provision for people with severe, long term mental illness and those who also have physical health problems"||"Developing integrated GP/primary care; Delivering the GP forward view; Supporting general practice development to be fit for the future; Work towards delegated commissioning"||Diabetes is identified as key area to be developed as part of Devon STPs prevention programme||On cancer, Devon STP indicates "We will also work in conjunction with national and regional service networking arrangements to develop, share and implement best practice and align our plans as appropriate across neighbouring STP areas – for example, Cancer Alliance"||Devon STP identifies a strategic plan for estates "Provide a transformed and innovative estate portfolio which delivers excellent quality, maintained and economical buildings and facilities which are efficient and responsive to the changing needs of the new model of care population and local communities of Devon"|
|"Reduce over-reliance on use of hospital beds to release around £90m"||Plan indicates that "Maternity/Paediatrics/ Neonatal service review" will take place as part of the review of acute hospital and specialist services||IN outlining the need for change the Devon STP states "Almost a quarter of local GPs plan to leave the NHS in 5 years and there are significant pressures on primary care services"||Devon STP will also "make use of capital received from disposal of assets for system wide re-investment in new buildings to support the reconfigured service model"|
|yes||closure of community hospital||"In South Devon & Torbay implementation of the care model as set out in the Integrated Care organisation (ICO) business case is pushing ahead with consultation on community services transformation including proposals for closure of four community hospitals. This started in September 2016"|
|"The changes we are proposing will result in a significant reduction in the number of acute and community beds needed across wider Devon"|
|maternity||Devon STP indicates that "maternity [services] are not clinically or financially sustainable in the long|
term without changes to the way they are delivered across Wider Devon"
|Dorset||w/c 31 October 2016||By 2021, the health and social care system in Dorset will be nearly £230m short of the funds it needs to balance its books. The published Dorset STP confirms a plan to cut around 240 hospital beds and also says there will be a reduction in the number of GP sites across Dorset but reveals very few details about what this means for local people.||Full Draft Published||Dorset STP submission - October 2016||£190 million (NHS only inc. specialised commissioning)||£229 million (NHS only inc. specialised commissioning)||Yes||acute||Dorset STP states: "As a result of the proposed One Acute Network we expect the bed capacity in Dorset to reduce to around an estimated 1,570 beds, from a level of 1,810 in 2013/14. The major change will result from shifting beds to the planned Major Emergency Hospital and a reduced number being required at the Major Planned Hospital"||Dorset STP states it has "ambitious plans to improve the maternity and paediatric services that are delivered in our acute hospitals and in the community." This includes offering a "larger and higher quality range of services in the community to reduce the need for local people to have to attend hospital". Plan states that for pregnant women, "we will increase the provision of midwife-led care across the county"||"We are committed to tackling mental health with the same energy and priority as we have tackled physical illness in order to deliver ‘parity of esteem’ in line with the Five Year Forward View for Mental Health"||Dorset STP includes proposal to introduce community hubs which are "expected to be supported by strengthened networks of GP practices, offering patients a wider range of universal and more specialist services, including urgent care seven days a week"||Dorset aims to find provider efficiencies - pathology services are identified as one of the areas where efficiencies will be found. The Dorset STP does not provide any details about how pathology services will be reformed||Dorset STP includes a proposal to create "Integrated Community Services". One of the priorities for this service is to "improve personalised care for people with complex needs, including individuals with learning disabilities"||"Establish single acute networks for services such as cancer, heart disease and stroke, so that consistent services are provided for people across Dorset"||"We have also started a Dementia Services Review jointly with our local authority partners this year, in support of our commitment to the 2020 NHS Mandate goals for dementia care. This will include looking closely at how to improve the time it takes to access a diagnostic assessment and post diagnostic support, our inpatient services and specialist dementia intermediate care. We expect to identify opportunities to deliver more services to reduce social isolation that could be provided from the proposed community hubs."||Dorset plan states there is "scope to utilise our resources and estate much more efficiently"|
|district general hospitals||Dorset STP states that "plan is to reconfigure the organisation of our existing three district general hospitals into three centres of excellence with better defined and more specialist roles". Plan goes on to say: "CCG is planning to consult the public on two options for reconfiguring Poole Hospital and Royal Bournemouth Hospital"||"We will reorganise hospital based care by implementing the Royal College review recommendation to consider 'by exploringthe integration of services between Dorset County Hospital and Yeovil District Hospital such that there could be one site delivering consultant led obstetric care and one site with a midwifery led unit"||As part of the "integrated community services programme reconfiguration" the Dorset STP states it will be: "reviewing the proposed options for how the public sector estate across Dorset could be better organised to deliver community services by considering value for money, capital requirements, feasibility and deliverability"|
|GP sites||Dorset STP suggests that "a reduction in the number of GP sites and development of community hubs will allow more services to be consistently and efficiently delivered across the country"|
|community hospitals||"plans for expanded integrated teams could deliver more and better services from a fewer number of sites than the 13 community hospitals with beds"|
|Durham, Darlington and Tees, Hambleton, Richmondshire and Whitby||w/c 24 October 2016||The Durham, Darlington and Tees, Hambleton, Richmondshire and Whitby STP includes plans to explore an "acute hospital reconfiguration". Options being considered include the consolidation of A&E, acute medicine and acute surgery onto two sites which could mean closing hospital beds or hospital wards. They have indicated that there are workforce challenges - in other words, not enough staff - facing services, including maternity services.||YES||DDTHRW October Submission||unclear||£281 million (NHS only, unclear if this includes specialised services)||Bed closure - yes; Service reconfiguration - yes||Learning disability, fraily and elderly, acute services||Delivery plan includes "Acute Hospital Reconfiguration" - plan indicates that reconfiguration is being driven by workforce challenges. Consolidation of A&E, Acute Surgery and Acute Medicine, including:|
Consolidation of A&E departments on to two sites
Consolidation of Acute Medicine onto two site
Consolidation of Acute Surgery onto two sites - ; on frail and elderly beds, the plans states: "Reduce frail elderly bed days by 20% over the next five years"
|Plan identifies workforce concerns: "Insufficient workforce to safely operate current numbers of sites i.e. maternity". Plan indicates there will be consolidation across sites for obstetrics, paediatrics and NICU|
• Consolidation of obstetrics
• Consolidation of paediatrics services
• Consolidation on NICU
|"Mental health is everywhere and the health needs of our population are increasing. We are looking to build high quality services and a highly skilled workforce that not only delivers value for money and are financially sustainable, but that provide more of our population with early interventions and increased access to treatment across all of our communities"||STP vision is for a "new style of primary care intervention is delivered through integrated primary care teams". Ambition includes increase in workforce (GPs and non-GPs), primary care delivered at scale through hubs and better collaboration between practices. Plan notes that "access to and utilisation of Estates and Technology Transformation Funding" is key determinant to delivering primary care plans||"Pathology Collaboration: Consolidation of pathology services"||On Learning Disabilities, STP Action includes: "Co-production of new service model, Agree and implement bed closures, Agree financial flows". Plan states that "This vision was developed by all partners and stakeholders, including people with a learning disability, families and carers"||Plan outlines a vision to improve cancer services across the footprint - and ensure that footprint acheives cancer wait times and improves survival outcomes. In the short term this includes increasing cancer prevention pathways (eg smoking cessation programmes), diagnosing more cancers earlier (for instance by increasing cancer diagnostic capacity)||"Continued focus on memory clinics and cross system dementia care services to ensure maintenance of diagnosis rate and effective post diagnosis support" and "Implement enhanced system wide dementia support"||"Estates is an enabler for the STP to deliver its service ambitions and close the financial gap" "Improved utilisation of core estate and rationalisation and disposal of older not fit for purpose buildings to reduce poor quality accommodation; eliminate backlog maintenance; void and excess running costs and facilities. This will allow us to maximise existing identified core sites and buildings through increasing occupancy and utilisation. Through current estates strategies we will ensure the retained estate is energy efficient and properly maintained"|
|Frimley Health||w/c 21 November 2016||By 2021, the health and social care system in Frimley Health footprint is projected to be £236m short of the funds it needs to balance its books while maintaining the same level of care for patients. The STP states that one of the area's priorities over the next 5 years is "redesigning urgent and emergency care, including integrated working and primary care models providing timely care in the most appropriate place". However the plan offers very limited information about how this "redesigned" service will affect the service patients receive.||Full Draft Published||http://www.surreyheathccg.nhs.uk/policies/stp/811-frimley-stp-oct-submission-for-publication||£248 million||£236 million (includes NHS and social care)||£7 million||urgent and emergency care||Plan states that one of the area's priorities for the next 5 years is "Redesigning urgent and emergency care, including integrated working and primary care models providing timely care in the most appropriate place". Plan offers very limited information about how the U&EC will be "redesigned" - no mention of site closures or bed closures is made. Reveiw of plan suggests that part of the redesign of U&EC services will largely be built around strengthening primary care / GP services, and streamlining the urgent care system so patients are seen/discharged quicker||Plan implies there will be an investment in maternity services "Deliver significant capital investment and reconfiguration of acute estate to transform elective care at Heatherwood Hospital and the emergency and maternity departments at Wexham Park Hospital to improve productivity and the quality of care"||"The Frimley Health and Care STP places a strong focus on supporting good mental health and physical health and will support the delivery of the Five Year Forward View for Mental Health and our local transforming care plans for people with learning disabilities. The delivery of the STP requires mental health and learning disabilities to be integrated throughout the plan and this has been embedded in each workstream"||One of the initiatives the Frimley Health STP footprint will focus on in 16/17 - 17/18 is "Lay foundations for a new model of general practice provided at scale, including development of GP federations to improve resilience and capacity"||Plan identifies a roadmap for helping people to take responsibility for their own care. One of the programmes under this workstream is "Development of a project to increase referrals to the National Diabetes Prevention Programme" - this will see the design of a pilot for testing out "high impact interventions". Pilot likely to be run 17/18||As it relates to primary care/GPs, the plan outlines its approach to learning disabilities: "Integration of mental health practitioners in extended primary care teams; including Clinician to clinician video consultation , redesigned mental health practitioner roles, expanding talking therapies for long term condition use, and developing integrated physical mental health and learning disabilities pathways within primary care"||Plan states that there will be investment in cancer services "A new multi-million pound radiotherapy centre built on the Wexham Park Hospital site will reduce travel times for local cancer patients"||Estates is identified as an 'enabler': "Purpose: to deliver an efficient and fit for purpose estate infrastructure across the STP footprint that|
supports delivery of the seven initiatives and new care models"
|Plan states that "We are not planning for any significant change in physical acute capacity (beds) but existing capacity needs to be redesigned to be used much more productively"||IN the context of primary care, the plan outlines its approach to mental health "Integration of mental health practitioners in extended primary care teams; including Clinician to clinician video consultation , redesigned mental health practitioner roles, expanding talking therapies for long term condition use, and developing integrated physical mental health and learning disabilities pathways within primary care"||the "take responsibility for their own health" workstream states the following: "Year 1 and Year 2 priorities will be tobacco cessation in elective care, early cardiac detection, diabetes and physical inactivity utilising digital technology via a patient portal and nudge techniques as part of these programmes". One of the deliverables of this programme is: "Roll out of national diabetes prevention programme"||On the need to improve LD services, the plan states: "20% of our population has one long term condition (LTCs), 9% have two and 10% have more than two. Our aim is to improve the management of LTCs before they get to a stage where they are complex and multiple. We want to improve the care and outcomes for people with these conditions and to avoid or delay them acquiring more. We know that there is a particular need to make improvements for people with severe mental health, learning disability and acquired brain injury.||Estate priorities include:|
• Combining the One Public Estate work across the STP footprint to make optimal use of the estate and deliver co-location of services that improve integration of care and support and efficiency. Considering local options across the public sector for a shared approach to property maintenance and management.
• Securing a local agreement about the use of benefits from disposals and their support to develop our new care models
• Achieve a greater collective influence on NHS Property Services to prioritise the estate improvements required to deliver our STP – many of which are not fit for purpose.
• Address the immediate estate constraints in primary care to ensure it is fit for purpose. This will include:
• Refurbishing buildings where they don’t meet standards
• Investing in new accommodation that expands the range of services and delivers new care models
• Delivering co-location options
• Identify locations for and develop integrated care decision making hubs across all localities by the end of 2018"
|Investment in Wexham Park Hospital, including new emergency and maternity departments, and radiotherapy centre for cancer patients|
"£130 million will be invested to bring the NHS up-to-date, including replacing the old Heatherwood Hospital in Ascot with a purpose built new hospital for operations such as hip and knee replacement, upgrading the Emergency Department and maternity unit at Wexham Park Hospital."
|Gloucestershire||w/c 7 November 2016||There are plans in Gloucestershire to reduce the costs of dementia care and make £8m worth of savings in pathology services. The Gloucestershire STP also outlines a proposal to redesign the area's models of care in order to "reduce the reliance on inpatient care". This could mean cuts to inpatient beds.||Final Draft Submission||Final draft submission||not found||£226 million (inc. NHS, social care and specialised commissioining)||not found||YES||urgent care||Plan states that by 2017 areas will have "Completed an evidence-based proposal to reshape Urgent Care Pathways within Gloucestershire across hospital and community based services for engagement with our local community. This will start to inform our thinking on a whole county bed model to make best use of resources available across our county and support delivery of 7 day services"||Plan indicates that by 2017 the area will have developed an "integrated specialist perinatal health service comprising of specialist maternity"||Mental Health is identified as one of the "Specific Improvement Opportunities – Cost and Quality" - the plans states: "Mental health problems: psychosis pathway, Improving Access to Psychological Therapies (IAPT) Pathway and reducing need for out of area treatments"||On primary care by 2017 plan states it will have "Agreed our emerging model of 16 GP cluster groups, supporting these to integrate and develop new ways of working, such as developing shared clinical and pharmaceutical policies and back of ce functions such as shared telephony"||Plan identifies pathology as on of the areas where there is clinical variation: "Opportunities have also been identified in diagnostics, pathology, variation in care setting and in primary care practice, these are estimated to be able to deliver c£8m"||On diabetes the area will be focusing on diabetes as part of the Yr 2 activity of the pathway redesign programme "systematically redesign the way care is delivered in our system by reorganising care pathways and delivery systems"||Cancer is identified as one of the "Specific Improvement Opportunities – Cost and Quality" - the plans states: "Cancer and tumours: increasing detection of breast cancer at an early stage, increasing screening uptake, improving mortality, increasing lung cancer detection"||Plan states that dementia is one of the yr 1 priorities of the "Clinical Programme Approach" that is being rolled out. This programme will see people across the STP footprint "work together across our system to redesign pathways of care". As part of this programme on dementia, "pathways of care will be designed to maximise delivery locally, (utilising the full range of assets in a community, including technology) reducing the dependency on hospital based care, and reducing costs in the system overall"||Plan has pulled together a "Joint Estates Strategy" with partners drawn from "County and District Councils, Police, Fire Service, Ambulance Service, Gloucestershire NHS Foundation Trust, Gloucestershire Care Services and the 2Gether Trust have set up a ‘One Gloucestershire Estates’ initiative. This group has mapped information on all assets held by all organisations as well as collecting and sharing capacity and usage data. Many opportunities have already been taken to rationalise land and buildings as well as implementing some colocation models/public sector hubs"|
|specialised services||"Continue to bring together specialist services and resources where possible. We will also reduce the reliance on inpatient care (and consequently the need for bed based services) across our system by redesigning our models of care in order to provide services more ef ciently and effectively in future"||Plans outlines the approach to maternity services: "Improving the experience of our maternity services and the ndings of the National Maternity Services Review: Better Births (2016) continue to be key drivers in our approach to improving maternity services in Gloucestershire. Our resulting action plan has seen the revised pathway for unscheduled care for maternity services and highlighted postnatal care as a key area of focus for improvement locally"||"Joint Estates Strategy" indicates that one of the early ambitions is to: "Dispose of surplus estate to generate capital receipts for reinvestment"|
|Greater Manchester||w/c 14 November 2016||By 2021, the health and social care system in Greater Manchester is projected to be over £1bn short of the funds it needs to balance its books while maintaining the same level of care for patients. Greater Manchester's STP outlines plans to redesign a number of clinical areas, including paediatrics, maternity and obstetrics but does not give any details about what this redesign means or how local people will be affected.||Implementation Plan||GM Implementation Plan||£1,073.000 (incldes health and social care)||£14 million (does not include social care)||GM identifies "Standardising acute and specialist services to the best evidence" as one of its "Transformation Themes"|
With respect to acute and specialist services, the GM plan states: "Hospitals across GM are working together across a range of clinical services to respond to the way care is being transformed in localities; to deliver seven day services; and to standardise and improve the quality, safety and efficiency of patient care, so that everyone in GM can benefit equally from the same high standards that are already provided in some of our hospitals."
This programme of transformation has 3 main pillars:
"• Specialised services and the delivery of IOG compliance.
• Healthier Together implementation. The sector business will be completed by December 2016 and the transfer of high risk elective patients to Hub sites as defined in the agreed models of care will commence in April 2017.
• The development of GM clinical redesign priority areas. The identification and prioritisation of 8 clinical areas (paediatrics, maternity and obstetrics, respiratory and cardiology, MSK and Orthopaedics, breast, urology, neuro-rehabilitation and vascular) has been undertaken. Project initiation documents and the cases for change are in development"
|One of the GM clinical redesign priority areas is "paediatrics, maternity and obstetrics"||Greater Manchester is developing a primary care strategy which is based on: |
"- People powered changes in health and behaviour - Creating a primary care system that more proactively supports people and communities to take charge - and responsibility for managing their own health and wellbeing, whether they are well or ill.
- Population based models of care - Strengthening wider primary care provision to pro-actively manage patients in the community and see the shift in people attending hospital who could be better supported in the community centred, accessible, inclusive and results in the best possible outcome for the individual
- Consistently high quality care- Ensuring high-quality care that is safe, effective, person-centred accessible, inclusive and results in the best possible outcome for the individual"
|GM plan identifies "Standardising back office and support functions" as one of its transformation themes. The plan states that "Changes are already happening locally, but we will continue to explore how we can share ideas, ways of working, buildings, technology, research and development and training -making sure standards are consistent and high across GM, as well as saving money". |
STP goes on to state that "The main sections of this programme of work are structured around 5 pillars: Procurement, Hospital pharmacy, Pathology, Radiology and Corporate functions" and that "For pathology and radiology a baseline data collection exercise is in progress to inform the next steps for the programme"
|GM's ambition for Learning Disabilities and Autism services is predicated on four key objectives: |
- Improving in / out reach intensive support
- Expansion of community based accommodation
- 60%+ reduction in non-secure beds
- 40%+ Reduction in the number of secure commissioned beds
|"Cancer Vanguard - to develop new GM wide social marketing strategies for cancer to upscale prevention and earlier intervention, apply a multi-faceted approach to nurture a social movement across the entire cancer prevention spectrum, to improve access to and uptake of three national cancer screening programmes (bowel, breast, and cervical) among the eligible population of GM residents and tailor preventative approaches to reduce the chance of secondary cancer"||"The GM Strategic Plan will require a reconfiguration of the health and social care estate to ensure we can deliver our vision from a property base that is fit for purpose in terms of location, configuration and specification"|
|"Manchester are developing proposals for the Single Hospital Service in Manchester, ensuring that key stakeholders were engaged and involved in the process of identifying the implications of a single hospital service model" - although the details are not outlined in the STP, this proposal refers to plans to merge three of GMs hospitals so they come under the same management.||"The GM Cancer Vanguard projects relating to reforming the commissioning landscape and the effective use of cancer budgets are addressing services to be commissioned and provided at GM, sector and locality level and the mechanisms to incentivise prevention and early detection / diagnosis of cancer, with the dual aims of reducing the incidence of cancer and improving cancer survival. This work includes making proposals for the establishment of an Accountable Cancer Network (ACN) that will be responsible for ensuring the delivery of the plan"||GM Plan identifies a number of "Estates Targeted Outcomes", including:|
"- Provide increased economic and social value through the re-use of surplus land and property for housing and employment opportunities
- Rationalise the surplus estate
- Use property as a catalyst for service transformation and integration
- Efficient management and utilisation of the public estate to reduce total property running costs"
|Hampshire and the Isle of Wight||w/c 21 November 2016||By 2021, the health and social care system in Hampshire and the Isle of White will be nearly £600m short of the funds it needs to balance its books. The published Hampshire and Isle of White STP plans to cut 300 hospital beds as well as reducing the estate footprint by 20%. It also plans to "reconfigure unsustainable acute services" to help make over £200m efficiency savings in the acute sector.||Final draft||http://www.isleofwightccg.nhs.uk/HIOW STP Delivery Plan 21Oct16 FinalDraft.pdf||£194.7 million (a recent news article reported that the STP have been told they are "highly unlikely" to receive this level of capital funding - https://www.hsj.co.uk/topics/finance-and-efficiency/exclusive-stp-told-its-capital-demand-highly-unlikely-to-be-met/7013098.article)||£540-610 million||£577 million NHS organisations + £192 million local council social care||0 (unclear from the plan how the social care deficit is being treated)||Yes||"Bed reductions"||"We will use our bed capacity more effectively, and will seek to generate 9% efficiency in our acute bed stock (worth c.300 beds)."||"We are implementing the national recommendations , including those in maternity services to improve outcomes and reduce variations in practice."||"We are committed to valuing mental and physical health equally to ensure that support for mental health is embedded holistically across the system and not seen in isolation in order to achieve parity of esteem."||"Extended primary care access and increased GP capacity to manage complex care due to improved skill-mix in wider workforce"||"A first wave of collaborative transformational supporting services projects will include: Back Office Services Review; Pathology consortia (re-visited); Theatre Capacity Review; Pharmacy collaboration; Estates/Capital ; and Out Patient Digital Services."||In 2017/18 - "National diabetes pathways fully implemented."||"We are making tangible improvements to mental health services for children and adults, and services for people with learning disabilities."||"The acute alliance support the objectives of the cancer alliance and are linking directly with relevant clinical service reviews and prevention projects, including increased screening uptake and delayering access to increase early diagnosis."||New models of integrated care - "Make health services more accessible and more effective for patients, improving both their experiences and the outcomes of their care and treatment. This could mean fewer trips to hospitals as cancer and dementia specialists hold clinics local surgeries, one point of call for family doctors, community nurses, social and mental health services, or access to blood tests, dialysis or even chemotherapy closer to home"||"Estate footprint reduced by 19% and estate costs reduced by £24m"|
|Acute services||"Acute hospital providers are working as an Alliance to reconfigure unsustainable acute services to improve outcomes and optimise the delivery for the population."||By the end of 2016/17 - "We will commission mental health services on an Alliance wide basis initially focussing on out of area placements and crisis response."||"We will develop a highly skilled integrated primary care workforce with a greater range of healthcare professionals including qualified nurses, allied health professionals and pharmacists, who are equipped with the skills and experience to work in integrated teams. We are developing a Community Provider Education Network to create the infrastructure needed to deliver a highly skilled multi-professional workforce to work alongside our GPs."|
|Acute services||Solent Acute Alliance. - "To deliver the highest quality, safe and sustainable acute services to southern Hampshire and the Isle of Wight. To improve outcomes, reduce clinical variation & cost through collaboration between UHS, PHT, IoW NHST & Lymington Hospital. Provide equity of access, highest quality, safe services for the population." Expect - "Efficiencies of £165m by 2020/21"|
|Herefordshire and Worcestershire||w/c 21 November 2016||The Herefordhsire and Worcestershire STP outlines plans to "remodel urgent care services" in the area, which may result in around half of the community hospital beds in Herefordshire and Worcestershire being cut. The STP also says it will "release" unwanted NHS property and land - this means selling NHS buildings and assets.||Final Draft Submission||Full draft plan||£229.6 million (does not include social care)||stroke services||One of the STP's priorities is " Establish clinically and financially sustainable services" . In the context of stroke services, the STP's "aim is to deliver a more consistent and resilient stroke service across the STP footprint". Two of the short-term goals for Worcestershire are: |
- "Agreement to the consolidation of community hospital beds providing inpatient stroke rehabilitation with seven day services.
- Agreement to the consolidation of community hospital beds providing inpatient stroke rehabilitation on one site ensuring maximum capacity available 7 days a week"
|Effecting improved outcomes for maternity services is a key priority. Headline proposals include:|
"• Implement the clinical model for maternity inpatient, new born and children’s services within Future of Acute Services in Worcestershire programme.
• Develop a jointly commissioned, jointly provided maternity service across the whole footprint delivering the Better Births strategy.
• Establish a single service with specialist teams working under a common management structure, delivered locally within both counties"
|In terms of improving mental health and learning disability care, the plan identifies the following actions:|
"- Increasing visibility, awareness and acceptability of mental health through a high profile Mental Health Cabinet
- Collaboration to deliver a range of care more locally at an STP/STP Plus Level
- Increasing access and availability of psychological therapy to 25% Develop early intervention services in line with national proposals Development of CAMHs community eating disorder services Development of perinatal mental health services
- Development of crisis care and 24/7 mental health urgent care services.
- Development of dementia services – with a focus on early intervention, strengthened VCS links and interface with frailty pathway Development of CAMHS emergency, urgent and routine pathways
- Development of acute mental health care – reduce the need for admissions out of area and the number of re-admissions Development of integrated mental health and physical health care pathways in line with MCP developments-- Development of personality disorder services
- Development of adult ADHD pathways subject to investment profile"
|Effecting "sustainable general practice" is identified as a key priority for the STP. On this, the STP states:|
"• Prioritise investment to ensure delivery of the General Practice Forward View – developing primary care at scale “bottom-up” with practices , community pharmacy, third sector and health and care services.
• Redesign the primary care workforce, sharing resources across primary and secondary care to provide resilience and sustainability as well as capacity.
• Adopt an anticipatory model of provision – with proactive identification, case management and an MDT approach for those at risk of ill-health.
• Share information across practices and other providers to enable seamless care.
• Moveto“big system management”– with real time datacollection and analysis providing the intelligence to support continuous quality improvement and demand management"
|"Explore the benefits from integration in pathology, radiology and pharmacy services across the footprint"||Plan outlines a "prevention" workstream. One of the elements is to introduce a "Lifestyle change programmes: focusing on obesity (diet and physical activity) smoking and alcohol harm reduction. National Diabetes Prevention programme rolled out across the footprint, as part of an integrated obesity strategy"||Under the banner of "Establish clinically and financially sustainable services", the STP outlines that "there is reduced expenditure in other programme areas, such as urgent care and complex care (ie CHC and social care packages) from the|
increased investment in mental health and learning disability service".
The area aims to
- With local authorities, develop joint outcomes and shared care for people with learning disabilities"
- Transforming care” for people with learning disabilities – to reduce the number of people accessing services out of area"
- Improving rates of access to or sustained education, training and or employment - for people with learning disabilities - reducing health inequalities"
|Cancer is identified as a "transformation" priority: "Establish sustainable services through development of the right networks and collaborations across and beyond the STP footprint to improve urgent care, cancer care, elective care, maternity services, specialist mental health and learning disability services."||STP is looking to develop "Dementia friendly communities – integrating with dementia services to provide dementia friends training and support for Dementia Alliances"|
|Elsewhere in the STP it states that "In addition to this [do nothing deficit], the financial modelling shows that the two local authorities combined have a “do nothing” gap of circa £84m that are being addressed through local efficiency savings alongside the STP– taking the system gap to £336.6m"||urgent care services||Plan states a need to "Improve urgent care pathways and out of hospital care models to improve access performance and create better outcomes, resulting in a requirement for fewer beds, reduced staffing and estate requirements."|
Plan goes on to state that delivering changes to urgent care will require a "Review of existing access points and with the potential consolidation onto fewer individual sites" and that "Whichever model is pursued, there will need to be access to the right number of hospital beds to support patient care needs", and "if partners can achieve the transformational changes that are sought in out of hospital and social care provision, there will be a significantly lower number of hospital beds required than there are now"
|The overall aim for the area in the context of maternity services is to "that our citizens have access to high quality, safe and sustainable, acute, women and newborn/neonatal and mental health services, localised where possible and centralised where necessary". THis is set against a backdrop of existing poor quality in the area "Within Worcestershire maternity services are temporarily suspended on the Redditch site and re-provided on the Worcester site due to the Trust not being able to recruit sufficient staff to provide clinically sustainable services across two sites. The Future of Acute Services at Hospitals in Worcestershire (FOASHW) is about to commence consultation on the permanent centralisation of these services on the Worcestershire Royal Site. This is a critical component of the clinical and financial sustainability of the Worcestershire service"||One of the programmes is to "Maximise efficiency and effectiveness" with "DIAGNOSTICS AND CLINICAL SUPPORT" a component of this. |
Programme articulates the following changes:
"There are critical changes to be pursued within the STP.
(1) Amalgamation of pathology laboratory services across the STP footprint and beyond and greater functional sharing and consolidation of infrastructure in other clinical support services such as radiology and pharmacy.
(2) Development of agreed system demand management strategies and delivery mechanisms, with the aim of eliminating unnecessary requests and reducing overall requested activity"
|Plan outlines the following steps for "improving mental health and learning disability care"||"Expand pan STP working on cancer services and deliver the requirements of the national taskforce"||Under the banner of "Establish clinically and financially sustainable services", the STP outlines the following appraoch for dementia:|
"- Strengthened management of people with dementia in acute urgent care systems and primary care at scale"
- Collaboration to deliver a range of care more locally at an STP/STP Plus level i.e. Improved access to CAMHs Tier 3.5 to reduce demand for Tier 4
CAMHS, Locked Rehabilitation, Complex Dementia services, eating disorder and personality disorder services"
|On estates, the proposal is to "Develop a place based estates strategy and a place based transport strategy"|
|bed closures||Plans to remodel urgent care services include the following projections:|
"The modelling, which is based on the agreed system assumptions shows the following:
• Herefordshire - The need for a +15% increase the number of acute beds in Herefordshire, but the potential for a reduction of -62% reduction in the number of community hospital beds.
• Worcestershire – There is potential for a small reduction in the number of acute beds and a -44% reduction in the number of community hospital and resource centre beds. In terms of acute beds, the main issue to address is location, with more beds required in Worcester but less required in Redditch. In addition to the community bed numbers, there is scope to reduce the number of NHS commissioned beds from the private care home sector from 86 in the base year to 9 in 2020/21
|Plan identifies the following deliverables for maternity services:|
"- Implement the clinical model for maternity inpatient, new born and children’s services within Future of Acute Services in Worcestershire programme.
- Develop a jointly commissioned, jointly provided maternity service across the whole footprint.
- Establish a single service with specialist teams working under a common management structure, delivered locally.
- Deliver the FOASW objectives for gynaecology"
|On pathology services specifically, the STP states the following:|
"• Early exploration of a consolidated service across both counties.
• Longer term plan to join forces with a larger regional provider or to explore the option of
developing a private sector partnership model"
|Under the banner of "Establish clinically and financially sustainable services", the STP outlines the following appraoch for cancer:|
"Life threatening conditions (cancer and others) -Increase funding to meet demographic pressures and increasing illness. Improve efficiency and reduce waste and waits across pathways and for all critical complex elective care, for clinical
sustainability and quality outcomes, we will concentrate provision in centres of excellence". The STP indicates that the following changes will be made:
"• As part of the Specialised Services Rural Pathfinder we expect to redefine existing pathways to be locally commissioned, repatriate some current pathways including renal, some cancers and cardiac care, working closely with regional specialised providers.
• Implement alternative models for cancer survivorship through remote monitoring and supporting patients in out of hospital environments"
|STP outlines an ambition to develop a "Single Place Based Estates Strategy – enabling co-location and service integration and the release of unwanted property and land. Careful consideration will be needed to see how the primary care estate can be included in this work given the different nature of ownership, financing and liability arrangements in place"|
|Hertfordshire and West Essex||W/c 19 December||By 2021, the health and social care system in Hertfordshire and West Essex is projected to be £548m short of the funds it needs to balance its books while maintaining the same level of care for patients. The plan is short of important detail on how it'll close the funding gap without cuts or closures to services but, through analysis carried out by the accountants KPMG and Deloitte, does identify where efficiency savings can be made through "changes in activity" and managing "demand for services differently".||Draft submission to regulators||http://www.healthierfuture.org.uk/sites/default/files/publications/2016/December/STP-submission-FINAL251116.pdf||West Hertfordshire NHS Trust Hospitals - £178 million, Princess Alexandra NHS Trust Hospital - £150 million||£234 million by 2019/2200 (Hertfordshire and West Essex combined)||£548 million (all organisations combined), £397 million (NHS only)||£5 million surplus||Yes||Beds||"Through reducing the volume of referrals into secondary care, we will also support colleagues working to transform acute service to release capacity and ‘right size’ their overall bed base to the changing demands of our population."||Some of the capital funds requested are for improvements to maternity services at both Princess Alexandra NHS Trust Hospital and West Hertfordshire NHS Trust Hospitals||"We aim to dramatically improve outcomes and life expectancy for people who have a mental illness and those with a learning disability. We will do this by providing outstanding care and services which make a positive difference to the lives of service users and their carers. To help achieve this, we have committed across the STP that mental health and learning disability services will be given the same emphasis as physical health in local care planning and delivery."||"The principles of our commissioning approach will be based on outcomes, best practice and value, and will focus on moving activity from acute to community and primary care. We will focus on the whole person, taking into consideration both their physical and mental health needs."||"In the STP, our main focus will be to support people to improve their health and wellbeing, and to live well with long-term conditions, including initiatives to prevent the consequences of some conditions, such as diabetes-related amputations and falls."||"Care will be provided whenever possible in people’s own homes and community settings, based on a single care plan delivered by an integrated, multidisciplinary team. Mental health and learning disability services will be part of the integrated teams, ensuring that an individual’s all-round health and care needs are met"||"Our vision for cancer services is to collaborate with local partners to deliver onesystem, patient centred, exceptional care for our patients. We provide a full range of cancer services that meet NICE guidelines, including a full range of diagnostic services, Clinical Nurse Specialist Service, acute oncology service supporting early diagnosis and supporting patients living with and beyond cancer through the Recovery Package"||"Improving dementia diagnosis and post diagnostic support"||"Each trust has significant issues with the quality of their estate including large areas of the clinical environment. The STP therefore includes the need for capital funding from each of the Trusts to mitigate the current problems and ensure the continued provision of clinical services on the existing sites into the future."|
|acute services||"Partnerships between East and North Hertfordshire NHS Trust and Princess Alexandra Hospital NHS Trust, and West Hertfordshire Hospitals NHS Trust and the Royal Free London NHS Foundation Trust, in order to support improved patient care, clinical and financial sustainability and deliver services more efficiently"||"Building on work that has been undertaken to date; we are focusing on the further development of integrated services wrapped around GP practices, developing place based care in neighbourhoods/localities. In doing so we will increase collaboration across services, reduce duplication, and will ensure that people only need to go to hospital when it is absolutely necessary."||"We have committed across the STP that mental health and learning disability services will be given the same emphasis as physical health in local care planning and delivery."||"The figures in the table are based on work carried out on our behalf by management consultancy firms KPMG and Deloitte to model changes in activity and manage demand for services differently."|
|Humber, Coast and Vale||w/c 21 November||By 2021, the health and social care system in the Humber, Coast and Vale is projected to be £420m short of the funds it needs to balance its books while maintaining the same level of care for patients. However, the plan is short of important detail on how it will close the funding gap without cuts or closures to services.||Full draft published||http://www.valeofyorkccg.nhs.uk/data/uploads/humber-coast-and-vale-sustainability-and-transformation-plan.pdf||£420 million||Specialist services||"There are plans to review complex rehabilitation services, paediatrics, neonatal intensive care and specialised orthopaedics over the next 5 years."||Explore the possibility of some hospital sites becoming lead providers for some cancers. For example a hospital may specialise in lung cancer from prevention through to post treatment.|
|Hospitals||The plan states that "the case for change sets out the reasons why the current level of hospital care cannot remain as it is now" with indications that there will be changes to North Lincolnshire and Goole Hospitals and Scarborough|
|Kent & Medway||w/c 21 November||By 2021, the health and social care system in the Kent and Medway is projected to be £486m short of the funds it needs to balance its books while maintaining the same level of care for patients. Its plan is proposing a 'hospital transformation' including a possible cut of 10% to the number of acute beds across the footprint area.||£486m (including social care)||£29m (associated to financial pressures that arise as a result of the Ebbsfleet Health New Town Development)||Yes||Acute care||Possible 10% reduction in acute beds, as a response to a range of measures including better discharge, limits to 3-9 day elective stays, and avoiding emergency admissions through more proactive and coordinated care||Plan highlights an ambition to 'Implement an estate efficiency savings programme through: optimising asset utilisation and occupancy; overall management of the estate; consolidation of support services; and realisation of surplus assets across the common estate.'|
|Lancashire and South Cumbria||w/c 14 November 2016||By 2021, the health and social care system in Lancashire and South Cumbria is projected to be £572m short of the funds it needs to balance its books while maintaining the same level of care for patients. However, the plan is short of important detail on how it'll close the funding gap without cuts or closures to services.||STP Plan||£160 million in order to develop new models of care, as well as STF funding to support transformaitonal activites of £21.7 million in 2017/18, £26.7 million in 2018/19 and £14.6 million in 2019/20.||£572 million||Acute / community hospital||"We will review the balance of acute physical & mental health care across hospital & community sites to ensure delivery of planned & emergency care at the clinically correct scale to generate consistent quality of care & optimal outcomes, making best use of scarce skills, maximising effectiveness of spend"||"Ensuring mental health needs are equal to physical health"||"Transformation of primary care as the nucleus of a personal, wellbeing, community based model of care"||"Those with Long Term Conditions such as COPD , Diabetes and Heart failure will benefit from structured education and support to help them to manage the own condition as effectively as possible."||"Achieve parity of esteem, as people with learning disabilities and/or autism have a shorter life expectancy than those who don’t"||"The evidence suggests that more specialised surgery, some cancer and other services could benefit from centralisation in centres of excellence with better outcomes for patients and fewer deaths. We will work to make sure people are given consistent access to the best possible specialist treatments. Creating these centres of excellence networked with local hospitals will help save more lives."||"Continue to meet a dementia diagnosis rate of at least two-thirds of the estimated number of people with dementia."||"Rationalisation of clinical support/general support services and back office functions."|
|Annex to STP plan||"A one service approach to our acute physical and mental health services to ensure specialties are delivered at the clinically correct scale within the necessary co-dependencies of related disciplines."||"We will focus primary care teams on systematic, evidence based secondary prevention to reduce the risk of further complication or deterioration in those already suffering from long term conditions."||"Constraints on capital are understood and the option of non-NHS sources will be examined carefully across the geography."|
|Leicester, Leicestershire and Rutland||w/c 21 November 2016||Leicester, Leicestershire and Rutland STP has outlined plans for major changes to the footprint's hospitals services, including a proposal to close the Hinckley and Bosworth Hospital and the midwife led birthing unit at St. Marys Hospital Melton Mowbrary. Health leaders in the area are also planning to "reconfigure" health services in order to balance the books and say that "acute reconfiguration" will deliver savings of £25.6m by 2020-21.||Full Draft||http://www.bettercareleicester.nhs.uk/EasysiteWeb/getresource.axd?AssetID=46236||"Currently the LLR system has an indicative allocation of £66m for transformation funding"||£700 million||£399.3 million (health £341.6 and social care £57.7m)||Hospital closure||Plan outlines "Proposed changes to the provision of services for Hinckley and Bosworth", which if enacted would result in the closure of the Hinckley and Bosworth Hospital. Plan states: "A review of service provision in Hinckley was undertaken in 2015 to establish the options available to deliver planned care outpatient services in the town. The proposed service would be an extension of the diagnostics available in Hinckley and Bosworth hospital, and an extension of Hinckley Health Centre. The preferred option, requiring statutory public consultation, if supported would see a move to modern planned care facilities in Hinckley, and result in the closure of Hinckley and District hospital". Plan also identifies "Public consultation response leading to difficultly in implementing preferred option (including hospital closure and sale)" as a key risk||On maternity services the STP states "A report in 2012 identified maternity services as unsustainable in the longer term and a review of the services has been taking place since then". Plan goes on to say "It is proposed that hospital based women’s services, including gynaecology and maternity, will be delivered by UHL from one site, the Royal Infirmary. Some outpatient and day case procedures will continue to be delivered from the community hospitals with an increase in services in some cases"||On mental health the STP states: "We will also work to achieve specific planning guidance to maintain mental health access standards, eliminate out of area placements and reduce the incidence of suicide"|
The specific deliverables identified include:
"- Widen choice and effectiveness in crisis response and reduce demand for beds: Remodel Community Mental Health Teams, review Psychiatric Intensive Care provision, and strengthen; IAPT, Liaison Psychiatry, Perinatal and Eating Disorder services and develop NICE compliant services for First Episodes in Psychosis and Personality Disorder.
- Increase clinical efficiency and partnership processes: to create alternatives to acute admission and enable flow through acute hospital beds, including care management, access and support to mainstream and potentially bespoke accommodation.
- Reduce suicide and increase resilience and promote recovery and independence: to enable people to manage their health more effectively we will develop awareness and support skills in the population and develop recovery networks, social prescribing and workplace health.
- Meet rehabilitation needs locally: we will develop a local integrated offer enabling fewer placements out of area and by conducting rigorous reviews so that people have appropriate care packages closer to home at reduced cost, potentially using this redirected investments to build local infrastructure.
|"in partnership with Local Authorities and Public Health we will scale up a proactive approach to Health Promotion and primary secondary and tertiary ill-health prevention. This will include the implementation of the National Diabetes Prevention Programme."||Plan states "Redesign pathways to deliver improved outcomes for patients and deliver core access and quality standards" with learning disabilities being one of the areas where pathways will be designed: "In line with national guidance on Transforming Care, we have a comprehensive plan to transform care for people with learning disabilities, including implementing enhanced community provision, with a corresponding reduction in inpatient capacity, and undertaking our care and treatment reviews. By 2018/19, our aim is to produce and deliver responsible, high quality, safe learning disability services and support that maximise independence, offer choice, are person-centred, good value, and meet the needs and aspirations of individuals and their family carers". |
Specific initiatives include:
- Provide proactive, preventive care, with better identification of people at risk, and early intervention. We will empower people by expanding personal health budgets and through independent advocacy and a greater choice in housing.
- Provide specialist multi-disciplinary support in the community including intensive support when necessary to avoid admission to mental health inpatient settings through the provision of a refocused and enhanced Learning Disability Outreach Team which will reduce the need for inpatient beds.
- Improve health and wellbeing of people with Learning Disability and their family carer(s) through reviewing short break provision and ensuring engagement with preventative health initiatives"
|Plan states that "Redesign pathways to deliver improved outcomes for patients and deliver core access and quality standards" with cancer being one of the specialities where pathways will be redesigned. The specific deliverables identified include:|
"- Deliver the Constitutional Standard Recovery Action Plan: to ensure compliance by March 2017.
- Prevention: develop and continue to run programmes to prevent and early detect cancers and reduce the risk factors such as smoking.
- Improve the early detection of cancers: we will do this through a programme of prevention and early detection, raising the profile of symptoms, improving pathways and access to diagnostics.
- Develop a survivorship and health recovery offer: to support patients following diagnosis and treatment including the provision of treatment summaries, health and wellbeing events and cancer care reviews.
- Review and redesign pathways: to meet the 2020 requirement that all patients should have access to high quality services working with our local Cancer Alliance.
- Ensure sufficient capacity to meet the 2020 standard of 95% of people with a suspected cancer should receive a definitive diagnosis or otherwise within four weeks of referral"
|"Making best use of our estates: much of the estate across LLR is owned by University Hospital Leicester and Leicestershire Partnership Trust, there are a small number of properties which are owned or managed by NHS Property Services. The service reconfiguration work detailed in this plan has resulted in estate strategies for both provider organisations which will consolidate the estate onto fewer sites. The next phase of our estate work is to improve utilisation rates and to explore what opportunities there are to work with local authorities and wider public sector on estate efficiencies"|
|acute service reconfiguration||On Acute reconfiguration plans, the STP states: "Our proposals for service configuration to ensure clinical and financial sustainability are structured on three main areas on which we will go to formal consultation. These are:|
- Acute reconfiguration to move all acute clinical services onto two sites, the Leicester Royal Infirmary and the Glenfield.
- Remodel maternity services to consolidate services onto one site at the Royal Infirmary and subject to preferences expressed during consultation provide a midwife lead unit at the General Hospital.
- Reconfiguration of community hospitals to reduce the number of sites with inpatients beds from 8 to 6 sites and redesign services in Lutterworth, Oakham and Hinckley
"The acute reconfiguration is expected to deliver gross savings of £25.6M by 2020-21"
|STP indicates that "Disposal proceeds from surplus estate across LLR will exceed £40M - to be reinvested in hospital refurbishment"|
|maternity services reconfiguration||"The proposal is to consolidate maternity services onto the Royal Infirmary site with the option to retain a midwife led birthing unit at the General Hospital". Plan states that these changes would result in hospital closure "Yes. The midwife led birthing until at St. Marys Hospital Melton Mowbrary will close"|
|"The proposed removal of inpatient services from Rutland Memorial Hospital in Oakham"|
|bed closures||"Key Bed Changes|
Acute Beds 2016/17 beds 1940 2020/21 beds 1697
Community Hospital Beds 2016/17 beds 233 2020/21 beds 195"
|workforce changes||"Key Workforce Changes|
Primary care up 10% between 2016/17 (2271 WTE) and 2020 (2505 WTE) Provider workforce down 4% over the same period from 19805 to 18303"
|Lincolnshire||W/c 12 December 2016||By 2021, the health system in Lincolnshire is projected to be over £180m short of the funds it needs to balance its books while maintaining the same level of care for patients. To close the financial gap the area plans to carry out a reconfiguration of their acute and maternity services. In the past NHS reconfiguration has meant cuts.||Final draft submission||Full submission||"£205 million is required to enable critical infrastructure changes to support clinical redesign"||£182,054.00||Surplus £1.2 million||Yes||acute services - Grantham||"An Urgent Care Centre (UCC) backed up by a medical take providing ambulatory care services and bed based selected medical admissions supporting the neighbourhood teams. Model not yet fully developed but will have a strong focus on frailty and rapid turnaround into community support. UCC likely to be led by the MCP working in partnership with acute provider(s)."||Maternity - "Develop single team across both sites to deliver Consultant led Obstetrics services with co-located midwifery led units on both sites"||"Adult Community Mental Health Team transformation – focussing on integration with other providers and wider community services through the Neighbourhood teams"||"However, for the majority there will need to be a stepped change to move services closer to home with the development of Neighbourhood Teams and the significant expansion of primary care based services across all care groups."||"Reduce duplicate diagnostic testing including radiology and pathology"||"Movement of planned care activity into the community (possibly to include, diabetes medicine, dermatology, ophthalmology, orthodontics, pain management, Endocrinology, Neurology, Rheumatology - depending on outcome of cost-benefit analysis) "||"Learning Disabilities reconfiguration - Continue the fully developed integrated community service and the consultation on the closure of Long Leys Court - the unit has been temporally closed since June 2015."||"Secondary care services, such as Cancer services, will be organised to ensure they are co-located with services where there are clinical interdependencies"||"Whilst there will be increased opportunities for more pooling of resources to commission at scale as we have done with transitional (intermediate care), there is an increased focus on “personalisation” with the deployment of personal budgets across health and social care for people with dementia, learning disabilities and severe and enduring mental health problems."||"Carter Recommendations- Estates rationalisation (assume 3% saving on premises costs)"|
|acute services||"Acute Site Reconfiguration (ULHT-led workstream that will be informed by change in demand and patient flow as a consequence of other workstreams)"||"The plan outlines a very different future than at present for Lincolnshire with primary care and community services playing an increasingly central part in the system with greater integration between health and social care and services which are built around patients and citizens rather than services that they have to fit into."||"Diabetes service - new model in place including reconfiguration"||"Healthcare estate requires reshaping and investment to enable new models of care and sustainable services"|
|Various||"PUBLIC CONSULTATION on options for maternity, neonatal and paediatric options will include whether to centralise emergency paediatric surgery in Lincolnshire"||"Genuine cross-professional cross-organisational working, including primary care, community nursing, mental health practitioners, social care professionals, hospital based expertise and diagnostics, third sector and others – focussed on the needs of the populations"|
|Various||"Consolidation of service to make best use of resource, infrastructure and technology. This is likely to include Breast Services, Orthopaedics and acute Ophthalmology & ENT"|
|Mid and South Essex (as the Mid and South Essex Success Regime)||w/c 21 November 2016||Mid and South Essex STP has outlined plans for major changes to the footprint's three acute hospitals, potentially with two of the area's A&Es downgraded. They plan for this reconfiguration to contribute £17.1m in savings towards the £407m the footprint needs to find by 2021 to balance their budget.||Final draft submission||http://www.successregimeessex.co.uk/overall-plan-summary/||"Capital funding, to support the reconfiguration of the local acute hospitals and enable a shift of services into primary and community settings"||£94 million (in 2016/17)||£407 million||£0.00||Yes||Acute services||Savings of "£17.1m from acute reconfiguration"||"The STP is leading the formation of an all age mental health joint commissioning team to commission services on behalf of Essex CCGs and local authorities"||"Refinement of local health and care model – with enhanced focus on releasing GP capacity"||"The Mid and South Essex Success Regime will develop single clinical and corporate support services, delivering high quality, cost-effective services in a hub-and-spoke model as informed by the Carter review"||• Increase capacity in the LD intensive support team|
• Pilot community forensic services
• Reduce inpatient stays through increased community provision, crisis support and systematic care and treatment review
• Improve transition from children's to adult learning disability service
• Enhance services
|"Standardise lease cost arrangements across the three Trusts; consolidate services and maximise current estate"|
|Elective surgery||"Elective surgery (consolidated onto one site on a sub specialty level)"||"GPs will work with a range of professionals to ensure joined up care planning and delivery, including: social workers, district nurses, occupational therapists, mental health, pharmacists, voluntary sector and the police"|
|Acute services||"Reconfiguration of acute services to provide high|
quality, safer, more efficient
• 3 hospitals working as a group
• Re-designate emergency centres
• Separate elective and non-elective care
• Consolidate services"
|"Mid and South Essex operates three acute hospitals, with most services delivered at all three sites. While there are many examples of excellent care, the hospitals are facing rising non-elective demands, and clinical workforce gaps. This is leading to increasing operational and financial pressures. Building stronger health and care localities, and decompressing the non-elective pathway is core to meeting these challenges|
Reconfiguration, supported by redesign of clinical pathways, then has the potential to address the quality and safety concerns and deliver care more sustainably:
• Greater specialisation of clinical staff and equipment, and
increasing focus to provide senior medical cover ...
• ...with the potential to deliver 7-day services and other
emerging standards within current staffing levels"
|Milton Keynes, Bedfordshire and Luton||w/c 7 November 2016||By 2021, the Milton Keynes, Bedfordshire and Luton STP footprint is projected to be over £300m short of the funds it needs to balance its books while maintaining the same level of care for patients. The plan outlines proposed major changes to specialist hospital care in order to ensure those services are 'financially sustainable'.||Final Draft Submission||Final submission||£311 million (unclear if includes specialised commissioning and social care)||£8 million surplus||Yes||secondary care services||Priority 3 of the BLMK STP is "Sustainable secondary care services across BLMK" - STP states that one of the goals of Priority 3 is "To ensure that changes to the configuration or operation of secondary care services across BLMK are planned and developed with all three hospitals centrally involved". The plan also states that "Since June, the STP has assumed responsibility for developing proposals to modernise secondary care services across BLMK, rendering them both clinically and financially sustainable. |
All three hospitals are centrally involved in this work" and that a "Secondary Care Services Transformation Board [SCSTB] has been set up and is overseeing four discrete workstreams, covering clinical services, clinical support services, non- clinical support services and the non-medical clinical workforce".
The plan goes on to state: "The SCSTB expects to complete plans for creating an integrated model of leadership, management and operations across the three hospitals by 31st March 2017" and that "Any significant changes to secondary care services that might emerge from this work will be taken forward through close engagement with STP partners, and will also involve appropriate statutory consultation with the general public"
|STP outines a programme call “Better Care, Closer” which aims to "achieve a common integrated model for hospital care, community health services, primary care and social care through a place- based approach. It will be delivered through the development of a standardised BLMK approach to care co-ordination and delivery involving: |
- Developing primary care at scale (which may include mergers; partnerships or other practice collaboration)
- Enhanced Primary Care - core general practice workforce is expanded strengthened to deliver better access, well-being and chronic disease management"
|"Clinical support services – to build on the recommendations of the Carter report, and identify opportunities arising from integrating clinical support services which support the design and implementation of optimally configured pathology" including "Operational Design and procurement model for single pathology service delivering"||Priority 2 of the BLMK STP is "High quality, scaled and resilient out of hospital services across BLMK", with one of the key goals of Priority 2 being that the area "Supports the transformation of services for people with Learning Disabilities"|
The key goals of Priority 2 are
|Norfolk and Waveney||w/c 21 November 2016||By 2021, the Norfolk and Waveney STP footprint wants to see a 20% reduction in A&E attendances and a 20% reduction in acute beds, but the STP doesn't provide any detail about what this means for patients or their families. The STP also states there will be a "consolidation of estates". Historically this has meant selling NHS buildings.||Final draft submission||http://www.jpaget.nhs.uk/media/334276/Norfolk-and-Waveney-STP.pdf||£415.6 million (£316.6m relating to health system and £99.1m arising from social care and non-NHS)||ON acute services the plans state one of their objectives is "Ensuring acute clinical service sustainability at an STP footprint level across the key nominated specialty areas and their interdependencies". The KPI to measure success against this objective include: |
"• 20% reduction in A&E attendances and non-elective admissions (primarily delivered by avoidance schemes in primary care and out of hospital work streams)
• 20% reduction of acute bed days (post 2 days initial assessment) delivered by growth of out of hospital capacity (not just additional community beds)
• 15% reduction of acute bed days (post 2 days initial assessment), delivered by improving hospital processes
• Achievement of national cancer waiting time and RTT standards"
Plan does not specifically state that acute services will be reconfigured or that acute beds will be closed.
|Plan indicates that there will be a review of acute services ("development and delivery of more integrated acute care services across the Norfolk & Waveney") may take place, one being maternity services: "Clinical, operational and financial sustainability assessment of 7 nominated acute specialties (maternity, cancer, radiology, cardiology, stroke, dermatology, and paediatrics) for the three acute trusts. This incorporates analysis of workforce and clinical activity, performance against service guidelines, and assessment of local and regional patient flow".||For mental health the plan, identifies the following priorities: |
- Rehabilitation and Reablement (Complex Needs)
- Implement a consistent MH liaison service across N&W
- Supporting people with MH Co-morbidities
|Plan identifies supporting primary care as a key focus, and outlines the following objectives for GPs:|
"Develop and extend N&W primary care provision to:
• Enable N&W primary care to work at scale with flexible initiatives.
• Release existing capacity to meet increasing demand.
• Improve primary care staff retention, recruitment and skill-mix.
• Improve same day access to primary care.
• Improve the relationship between primary and secondary care.
• Enable Local provision that is responsive to individual and local needs with commonly agreed outcomes across the footprint.
• Facilitate alignment with new models of care, supporting a shift from the acute setting to care delivered closer to home.
• Develop a primary care strategy for the footprint"
|Plan indicates that there will be a review of acute services ("development and delivery of more integrated acute care services across the Norfolk & Waveney") may take place, one being maternity services: "Clinical, operational and financial sustainability assessment of 7 nominated acute specialties (maternity, cancer, radiology, cardiology, stroke, dermatology, and paediatrics) for the three acute trusts. This incorporates analysis of workforce and clinical activity, performance against service guidelines, and assessment of local and regional patient flow".||Dementia is identified as one of the STP footprint's priority areas under its mental health strategy. On Dementia, the plan states: "Dementia|
• Simplified pathways across N&W that make better links with community provision and physical care health needs, starting from an increased diagnosis rate
• Specialist dementia / carers workers aligned with the social prescribing model (Prevention and Wellbeing), dementia friendly communities and VCS support. Training for community staff to recognise dementia.
• Joined up mental and physical health care for people diagnosed with dementia, supported by wider out of hospital services and specialist mental health provision where needed, including reablement for people with dementia."
|STP outilnes an approach for a "consolidation of estates"|
|Plan indicates that there will be a review of acute services ("development and delivery of more integrated acute care services across the Norfolk & Waveney") may take place, one being maternity services: "Clinical, operational and financial sustainability assessment of 7 nominated acute specialties (maternity, cancer, radiology, cardiology, stroke, dermatology, and paediatrics) for the three acute trusts. This incorporates analysis of workforce and clinical activity, performance against service guidelines, and assessment of local and regional patient flow". |
Plan does not state that any of these services will be reconfigured or what the review might mean in terms of service design
|Under the "Primary, Community and Social Care" workstream there is an overal objective to: "Develop an integrated model of care that incorporates primary, community, secondary and social care". One of the identified aims of this work is to "Agree a strategy across the footprint for children, young people and maternity services" - no additional detail about this aspect of reform is articulated||Objective of the Mental Health strategy outlined in the STP is "Reduce acute hospital and residential care use for people of all ages with reported MH problem, including children and young people and dementi"||STP identifies the following priorities for estates: "Developing and implementing an integrated estates strategy" and "Releasing and generating value"|
|North Central London||w/c 24 October 2016||The North Central London STP outlines a "long list" of services to be considered for consolodation, including: emergency surgery (out of hours), maternity services, general dermatology, elective orthopedics and mental health crisis care. By 2021, the health and social care system in North Central London is projected to be £876m short of the funds it needs to balance its books while maintaining the same level of care for patients.||YES||NC London STP - Full Draft Plan - October 2016||£771 million (NHS only - includes specialised commissioning)||£1184 ( based on £876 million for NHS inc. specialised commissioning + social care gap of roughly £308 million)||Plan indicates that the consolidation of services is in scope for the STP footprints plans; the plan stresses that "No decisions have been made, but we have identified services where we will review whether some form of consolidation may be worth consideration" these include. Plan suggests that "senior clinicians have systematically assessed services based on whether consolidation or alternative networking is required and / or could be beneficial". In context of hospital closure, the plan references proposals to "relocate" Moorfields Eye hospital from its current site to a new site - this plan has been underway for some time||Plan indicates that a "long list" of services to be reviewed has been drawn up - this inlcudes: emergency surgery (out of hours), maternity services, general dermatology, elective orthopedics, mental health crisis care.||Plan indicates that maternity services may be one of the areas where consolidation of services will take place.||Plan suggests expansion of "GP front door model in Emergency Departments: we will review the existing provision across NCL of GP led triage, treatment and streaming for all ambulatory patients will be provided at the front door of Emergency Departments"||The plan states it "will identify clinical areas that might benefit from being organised differently (e.g. managing multiple services as a single service)", with pathology services identified as one of these areas.||Plan identifies "learning disabilities is a key area of focus [for social care] given that half of social care spend is on this group, and that children with special educational needs and learning disabilities have worse long term outcomes in both health and education. We need to start supporting those with learning disabilities from early childhood to ensure early detection and appropriate intervention"||Plan indicates that "Commissioners and providers across NCL joined together to form our Cancer Vanguard, in partnership with Manchester Cancer and Royal Marsden Partners, with the aim of achieving earlier cancer diagnosis, ensuring effective use of cancer outcomes information and adoption of recognised best practice across the full spectrum of cancer pathways", noting that the areas of focus are: understanding how to improve diagnosis (with early focus on colorectal and lunch cancer where many patients in NCL are diagnosed at late stage) - plan also notes that NCL will "roll out the Multi-disciplinary Diagnostic Clinic model for vague abdominal symptoms" to improve early diagnosis. In the context of new models of care, the NCL is developing a single provider model for radiotherapy ("to help achieve financial sustainability, reduce variation in clinical protocols and improve patient access to research and clinical innovations")||In the context of dementia, the plan states: "Investing in a dementia friendly NCL: looking at prevention and early intervention, supporting people to remain at home longer and supporting carers to ensure that we meet national standards around dementia, including a dementia diagnosis rate of at least two-thirds of the estimated number of people with dementia". The Plan states that "All NHS and social care staff will be trained in basic dementia awareness, with more advanced training for frontline staff who are more likely to encounter people living with dementia"||On estates the plan states: "Our vision is to provide a fit for purpose, cost-effective, integrated, accessible estate which enables the delivery of high quality health and social care services for our local population". Plan suggests that surplus land/estates will be sold, with some of the proceeds of these sales going towards PFI costs and "sales proceeds from surplus assets used to deliver new purpose built mental health accommodation, and the eventual relocation of Moorfields Eye Hospital to the St Pancras site. Clinical improvements would be prioritised through the building of a new Institute of Mental Health and an integrated Eye Hospital and Institute of Ophthalmology at the current St Pancras Hospital site"|
|http://www.camden.gov.uk/ccm/cms-service/stream/asset/?asset_id=3508165&||Most reference to maternity services in plan relates to public health initiatives and preventantion plans - for instance ensureing that "smoking cessation programmes are embedded across maternity services". Plan also states: that the footprint will use its existing maternity network "to ensure that our local maternity system implements the findings of the national Maternity review: Better Births"||"Extending access to primary care: patients will be able to access consultations with GPs or other primary care professionals in their local area for pre-bookable and unscheduled care appointments between 8am and 8pm 7 days a week"|
|North East London||w/c 7 November||North East London has asked for more money - over £500m of capital investment - to spend on the NHS. The North East London STP also states that there will changes to NHS services. This includes the downgrading of tthe King George Hospital in Ilford from an A&E to an urgent care centre. The STP also states that midwifery services will be reorganised, but fails to provide any details on what this means for women and their families.||Yes||North East London final draft submission||"Estimated net capital investment: £500-600m"||£511 million||£816 (includes £578 million for NHS only + £238 million LA and City of London Corp)||Do something surplus of £37 million, assuming £53 million of PFI savings and £49 million of savings from specialised commissioning||Yes||There are pre-exisiting plans for the downgrading of the King George Hospital in Illford (originally signed off by Andrew Lansley in 2011). The plan re-commits to the change.||"Health commissioners and providers in NEL remain committed to the safe and timely transition of King George Hospital emergency department from a full admitting A&E department to a 24/7 urgent care centre in order to improve the quality and sustainability of acute services. This is in line with the original proposals and public consultation undertaken as part of the Health for north east London programme and the changes ultimately agreed by the Secretary of State."||"Midwifery services will be reorganised to ensure that women can be offered continuity of care and improved choice for each part of the maternity pathway"||"Mental health services which integrate primary, community and social care support will prevent unnecessary admissions and provide a smooth transition to acute services if needed."||"Our systems will be underpinned by the development of|
high quality primary care at scale, as the foundation of an integrated community based model of care. The extended primary care offer will be supported by integrated locality based multidisciplinary health and social care teams."
|"for the following areas of non-clinical work, providers have developed task and finish groups aiming to reduce spend through consolidation and collaboration: pathology, back office finance and HR, procurement and IT"||"We also wish to widen the implementation of healthy living programmes such as the National Diabetes Prevention Programme to achieve Prostrate Specific Antigen obesity and diabetes targets. However, we have found it difficult to demonstrate its impact. To improve its impact, we will expand our mapping of diabetes prevalence and its risk factors to help identify at-risk patients."||The Transforming Care Partnerships in NEL are committed to working together to deliver the national service model [for learning disabilities]".||"We will reduce variation in access and quality of service by implementing whole pathway improvements which has already begun under the leadership of the NEL Clinical Senate."||"We will also improve access to dementia and perinatal mental health services, and services for people when they are in crisis."||"There are further transactional savings which can be made, such as sharing estates with providers or local authorities."|
|Acute services||"If possible, we will take advantage of appropriate consolidation of planned care services to allow for better outcomes and efficiency. In this way, there will be more effective use of experienced staff and specialised equipment available, enhancing clinical productivity."||"Federations are developing across NEL to increase productivity and are saving money through consolidation of back office functions and procurement"||"Partnership between commissioners, providers, and other public sector organisations to align incentives for estate release and support the delivery of new models of care"|
|http://www.nelstp.org.uk/downloads/Publications/NEL-STP-draft-policy-in-development-21-October-2016.pdf||Providers||"Providers have a unique opportunity to increase their productivity through collaboration. Cost improvement programmes will no longer be enough to achieve the scale of efficiency required to address our system-wide financial challenge. The STP has given providers the impetus to codesign new opportunities for productivity and service efficiency improvements beyond traditional organisational boundaries"||"We need to support primary care collaboration at scale to improve quality and sustainability across practices."||"Provider organisations, together with commissioner and partner organisations are working across NEL in an ambitious programme to redesign the delivery of health and social care services across the whole footprint including Whipps Cross, King George, Queen’s, St George’s, Newham, Homerton and Mile End. Whipps Cross will continue to provide acute services, and major health and wellbeing community facilities are proposed for St George’s, Whipps Cross, Mile End and St Leonard’s sites."|
|North West London||W/c 7 November||The North West London STP outlines a proposal to “consolidate services on fewer major acute sites”. They've said "we cannot deliver a clinically and financially sustainable system without transforming the way we deliver care, and without reconfiguring acute services". In the NHS, reconfiguration has historically meant cuts. North West London STP also indicates that even with these changes, they'll still be £19.9m short of the funds it needs to balance the area's books.||NW London Sustainability and Transformation Plan||Need further discussions around availability and accessibility of capital||£1.04 billion||£1.4bn, the plan includes a note - "The NWL ‘Do Nothing’ gap has changed since Jun ’16 STP due to changes in the underlying position of social care, and inclusion of the Royal Brompton & Harefield and the London Ambulance Service deficit attributable to NWL."||£19.9 million (assuming the whole £188 million specialised commissioning deficit is closed - there is not currently a plan for how to do this)||"The health system is clear that we cannot deliver a clinically and financially sustainable system without transforming the way we deliver care, and without reconfiguring acute services to enable us to staff our hospitals safely in the medium term."||Acute services||"Increasing the capacity of the major acute sites will enable consolidation of services, driving improved outcomes and longer term clinical and financial sustainability"||"Fully deliver on the vision for maternity set out in Better Births national maternity review – through our 15/16 reconfiguration programme we have already made significant progress delivering this vision for maternity. In 16/17 we will focus on providing continuity of care for women, so that maternity care is provided by a small team of midwives during the antenatal, intrapartum and postnatal period."||"Implement the new model of care for people with serious and long term mental health needs, to improve physical and mental health and increase life expectancy"||"Revolutionise the outpatient model by using technology to reduce the number of face to face outpatient consultations by up to 40% and integrating primary care with access to specialists"||"Back Office: this is new and additional priority agreed in September 2016. Deliver additional collaborative productivity opportunities. Agree priorities, geographic clusters and three year delivery plan with trajectory of benefits and any required investment identified. Integrated Procurement and Safer Staffing work within the wider Back Office plans."|| "Three key areas identified to be the largest priority to focus on at sector-wide level: diabetes prevention, atrial fibrillation and reducing hypertension. Identified and/or commenced work in 2016/17 in following areas:|
• Mobilisation of National Diabetes Prevention Programme
• Comprehensive diabetes performance dashboard at practice and CCG level
• Comprehensive referral process for patients with non-diabetic hyperglycaemia into the National Diabetes Programme"
|"Deliver the NW London Transforming Care Plan for people with Learning Disabilities, Autism and challenging behaviour – supporting c.25% of current inpatients in community settings"||"Improve cancer screening to increase early diagnosis and faster treatment"||"Integrate mental health and physical health support so that there is a coordinated approach, particularly for people with dementia and their carers"||"Poor quality estate will be addressed through a programme of rationalisation and investment that will transform the primary, community and acute estate to reflect patient needs now and in the future. This will require us to retain land receipts to invest in new and improved buildings"|
|"Consolidate acute services onto five sites "||"We will transform General Practice, with consistent services to the whole population ensuring proactive, co-ordinated and accessible care is available to all, as set out in the Transforming Primary Care in London: a Strategic Commissioning Framework."||"Supporting and publicising national campaigns and work such as on cancer prevention, mental health stigma and self care"|
|"Consolidate services on fewer major acute sites, delivering more comprehensive, better staffed hospitals able to provide the best 7-day quality care (The consolidation of acute services to fewer sites is not supported by the London Boroughs of Ealing and Hammersmith and Fulham)."||"Improve cancer screening to increase early diagnosis and faster treatment"|
|Northamptonshire||W/c 12 December||By 2021, the health system in Northamptonshire is projected to be over £230m short of the funds it needs to balance its books while maintaining the same level of care for patients. The plans provide little detail, but says that they will seek to have a "right-sized acute bed capacity countywide". This could mean a reduction in beds.||Final draft submission||Final plan||£218.5 million||£230 million (+£31.4 million social care deficit)||£0.00||Yes||beds||"Right-sized acute bed capacity countywide"||"New models of care to ensure consistent, effective, compassionate primary care mental health services."||"Development of integrated out of hospital service model that will see closer integration between the four main areas, acute, NHFT, GP federations/super practice and social care and a closer working arrangement to the common goals laid out within the STP"||"Pathology – Single county-wide service"||"Disease management – optimise care packages for certain long-term conditions – diabetes, heart failure, atrial fibrillation and COPD."||"Timely access to community based services for key patient groups e.g. those with eating disorders, mental health and alcohol issues, learning disabilities and children and young people with complex needs."||"Cancer – earlier diagnosis, proactive care and reduced NEL admissions"||"Promoting independence & quality of life for older adults Programmes to support isolated groups, low level MH issues & dementia, community development & cohesion, self-care, end of life choices, carers, etc"||"Respond to the “Carter” challenge to reduce NHS trust non-clinical footprint by 35%"|
|acute service||"In respect of acute configuration the drive of the STP is to develop a single service across the county"||"Same day access to an appropriate health or social care professional via a GP led multi-disciplinary service model which includes therapists, pharmacists, community physical and mental health nurses and social workers. Delivery will be through a network of practices and/or hubs within each Federation, with services available from early morning into the evening, 7 days a week."||"Learning Disabilities - Transform care for people with learning disabilities in Northants by: increasing choice for patients/families via personal budgets, providing more care in the community, increasing early intervention and support, and strengthening care and treatment reviews."|
|acute service||"Review and redesign of clinical services across the Trusts to eliminate variation, establish and deliver opportunities for collaboration that unlock efficiencies and deliver best value from our combined resources."|
|Northumberland, Tyne and Wear||w/c 7 November||The Northumberland, Tyne and Wear STP says that "There are currently seven acute sites operating in the footprint, and the system is looking actively into options for consolidation of services across sites". In the NHS, 'consolidation of sites' has historically meant cuts but the STP reveals very little information about what might happen to services and how this will impact local residents.||Final draft submission||Final plan||It is unclear from the plan what the total funding request is, but the estates strategy alone requires in the reginon of £85 million||£960 million||£641 million||£0.00||Yes||Acute services||"There are currently seven acute sites operating in the footprint, and the system is looking actively into options for consolidation of services across sites to make better use of available resources and ease workforce pressures. The collaboration between City Hospitals Sunderland and South Tyneside FT exemplifies the opportunities for cooperation that the STP is looking to exploit."||"The newly created ‘Local Maternity System’ (LMS) will co-ordinate and oversee a programme of work to develop this new, innovative, and transformative service model"||The plan aims to "provide Mental Health care that is ‘closer to home’ and easily accessible, coordinated and supported by appropriate|
specialist input implemented through the MH5FV"
|"We will explore and develop alternative closer to home service models that improve productivity and create value by working with communities to provide need based support and reduce the reliance on hospitals and care homes."||"In addition to these focus areas, a range of additional solutions will help to bring the system into overall financial balance by 2020/21. These include pathology consolidation, shared back office arrangements"||"Roll out the diabetes prevention programme"||"Implement the North East and Cumbria Learning Disability Transformation plan to reduce reliance on inpatient admissions and develop community support approaches whilst promoting prevention and early intervention"||"Each CCG will have a local plan that fits with the Cancer Alliance overall objective."||"Prevention and earlier identification of dementia" is a health and wellbeing priority for South Tyneside, Sunderland and North Durham||"Rationalisation and disposal of non-core sites and buildings to reduce poor quality accommodation; eliminate backlog maintenance; void and excess running costs"|
|The plan states that there will be a "re-design of mental health in-patient care, which is affordable, high quality, 7 day and consistent"||"Transform approach to support people living with and beyond cancer"|
|Nottinghamshire||w/c 28 November||The Nottinghamshire STP lays out plans to close 200 hospital beds as well as "a potential reduction in [the] core professionally registered" workforce, which includes nurses. The footprint also indicates that even with these changes, they'll still be £38m short of the funds it needs to balance the area's books.||Final draft submission||Final draft submission||£500 million||£628 million||£38 million||Yes||acute service||"Start to implement the 10 year Acute Transformational Plan, stage by stage, to deliver the reconfiguration model of the acute estate that will see an increase in primary, community, social care and carer services to support the reduction of estate/services of the acute providers in accordance with the FYFV"||"Provide coordinated primary, community, mental health and social care support for people with high and emerging risk through multidisciplinary team (MDTs)"||"Increase capacity and capability in community services so that people will have swift access to community services, particularly mental health, social care services and homecare to enable reduction of beds in acute care settings (described in High impact area 3: Simplify Urgent and Emergency Care)."||"Improved access to resilient primary and community based care (e.g. access to General Practice 8am-8pm, 7 days a week)"||"There is significant opportunity for consolidation into a central laboratory of all GP activity and routine and specialist blood sciences, microbiology and molecular diagnostic activity with a turnaround time greater than 4 hours."||"People with long term conditions such as diabetes are able to monitor and manage their health independently at home using technology."||"Adopt risk stratification processes to ensure that proactive preventative interventions are targeted at people most at risk of losing independence and wellbeing, including vulnerable adults, people with learning disabilities, people with physical disabilities and people with mental health needs (link with Primary, Community, Social care and carers workstream). This includes finding individuals who could potentially be ‘at risk’ in the future from early indicators and providing targeted support and engagement to prevent crises"||"Diagnose more cancers earlier, through improved screening models, GP access to diagnostics (more diagnostic capacity – especially imaging and endoscopy) and theroll out of the Qcancer risk tool embedded in GP systems"||"Increase early identification of chronic and episodic conditions, in particular in cancer and dementia, through empowering the workforce to identify and respond to early signs of disease and isolation"||"Respond to the Carter review and corporate services consolidation to support a potential reduction in floor area of administrative estate by 2,500 sqm. – 3,500 sqm. or between 70% and 100% of total floor area. Potential to reduce running costs by £1.3m – £1.5m, with required capital expenditure. Known schemes include the retraction from rented accommodation as Trust HQ within the Mid Notts footprint £0.8 to 1.0m"|
|£140.5 million||acute service||"• NUH reconfiguration to maximise activity at QMC and significantly downsize city hospital will deliver over a 10 year period a circa 15- 20% reduction in the NUH estate with estates revenue savings circa £15m. The East Midlands Trauma Centre is the catalyst for change which will be housed at QMC – Hot site|
• The acute reconfiguration work will also reduce outpatients departments in the acute & bed space to align with the shift of activity into the community"
|"Provide coordinated primary, community, mental health and social care support for people with high and emerging risk through multidisciplinary team (MDTs)"||"Use technology to enable citizens to book General Practice appointments and access advice online or through telephone consultations"|
|acute service||"Shared Service Collaboration between NUH & SFH eg CSSD/ADU re-provision (pt. of the acute reconfiguration)|
• Realise further 30,000sq.m reduction in floor area circa £9m. Reduction in backlog from demolition and disposal of buildings £1.9m at City and £12.8m at Kings Mill."
|acute service||"First and foremost, at least 95% of our citizens attending A&E will be seen and treated within four hours. Additionally, we will reduce the total number of emergency admissions by 5% via improved navigation of our citizens and workforce to appropriate services, reduce mental emergency attendances and readmissions over the next two years by 10%, and we will reduce 200 beds in our acute setting by providing better alternatives for our citizens who are medically fit to leave the hospital but currently do not have enough support in the community or at home."|
|Workforce||"o A growth in the primary care workforce of 24% with reductions elsewhere|
o Overall increase in advanced skills levels with potential reduction in core professionally registered levels
o An indication that the paybill can be reduced by 12m over five years due to the change in skillmix and activity implications – investment to achieve the change has not yet been quantified"
|Shropshire and Telford and Wrekin||W/C 5 December 2016||By 2021, Shropshire and Telford & Wrekin is is projected to be almost £131.4m short of the funds it needs to balance its books while maintaining the same level of care for patients. The plan confirms that one of the hospitals in either Telford or Shrewsbury will likely lose its A&E department but doesn't say which one.||Final Draft Submission||Reconfiguration of Trust's two hospitals - £311 million from 2017/18 - 2022/23. The plan makes clear that some of this funding may come from partnerships with the private sector||£131.4 million||Health economy surplus of £8.5 million||Yes||Acute||The plan makes it clear that the planned reconfiguration of the STPs two acute hospitals will go ahead, but makes no progress on identifying which of the Shrewsbury and Telsford hospitals will see it's A&E downgraded||"Mental health and Learning Disabilities are core to the development of Neighbourhood teams and will play a key role in the work of local teams. Psychiatric liaison and other specialist services such as Perinatal will play a an important role in ensuring that admissions to the acute hospitals are minimised."||"The same neighbourhood structure will be used as a basis for providing health and care services for people who need professional help but for whom hospital is not necessary. GPs, social care, community nurses and therapists, community mental health workers and learning disability practitioners will increasingly work together as a single team to provide a consistent range of services at a local level. These Neighbourhood Teams will be the first port of call for people with diabetes and other chronic conditions; for people who might otherwise have to go to hospital but who do not need emergency services; and for people who have recently been discharged from hospital."||"The health community has set a target to reduce Back Office Functions cost by £1.8m (inc Pathology)"||"These Neighbourhood Teams will be the first port of call for people with diabetes and other chronic conditions; for people who might otherwise have to go to hospital but who do not need emergency services; and for people who have recently been discharged from hospital."||"Our neighbourhood care model will remove existing barriers to integration and bring together primary, community and mental health services and learning disabilities with local authority, voluntary and the independent care sector to deliver the right care in the right place and maximise the efficiency and effectiveness of local services"||"Develop health economy wide cancer strategy based on National Cancer Taskforce priorities"||"Dementia will become an increasing pressure over the next few years. Our plans for the use of Big Data set out in the Digital Roadmap will help us to achieve this challenge."||"Flexible estate that will enhanced a dynamic healthcare economy"|
|Workforce||"New workforce roles being developed in conjunction with LETC"||"To support new models for sustainable Primary Care - addressing inequalities by attracting a multidisciplinary skilled workforce via a workforce strategy, to increase patient access, supported by excellent IT infrastructure and Estate."||"Reduction in estate"|
|Somerset||w/c 7 November 2016||Somerset STP is planning a reduction in numbers of beds and attempts to minimise the number of unplanned admissions being taken in. By 2021, Somerset is projected to be almost £600m short of the funds it needs to balance its books while maintaining the same level of care for patients. The plan says that the funding gap makes it hard to maintain a "full range of services" across the two acute hospitals within the available budget.||Final Draft Submission||Somerset Final Draft - Technical Submission - October 2016||£596 million (unclear if includes specialised commissioning and social care)||Predicted Footprint NHS Surplus /(Deficit) after STF Allocation of £16.1 million||yes||hospital services||"Redesign out of hospital services to reduce reliance on acute services and community beds" including: |
"• Proactive Care: Enhanced Primary Care and Risk Stratification
• Front door and rapid response teams
• Increased mental health teams and focus
• Increased non-bed based care models and reduction in activity levels
• Significant reduction in the Community Hospital Bed Base
• Enhanced integrated community and primary care services
• Reduction in delayed transfers of care, length of stay and unplanned admissions"
|Plan suggests that new maternity unit will be created at Musgrove Hospital (depends on capital funding becoming available)||Plan indicated there are "significant gaps in mental health services" including "inadequate specialist inpatient provision resulting in high numbers of being treated out of area"||On GPs, the STP states "there are significant challenges facing primary care teams in Somerset with the second highest level of GPs aged over 55yrs of all STP footprints. Recent figures show that 31% of GPs intend to retire in the next three years. This is compounded by the difficulties experienced in filling GP vacancies (50% of advertised posts remain unfilled)"||STP indicates that one of the priority areas is "Focus on prevention to develop a sustainable system", with cancer being one of the "overarching system priorities for primary, secondary and tertiary prevention"||STP indicates that one of the priority areas is "Focus on prevention to develop a sustainable system", with dementia being one of the "overarching system priorities for primary, secondary and tertiary prevention"||STP states that "Delivering the major strategic priorities will require a substantial focus on the use of estate across Somerset. This will include developing infrastructure to support integrated out-of-hospital care and more effective co-ordination of infrastructure between primary care and community hospitals" and that "all organisations in the Somerset STP footprint are working together on a Local Estates Strategy"|
|Plan states that "Radical new models of acute care are required that support investment in community based alternatives". |
On the rationale for acute service reconfiguration the STP states: "significant work force challenges combined with rising demand means we are finding it increasingly difficult to maintain the provision of a full range of services across the two acute hospitals within the available budget. While quality and safety are key priorities, we need to balance this with ease of access, recognising that sometimes it is better to travel further to ensure access to high quality care"
|STP indicates that one of the priority areas is "Focus on prevention to develop a sustainable system", with mental health being one of the "overarching system priorities for primary, secondary and tertiary prevention"||Developing a new model for Primary Care with the following elements: |
- Broaden skill mix including, Paramedics, pharmacists, health coaches / navigators, development of complex care MDTs, embedding physiotherapy and mental health services
- Identify solutions to manage same day demand in a more sustainable way, enhanced / extended 7 day services for patients
- Support patients to do more for themselves including active involvement in care planning
|acute service provision||Areas plans to address "clinically and financially unsustainable acute service provision" and indicates there will be "service reconfiguration for priority list of vulnerable services" with an initial focus on "Maternity and Paediatrics, Musculoskeletal, Dermatology, Oral Maxillo Facial Surgery, Histopathology, Urology and Oncology"||STP also identifies "Redesign of Out of Hospital Services" as a priority in order "to shift more health care from hospitals to settings closer to people’s home, and from reactive care to prevention". Plan states this "this includes mental health and social care having a rapid response and to work with hospitals to speed up discharge" and "Greater level of community mental health services ensuring people with mental health problems have support for physical health issues including prevention"|
|rationalise acute provider sites||In the context of estates strategic planning the STP indicates there is a focus on acute provider reconfiguration, specifically:|
"• Consider optimisation of estate and workforce to support better efficiency as well as collaborative delivery of services
• Develop options for shared back office functions"
|South East London||w/c 31 October 2016||By 2021, South East London is projected to be almost £1bn short of the funds it needs to balance its books while maintaining the same level of care for patients. The South East London STP states that changes to A&E departments are being considered but the plan does not provide clear details about what these changes mean in action and how they will affect local residents.||Full Draft Published||SE London STP - Full Draft Plan - 21 October 2016||£934 million (NHS only inc. specialised commissioning)||£5 million surplus||Yes||A&E||On A&E the SEL plan states: "Ensuring appropriate capacity, both through a redesign of A&E departments where required (as at GSTT and Greenwich), and to ensure appropriate bed capacity is available to support effective flow" - plan is unclear what 'redesign' means in action||Plan states that 'maternity and early years' is "one of the identified 10 prevention areas that require focus"||Plan states that mental health is "one of the identified 10 prevention areas that require focus"||SEL is working with HEE to "develop a local vision of the GP Forward View to: Develop roles such as care navigators and physician associates who can reduce some of the demands on GP time; Establish new ways of working across federations to reduce bureaucracy, administration and demand for clinical consultation, Create joint posts supporting multiple practices or working across health and social care"||Plan states that diabetes is "one of the identified 10 prevention areas that require focus"||On Cancer services the plan states: "new £160m purpose built Cancer Centre at Guy’s Hospital opened in September 2016. The centre will provide a consolidated a range of services previously located across SEL"||Plan states that Dementia and ageing is "one of the identified 10 prevention areas that require focus"||"the footprint has a ‘do nothing’ capital expenditure requirement of £1.1bn over the period to 2020/21"|
|orthopedic services||SEL plan states: "We believe that greater efficiency and quality of care can be delivered by working collaboratively across organisations. In areas such as elective orthopaedics there is evidence that consolidating services can improve care at a lower cost" - plan does not provide additiaonl details on how orthopedic services will be reconfigured||Maternity services is one of the areas where the SEL plan will work to standardise care across pathways. On Maternity services the plan states: "Creating continuity and promoting choice and mental and physical wellbeing through the maternity pathways, and to provide clearer information about care choices and standardised information, including identifying more of those at high risk before 10 weeks and a named midwife for women. Access for all women to perinatal mental health services."||Mental health is identified as one of the six focus areas for the Community Based Care plan SEL is developing. The plan states the following: "The STP commits that SEL residents will be supported to have greater control over care of their mental health, and highlights the significance of mental health in meeting its commitments overall. There is some positive practice in individual boroughs, particularly around prevention with children, young people, families and the wider determinants of mental health. However, most mental health services are treatment rather than prevention focused and there is no systemic approach to early intervention or work with specific groups. This is an area of opportunity to collaborate at SEL level on developing consistent strategic approaches and workforce development; e.g. mental health first aid training."||SEL plan seeks to "Consolidate clinical support services to generate economies of scale and deliver consistent, high quality services" with pathology and radiology idntified as two of the areas where there "are a range of future collaborative models which we [SEL] are considering across different services"||Diabetes is identified as one of the six focus areas for the Community Based Care plan SEL is developing. On diabetes the plans states: "As a National Diabetes Prevention Programme Pilot site, SEL already has a good offer for diabetes prevention in those identified with high risk. Prevention in this instance is consistently embedded into primary care, with strong examples of patient empowerment. We will look to build and enhance this work through shared learning across SEL and beyond to ensure consistency and to maximise the opportunitiesformulti-disciplinaryteam workingandshared services. We will seek to ensure that there is a coherent offer to identify and provide appropriate evidence based interventions for people at risk of diabetes both through the NDPP and Health Checks"||Learning disabilities is one of the areas where the SEL plan will work to standardise care across pathways. On learning disabilities and autism the SEL plan states: "The objectives of the south east London Transforming Care programme are to:|
• Improve the way we identify and meet the needs of people with LD/ autism are supported in
community settings with good quality, responsive services.
• Ensure consistent transition planning for all children from aged 14 upwards to plan how they
will live as independent adults wherever possible
• Enhance crisis intervention for people with LD and/ or autism where people are at risk of being
admitted to hospital to prevent admission
• Develop proactive support for people with LD and/ or autism so that people can live
independently in the community settings
• Improve hospital care and discharge planning for people with LD and/ or autism"
|SEL plan states there is "more to be done so that cancer services consistently meet national standards for all patients, particularly in terms of delivering on 62 day cancer waiting times to treatment". This will be achieved by implementing:|
"• Joint data systems, including a joint waiting list; • Care navigator roles that focus on the transfer of
patients between providers;
• An Accountable Clinical Network to provide a
coordinated approach to cancer with the sustainable delivery of national waiting times standards as a key first priority of the network;
• Support improved decision-making and patient choice;
• Review diagnostic capacity to ensure timely diagnosis and pathways of care;
• Create additional capacity with the opening of the new state of the art Comprehensive Cancer Centre at Guy's Hospital and new chemotherapy and radiotherapy facilities, closer to peoples homes in outer south east London, at Queen Mary's, Sidcup"
|Integrating mental health and physical health services is identified as a key priority area. In the context of dementia, the SEL plan includes a vision to provide "Improved services for people with dementia" through its Community Based Care programme||SEL plan notes there is "currently underutilisation [of estates] at some sites, and too high levels of activity at others. Lack of accurate data means strategic planning and decision making is difficult". SEL will improve estates usage by "Reducing the level of under-utilised and non-clinical space: by understanding the current state of all estate and increasing investing in digital technology to improve operational productivity and implementing digital delivery between all providers"|
|http://www.lmc.org.uk/visageimages/pdfs/2016/South%20sector/20160415%20SEL%20STP%20April%20submission%20v%20f%20(revised%20finances).pdf||cancer services||Plan states: "We believe that greater efficiency and quality of care can be delivered by working collaboratively across organisations" and that on cancer "we are also establishing two cancer centres, one at Guy’s and a smaller centre at Queen Mary’s" and that "services previously accessed across SEL now delivered at new Guys Cancer Centre" (opened Sept 2016)||The plan includes a commitment to meet national and regional standards. On dementia, SEL will "Maintain a dementia diagnosis rate of at least two thirds of estimated local prevalence, and have due regard to the forthcoming NHS implementation guidance on dementia focusing on post-diagnostic care and support"|
|South West London||The South West London STP outlines that one of the five A&Es currently running in the footprint area will be closed, although does not state which one, or how this will impact local people. By 2021, the health and social care system in South West London is projected to be £828m short of the funds it needs to balance its books while maintaining the same level of care for patients.||Full Draft Published||SW London STP - Full Draft Plan - 21 October 2016||"In May 2016, NHS England published indicative allocations for 2020/21 STP funding including Sustainability and Transformation Funding (“STF”) of £101m for south west London"||£600 million||£828 million (includes NHS & social care and specialised commissioning)||£0.00||YES||Acute services||"reduce the number of acute sites run by the four acute trusts from the current five" - plans states that "the main driver for reconfiguration of the acute sector is the view of clinicians, as expressed through the Clinical Board, that south west London will not be able to meet key clinical quality standards across five acute sites". PLan indicates that no decision has been reached regarding which of its five acute sites would be closed but suggests that St George Hospital in Tooting is a 'fixed point' (it is a tertiary stroke centre)||On maternity services the plan states: "We will support women’s choice in place of birth, including increasing the availability of home births and midwife-led care. For women who require obstetric-led care, we will ensure safe and sustainable services are in place. We will also explore new models for antenatal and postnatal care to ensure more personalised and patient-centred care" ... "We are committed to delivering against the recommendations of the Better Births - National Maternity Review (2016)"||"We are not consistently meeting the needs of people who have mental health problems or dementia. In mental health, we do not always provide the support people need at an early enough stage, which would prevent mental health hospital admissions"||Plan notes that acute trusts have identified productivity savings in a number of key areas, including "closer working on pathology"||"Better support for people with learning disabilities and autism by improving community and crisis prevention and primary and secondary care liaison services, to reduce hospital admissions and length of stay". No additional information about how this ambition will be realised is contained in the plan.||"We are not consistently meeting the needs of people who have mental health problems or dementia. In mental health, we do not always provide the support people need at an early enough stage, which would prevent mental health hospital admissions"||Plan notes that "Estates issues described elsewhere in the STP also impact on the delivery of specialised services" "Reconfiguration of the acute estate may release space that could be re-purposed for community uses or sold for capital release. The future configuration could also have a major impact on future backlog maintenance requirements. The potential to release surplus land will become clearer as the acute configuration work reaches its conclusions at which point it may be appropriate to consider a real estate joint venture (or other delivery vehicle) for redevelopment of surplus site areas for commercial uses and a long-term revenue stream to south west London"|
|South Yorkshire and Bassetlaw||w/c 7 November 2016||The plan says that NHS leaders "are already proposing changes to how we provide hyper acute stroke services and some children’s surgery in our region". The plan highlights that changes to stroke services are required because of a shortage of staff. There are also plans to "reshape our children’s and maternity services" although there is little detail. By 2021, the health and social care system in South Yorkshire and Bassetlaw is projected to be over £500m short of the funds it needs to balance its books while maintaining the same level of care for patients.||Final Draft Submission||Final draft submission||£500 million||£571 million (includes health and social care, unclear if includes specialised services)||not found||yes||acute stroke services||STP states that due to a "national shortage of clinical staff" "we are already proposing changes to how we provide hyper acute stroke services and some children’s surgery in our region because these shortages are having an impact locally"||On maternity services, due to to a "national shortage of specialist paediatric staff, which, coupled with rising demands and needing to meet higher national standards" STP states there is a "need to reshape our children’s and maternity services"||On mental health services the STP states: "We also want to review urgent care and acute based psychiatric liaison services"||On diabetes the STP states: "We will increase telehealth monitoring, personal and GP planning to proactively help people who have long term conditions, such as diabetes, chronic obstructive pulmonary disease, arthritis and hypertension"||"Mental health and learning disabilities" is identiied as one of the STP's workstream priorities||On cancer, the STP states: "As well as improving interventions for detecting cancers in the community, we also want to make changes around diagnostics and treatment"|
|Staffordshire||W/c 19 December 2016||By 2021, Staffordshire is projected to be over half a billion short of the funds it needs to balance its books while maintaining the same level of care for patients. The Staffordshire STP states that their plan "is likely to mean fewer hospital beds, less staff working in a hospital setting and more specialist services in fewer hospitals." The plan states that they plan to move from three to two A&Es and close over 100 community hospital beds.||Final draft submission||Final draft plan||"We will have to make some investment in the short term to make sure this works [acute reconfiguration], and we have factored this into our plans as we know this will lead to savings in the longer term."||£542 million (£286 million health only)||£1.42 million||Yes||acute services||"This is likely to mean fewer hospital beds, less staff working in a hospital setting and more specialist services in fewer hospitals. As part of this we will look to move from to three to two A&Es and one Urgent Care Centre and an exploration of potential options, though no decisions on the locations of these services has been made."||"Expansion of integrated personal health budgets and choice – particularly in maternity, end-of-life and elective care"||"Develop and agree the integrated work programme to support the MH input into the System Priority Programmes with a particular emphasis on supporting the “left shift”."||"Community and primary care interfaces will have been reconfigured to reduce the number of community hospitals beds supporting people closer to their home"||"Focus investment and prevention activities on tackling the top 3 issues e.g. obesity, smoking and diabetes along with addressing health inequalities."||"Delivery of the Transforming Care for People with Learning Disabilities"||"Creation of a fully integrated County wide cancer service incorporating all NHS and non-NHS providers"||"Maintain a minimum of two-thirds diagnosis rate for people with dementia"||"Estates will potentially be rationalised through the outputs of the formal consultation process."|
|Community hospital beds|
"• Temporary reduction in 68 community beds within year one.
• Potential to further reduce the community bed base by 99 beds within hospitals
within year two (subject to formal consultation)."
|"Improving maternity services and reducing the rate of stillbirths, neonatal and maternal deaths and brain injuries"||"Mental Health specialists will continue to be an integral part of all workstreams ensuring specialist clinics and parity of esteem remain a priority in development of clinical pathways, and key focus is on skills development within the community facing provision"||Aim to have - "Enhanced and proactive management of obesity and diabetes against all elements of the pathway is in place across health, care and self care"|
|Community hospital beds||"Community Hospital Management Plan|
• Closure of 105 community beds:
- 85 at Longton and Cheadle Hospitals.
- 20 at Haywood Hospital.
Further identified community beds will be closed during 16/17, the financial impact of which will be modelled.
• 11% of staffing and variable costs saved at Haywood Hospital in line with the numbers of beds reduced at the hospital"
|"Mental health will be embedded as part of comprehensive holistic care pathways integrated with physical health services in primary care, community services, for long term conditions, the frail elderly and in urgent care. The Transformation Programme for Mental Health will focus on two programme priorities: 1) Mental Health integration within the STP footprint 2) Specialist MH services an expectation that a collaborative approach to commissioning with specialised services will align resources/pathways and investments going forward to take a place based approach"|
|Suffolk and North East Essex||w/c 14 November 2016||By 2021, the health and social care system in Suffolk and North East Essex is projected to be £248m short of the funds it needs to balance its books while maintaining the same level of care for patients. However, the plan is short of important detail on how it'll close the funding gap without cuts or closures to services.||Implementation Plan||http://www.westsuffolkccg.nhs.uk/wp-content/uploads/2016/11/ST_Submissiondraft_VVFINAL.pdf||£248 million (inc. spec commissioning)||not clear||Changes to hospital services||Ipswich & Colchester Hospital Partnership "Both hospital sites will continue to provide a full emergency department and obstetric-led maternity units. We expect there will be significant centralisation and specialisation of clinical services and standardisation of clinical and managerial systems"|
Plan states that "no decisions have been made yet about how the long term partnership may be formalised" and that a "A strategic outline case will be prepared by January 2017 identifying the benefits and trade-offs related to a number of scenarios. A public, patient, staff, clinicians and stakeholder engagement plan is being developed and will be undertaken throughout the spring and summer of 2017. Further steps will depend on the outcome of this work, the availability of capital funding, and responses to public and stakeholder engagement / consultation. We anticipate that changes to services may be initiated from early 2018"
|In the context of mental health, the STP identifies "Provision of co-designed excellent, cost effective and transformational mental health services" as one of its priorities. Plan states that one of the key acheivements to date has been "Progressing the merger of North Essex and South Essex Partnership NHS Foundation Trusts" - note the plan to merge these two mental health trusts was announced in 2015. STP (and local media reports) reveals little detail about the merger, including whether or not the merger will lead to any clinical regonfiguration, site consolidation, bed closures or if the merger relates to management||In the context of primarycare the plan identifies the following priorities: |
"• Integration between primary care community services and social care
• Primary care at scale / super practices / a single partnership and allied collaborations
• Improved use of technology in general practice and within the neighbourhood / locality hubs
• Innovative estates solutions to ensure the primary care estate and infrastructure is fit for purpose"
|New Models of Care for Suffolk - STP states that "The West Suffolk Hospital and Ipswich Hospital management teams are working with wider local system partners to develop new models of care to provide health and care to our local population. Hospital teams and GP Federations are proposing to establish two joint ventures to integrate community and urgent care services across Suffolk"|
STP goes on to say "Ipswich & Colchester Hospitals have entered a long term partnership which may include specialisation of sites in different clinical areas to improve safety and quality of care"
|STP states there will be some "Inpatient Pathway Changes" - these will be enabled by factors such as a "Minor surgery pathway redesign with shift to community care (excluding suspected/confirmed cancer)" and "Reduce low clinical priority procedures"|
|urgent care||STP indicates an ambition ot provide "Integrated Out of Hospital Care". Of the Priorities and approaches identifed, the STP states: |
"• Shift a greater proportion of care from acute hospitals to be supported in community based settings with a strong reablement focus
• In North East Essex, an Out of Hospital Urgent Care Review to potentially develop an Urgent Care Centre, co-located with A&E
• In Suffolk, commission two alliances of local partners to implement integrated neighbourhood teams and 24/7 community based urgent care to reduce reliance on acute based care"
|Changes to community based care||"Over the next five years more care will be provided in community settings to improve patient experience through care closer to home. This will also take pressure off our hospitals". On Community Based Care, the plan states "We will offer patients more treatment and therapy outside of hospital, e.g. minor surgery, joint injections and clinic appointments"|
|improving care pathways||Plan states that "Over the next four years we will focus on 15 specialty areas in a phased approach. These have been chosen based upon their potential to contribute most to closing the health and wellbeing, finance and quality gaps". The plan states that: |
"Each review will focus on investigating the extent to which one or more of the following four potential models for these services: Services transferred whole or in part to community settings to be
provided in different ways, Networked services with potentially shared rotas across two or three sites, Services combined but delivered across multiple sites, Services consolidated onto a reduced number of sites"
On the specific areas for review, plan states:
"The following specialities have been prioritised for phase one which will commence in November 2016:
General medicine,Geriatrics; MSK (T&O, Pain, Rheumatology); Cardiology; Stroke; Gastroenterology include endoscopy
Phase 2 will include general surgery, vascular, breast, ENT, dermatology and A&E"
|Surrey Heartlands||w/c 14 November 2016||By 2021, Surrey Heartlands project that they will be £102m short of the funds they need to balance their books while maintaining the same level of care for patients. The plan indicates that they are working to "establish detailed options for service reconfiguration at site level, based on current interdependencies and capacity". In the past reconfigurations have meant cuts.||Final Draft Published||http://www.nwsurreyccg.nhs.uk/surreyheartlands/Documents/Surrey%20Heartlands%20STP%20October%202016.pdf||£102m (unclear if this includes social care or specialised commissioning)||unclear||hospital merger||Area had been contemplating a merger between Royal Surrey County Hospital NHS Foundation Trust with Ashford and St Peter’s Hospitals NHS Foundation Trust; these merger plans were first announced in May 2014 (pre-date STP process). Merger plans have since been paused until Q2 2017 after a review (see local media story: http://www.haslemereherald.com/article.cfm?id=114686&headline=Hospital%20trust%20merger%20is%20called%20off%20by%20RSCH§ionIs=news&searchyear=2016)||"We want to achieve sustainable, high quality physical and mental health care for women and children that is responsive to diverse local need and affordable. We believe we can achieve this through better integration of care across our systems". One of the assumptions stated is that "An integrated system approach will result in a 2-2.5% decrease in paediatric admissions/ attendances in each of the 5 years to 20/21, against 15/16 figures" and one of the states objectives of the workstream is to "Create one acute clinical management model for Surrey Heartlands obstetrics services".||STP identifies the following vision and outcome for out of hospital and primary care: |
"A model of care where each locality within the footprint manages care to a consistent set of standards and coordinates care across a consistent set of Surrey Heartlands pathways. Boundaries between settings begin to “blur” with providers spanning multiple settings. Traditional commissioner-provider model will be challenged. The new model will have generalist professionals at the heart of the system, but will see networks of doctors and hospitals coordinating care. Unnecessary spend will be eliminated and the model will be underpinned by a single system control total. Complex frail patients will be taken out of hospital settings ultimately delivering the best possible care for Surrey Heartlands patients"
|Plan devotes page to "Cardiovascular", with a stated vision for "Cardiovascular" being: "We aim to improve control and awareness of the population’s blood pressure and reduce the population risk of type 2 diabetes by developing innovative outreach methods and increasing case finding in primary care to identify at risk populations, allowing timely management in community settings (including psychological support) such as community hubs, pharmacists and GP Practices, promoting self-care and reducing the current reliance on specialist services". One of the risks for this workstreams is "Leakage of activity- Patients will have a view on the re-configuration required to deliver effective cardiovascular services- Mitigation: early engagement with the public, keep messages simple & consistent". Plan offers very limited information on the specifics of this workstream.||"Our vision is to transform cancer services in Surrey Heartlands to provide the very best cancer outcomes that also address the challenges of a growing and ageing population. Where it is possible, preventing the development of cancer in the first place. Where not, enable those diagnosed with cancer to live for as long and as well as is possible (increase survival rates) regardless of their background or where they live (reduce variation geographically and socio-economically). To support this, boost early diagnosis to enable the most effective treatments to be used, and provide the highest quality care and support, including psychological support, from the moment cancer is suspected. Our overall aim is to make big improvements in cancer services, by empowering the clinicians to lead the improvement programmes and place patient outcomes and experience at the heart of cancer care."|
|Plan devotes page to Urgent and Emergency Care, with a stated vision for U&EC being: "To deliver, Safer, Faster, Better through a whole system operating model. We will provide urgent and emergency care services for people of all ages, with physical and mental health problems, improving out-of-hospital services so that we deliver more care closer to home and reduce hospital attendances". The objectives of this workstream are: |
• Deliver a standardised Urgent and Emergency
• Deliver a forward thinking, multi-skilled,
• Deliver a single point of access for
• Inform and educate the general public in the use of Care service provision across Surrey Heartlands inter-disciplinary workforce professionals to get advice urgent care services and the benefit of self-care".
The STP DOES NOT explicitly state how U&EC services will be reformed but does identify the following risks:
"• Clinicians resist cultural and model changes – Clinical Lead to take responsibility for driving workstream level engagement with clinicians across the footprint
• Lack of capital to support reconfiguration and designation
• Inadequate numbers of different professional staff to deliver the specialist care required and challenges in recruitment"
|STP states the area has "Developed the [Surrey] Heartlands Academy model to create a collaborative mechanism for clinical transformation". Plan indicates that the Academy will act as a "key differentiator and core Surrey Heartlands enabler that will:|
• Act as the collaborative mechanism for a common, structured and consistent co- production process to service design and change
• Challenge unwarranted variation in practice
• Embed prevention throughout"
The Heartlands Academy appears to identify that £45m of efficiencies can be delivered across the following 5 clinical workstreams: Cardiovascular (£12.7m), Cancer (£8.8m), Mental Health (£0.5m), MSK (£8.6m), Women's and Childrens (£1.0m), Urgent and Emergency Care (£13.8m).
|Plan devotes page to "Acute Operating Model" (assumed to be Acute services but this is not clearly stated). Elsewhere in STP (p. 5) indicates that £15 of efficiences can be found through an "Specialist Acute Operating Model" initiative. STP goes on to state that "Current savings assumed from level of addressable fixed cost in inpatient specialties, with high fixed staffing requirements, currently operating over multiple sites. Quality, workforce sustainability and patient experience benefits also driving prioritisation". |
One of the objectives of the "Acute Operating Model" is to "Establish detailed options for service reconfiguration at site level, based on current interdependencies and capacity" (this may indicated that any plans to reconfigure acute services have not yet been finalised). The risks identified include:
"• Building clinical input to, and consensus around, potential changes – via ongoing engagement of Trust Medical Directors
• Public and patient concern about proposals – to be addressed with support of deliberative engagement process, and clear quality rationale for changes"
|Sussex and East Surrey||W/c 28 November||By 2021, the health and social care system in Sussex and East Surrey is projected to be £864m short of the funds it needs to balance its books while maintaining the same level of care for patients. However, the plan is short of important detail on how it'll close the funding gap without cuts or closures to services.||Final submission||£125 million from PDC and DH loans, £309.5 million from commercial capital partnerships and loans, £57 million from LDR bids||£580 million||£864 million (£653 million NHS only)||Do something NHS position is £59,962 deficit in 2020/21, this does not appear to include a plan to close the £112million social care budget||Yes||acute services||"Review current services and work with providers on rapid action plan to improve, or identify need for retendering"||"Our June submission highlighted the case for change across the footprint and since then we have created a Mental Health Review team to ensure each place-based plan delivers the MH5YFV . In managing the challenges of the years ahead, the integration of mental and physical health is at the core of our wider strategic thinking, enabling opportunities to co-design and improve access to care and treatment that is holistic, timely, of a high quality and delivered in an appropriate non stigmatising setting."||"Consolidation of Primary Care Systems and integration with Community Care Systems."||"Pathology and imaging collaboration"||"The footprint is committed to ensuring that the investment identified for mental health is spent on addressing the priorities identified in the MH5YFV & Transforming Care for People with Learning Disabilities and where there are gaps in service provision and variation in practice and outcomes across Sussex and East Surrey."||"Development of “Rapid Access Diagnostic Centres” and pathways for symptomatic patients, ring-fenced from acute diagnostics, addressing shortfall of imaging and endoscopy capacity"||"Improved access and availability of mental health knowledge and expertise in primary care to include early diagnosis and treatment of people with dementia & long term conditions and improved access to holistic care for people with mental health and / or a learning disability"||"Clarify engagement with local authorities in Estates discussions"|
|"Co-designed networked operating model developed with each place based plan & local populations that connects across the wider health and social care system, embedding the principles of integrated mental & physical wellbeing and providing a seamless interface with primary, acute and out of hospital care services and a ‘no wrong door approach.’"||"Strengthened GP services, through locality teams (or communities of practice), that coordinate care of patients – improving access, outcomes and delivering greater value to communities from available funding."||"Development of radiotherapy capacity (e.g., Eastbourne) and redevelopment of cancer centre as part of the 3Ts development at Brighton"||"Build on Dementia Crisis team in Coastal W. Sussex and Golden Ticket in High Weald Lewes & Havens and rolling this scheme out wider across the footprint by 17/18."|
|The Black Country||W/c 28 November||By 2021, The Black Country project that their health and social care sytem will be close to £700m short of the funds they need to balance their books while maintaining the same level of care for patients. The plan indicates that they are working to "complete acute reconfiguration through" the new Midland Metropolitan Hospital as well as rationalising the public sector estate.||Final submission||£103 million||£476.6 million||£681 (includes roughly £512 million + £167 social care)||£0 NHS Deficit + £118,926 social care deficit||Yes||Acute services||"‘Extended Collaboration between Service Providers’: Build network of secondary care excellence; Deliver efficiencies in support services; Complete acute reconfiguration through Midland Metropolitan Hospital; Commission for quality in care homes; Deliver Cost Improvement Programmes;" - Midland Metropolitan Hospital is currently under construction||"‘Maternity & Infant Health’: Develop standardised pathways of care for maternal/infant health; Review maternity capacity"||"'Mental Health & Learning Disabilities’: Become one commissioner for NHS services, Build the right support for Learning Disabilities in association with Council commissioning functions, Improve bed utilisation and stop out of area treatments, Deliver the WM Combined Authority Mental Health challenges, Deliver extended efficiencies through TCT partnership;"||"Local clinical teams involving GPs, community nurses, mental health services and social care will provide better coordinated care for our most vulnerable patients with very complex needs."||"Consolidate back office functions"||"Extended MDTs providing consultant outreach for diabetes, respiratory, mental health condition initially, extending a broader range of disease conditions;"||"Build the right support for Learning Disabilities in association with Council commissioning functions,"||"By bringing all cancer services up to the standard of the best, cancer one year survival rates will reach over 70 per cent in the Black Country and West Birmingham."||"Rationalise public sector estate"|
|Specialised services||"Specialised Commissioning teams will be working with providers and STPs to identify opportunities for consolidating services and developing networks."||"The delivery of GP services will be redesigned to facilitate patient consultation through modern technologies and digital platforms to increase access, productivity and reducing barriers associated with traditional consulting systems."||"Complete extant work to get shared pathology vision including rationalisation of histopathology."|
|West Yorkshire||W/c 7 November||West Yorkshire is currently undertaking a plan for major changes to frontline NHS services, including acute care. In Calderdale there are plans for 'large scale hospital change'. By 2021, the health and social care system in West Yorkshire is projected to be over £1bn short of the funds it needs to balance its books while maintaining the same level of care for patients. Even with big cuts, West Yorkshire predicts it'll still have a £91m funding gap by 2021.||Final submission||£94 million transformation funding, £78 million sustainability in 2021||£1075 million||£91 million||Yes||Acute services||"There are significant challenges in the acute sector and through collaborative working, standardisation and operational networks acute providers will reduce variation and improve resilience." The plan says that a business case for the Acute Colloboration programme will be available by December 2016.||"Collaborate with practices and Health and Social Care providers to develop and deliver high quality, evidence based, out of hospital services including advanced diagnostic testing, maternity care, specialists doctors, nurses and therapists and viable smaller hospitals"||"The providers of mental health services, working with commissioners and partners, are developing a Shared Outcomes Model to reduce variation in quality, improve outcomes and drive efficiency to ensure the sustainability of services."||Under the Operational Efficiencies solutions £7 million will be saved from Primary Medical care.||October 2016 - "Commence development of Case for change for Pathology & Corporate Services"||The plan focuses on reducing the incidence and complications associated with diabetes - "Diabetes cost between £1107 – £2836 per year. West Yorkshire and Harrogate has an estimated 226,000 people at high risk of diabetes, if 50% attend and 50% do not go on to diabetes the savings are £62.5m - £160m over 5 years."||In Kirkless - "• Implementation of the Transforming Care Programme for people with learning disabilities"||"The focus of the Cancer programme is to deliver the national cancer strategy in a way that makes sense in our region, ensuring that we deliver the best outcomes and experience."||Both the Wakefield and Leeds local plans set targets for dementia. Leeds to improve post diagnoiss support and Wakefield to improve diagnosis rate to the national target.||"We must be bold in rationalising our estate where this mutually agreed and evidence shows that this in the interests of patient care and integrated working, ensuring that more public sector estate is utilised cohesively and to best value."|
|"We will deliver good quality integrated primary care to local populations, with 24/7 services that meet the needs of that local population, ensuring that services are organised around peoples’ needs. This will be planned around a population size of c.30,000 – 50,000 (locally determined) with all resources focused on the holistic and community oriented care of that population."||"Develop approaches to using feedback from people affected by cancer & engaging them directly in service improvement, e.g. pilot real-time interactive patient portal"|
|West, North and East Cumbria||W/C 21 November||West, North and East Cumbria STP is planning a wide scale reconfiguration of maternity, paediatric, community hospital and acute hospital services. In the past reconfigurations have often meant cuts. By 2021 West, North and East Cumbria is projected to be almost £168m short of the funds it needs to balance its books while maintaining the same level of care for patients.||Final submission||"These include programme costs, double running costs, services|
needing to remain open across multiple sites on a transitionary basis, and staff training. Initial estimates suggest potential implementation costs would be approximately £22m over the 4 years 2017/18 and 2020/21."
|£163.8 million||£168 million||£4 milion ("The residual deficit in 2020/21 relates to the South Cumbria element of the CPFT deficit, which is outside the WNE Cumbria footprint."||Yes - reconifguration plans in Cumbria have been widely publicised as part of the Success Regime (a precursor to the STP)||Hosptial||"New Ways of Working across acute and emergency care."||"For maternity services, the provision of a consultant led maternity unit, an alongside midwife-led maternity unit and a special care baby unit at Cumberland Infirmary Carlisle along with a full range of antenatal and postnatal care. At West Cumberland Hospital in Whitehaven a standalone midwife-led maternity unit for low risk births, open 24 hours a day 365 days a year, with antenatal and postnatal care delivered by both consultants and midwives and with consultants on site between 8am and 8pm."||Align to or better the Carter metrics and emerging metrics for Mental|
Health and Community Services.'
|"Additional specific mitigations – these comprise of additional initiatives which could deliver further cost savings for WNE Cumbria and include consolidation savings through developing networks to deliver pathology services; role development within workforce delivery to support greater staffing efficiencies; and the potential economies of scale opportunities within GP services. These mitigations could reduce the financial challenge by £6m by 2020/21."||"Additional specific mitigations – these comprise of additional initiatives which could deliver further cost savings for WNE Cumbria and include consolidation savings through developing networks to deliver pathology services; role development within workforce delivery to support greater staffing efficiencies; and the potential economies of scale opportunities within GP services. These mitigations could reduce the financial challenge by £6m by 2020/21."||"Focussing services for people with learning disabilities, physical disabilities and mental health services on recovery and independence, to manage their needs and improve their physical health, and to live a full and integrated life in society."||"The STP has identified a major priority to renew the specialist|
radiotherapy infrastructure at the CIC site and has established
with NHS England Specialist Commissioners and a tertiary
services provider a proposal with high potential to sustain the
local service well into the future as part of the North East &
Cumbria Cancer Alliance."
|"Review and implementation of the dementia pathway for Cumbria."||"Ensure prominence within governance arrangements to ensure deliver estates element of STP. Build capacity and capability within organisations. Consolidation of in-house services."|
|Yes||Children's services||"For children’s services, the development of an inpatient paediatric unit serving West, North and East Cumbria based at Cumberland Infirmary Carlisle along with a short stay paediatric assessment unit. At West Cumberland Hospital, Whitehaven there would be a short stay paediatric assessment unit for children requiring short term observation and treatment. There would also be some overnight beds at Whitehaven for children with less acute, low risk illnesses but children who needed more acute inpatient admission would be transferred to Carlisle."||"Develop a whole-system approach to promoting emotional resilience and good mental health"||"Optimise the primary care estate through engagement with practices and a strategic approach to estate planning and delivery. Investigate system approaches to future ownership models for GP premises."||"In addition, we have identified an opportunity to utilise shared pathology services within our wider pathology clinical network beyond our STP boundary. Early discussions on this have taken place and we are aiming to consider detailed proposals and agree implementation plans from April 2017."||"Enhanced diagnosis, advice, treatment and support for people living with dementia in our communities."|
|Community hospitals||"The consultation around the reconfiguration of community hospital inpatient beds includes options for consolidating the total number of inpatient sites from 9 to 6 with a total bed base of 104. The preferred community option has been identified with a total net benefit by 2020/21estimated to be £0.9m."|