The “Hampshire and Isle of Wight Health & Care System STP Delivery Plan Final Draft” was published 21 October 2016. It is a long (42 page) and sometimes complex document, so we’ve decided to try and summarise it in simpler language, so everyone has an understanding of what is being planned for healthcare on the IOW. I encourage everyone to at least look at the full document which can be found by clicking here.
You can also find more information about how “My Life A Full Life” became a Vanguard Pilot Scheme, as well as a main delivery system for the STP, as stated in the STP final draft document above by Clicking Here
In it’s initial summary it states that, to address challenges they are changing how care is delivered, driving productivity and efficiency, transforming the workforce, investing in digital transformation, and redesigning the way agencies work together.
On page 5 it explains that the key components will be to design a new system of care to address challenges. Citizens will be encouraged to proactively manage their own health, and access support in the community. On this page it also mentions people from the isle of wight may have to travel further and they will try to minimise the impact of this, this shows right from the beginning services being lost from the Island has been on the cards.
On page 6 they discuss “Place Based systems” of integrated care”, “my life a full life” being the organisation for the Isle Of Wight. It is vanguard pilot scheme and the island bid to be chosen to have the pilot. Read more about this at this link.
On page 7 it talks about the priorities:
- To upgrade prevention and early intervention and self care.
- To accelerate the introduction of new models of care.
- Address Issues that delay discharge from hospitals
- Ensure provision of sustainable acute services
- Improve Mental Health services.
Under Governance on page 9 it says under “Governance”, that “The Hampshire And Isle Of Wight Health and Well Being Group” has been set up to “provide oversight of STP, and setting the overall direction”.
P10 talks about the “Delivery Structure” and is best described using this picture from the document.
Section 2 talks about “The Delivery Programme” There will be 6 core programmes, and 4 Enabling Programmes.
The 6 core Programmes
- 1. Prevention Scale
- 2. New Care Models
- 3. Effective Patient Flow
- 4. Solent acute alliance
- 5. North and Mid Hampshire configuration
- 6. Mental Health Alliance
The 4 Enabling programmes
- 7. Digital Infrastructure
- 8. Estate Infrastructure rationalisation.
- 9. Work force
- 10. New Commissioning Models.
These programmes are then discussed in more detail
Core Programme 1 Prevention at scale (p13)
It’s objective is to raise life expectancy and reduce dependency on health services by radical upgrade in prevention, early intervention, and safe care.
Investment required 0.6m
Saving 10m per annum by 2020/21
Core Programme 2 New Models Of Care (p14)
The objective is to improve the health and independence of the population through accelerated introduction of models of care. Also to ensure sustainability of Gps within wider integrated healthcare. All to be delivered by the different Vanguards in place across Hampshire “My Life a full Life” being ours on the Isle Of Wight.
Investment 36m per annum and national funding
Saving 45.6m per annum by 2020/21
Core Programme 3 Effective Flow And Discharge. (p15)
The objective is to ensure no patient stays in a bed longer than thier condition and care programme demands. To improve discharge planning and flow by investing in capacity to care for patients in more appropriate settings, also to ensure every patient has a discharge plan.
Investment 1m in 16/17
Saving 15m per annum by 2020/21
Core Programme 4 The Solent Acute Alliance (p16&17)
This is a collaboration between Univrsity hospital Southampton, Portsmouth hospital Trust, IOW NHS Trust, and Lymington hospital to improve outcomes reduc variations, and lower cost. The objective is to deliver high quality sustainable safe acute services. To improve outcomes and optimise delivery of acute care and ensuring sustainability.
Saving 165m per annum by 2020/21
Core Programme 5 North And Mid Hampshire
Talks about establishin a way to unroll all the other things discussed in this area, as this is the only area without a vanguard.
Investment. To be confirmed dependent on configuration.
Saving £41m CIP per annum by 2020/21
Core Programme 6 Mental Health Alliance.
Aims to improve quality and capacity and access to mental health services in Hampshire and The Isle Of Wight. This will be achieved by commisioners, local authorities, third sector organisations and service users all working together.
Investment 45m assumed to include partial funding of 5YFV additional funding required.
Saving 28mper annum by 2020/21
Then we move on to the “Enabling Programmes”
Enabling Programme 7 Digital (p20)
The aim is to give patients control of their information and how it’s used, allowing them to manage their long term conditions . Also to build fully integrated health and social care record, to allow staff to access it from anywhere.
Investment 35.4m in capital
Revenue 10m per annum
Enabling Programme 8 Estates (p22)
Talks about reduced demand for estate, which will release surplus estate for other uses such as housing. The priority being to replace the worst estate.
Flexible estate solutions that enable new care models toto b delivered, a core group of Hampshire and Isle Of Wight leads is in place.
New models of care will include “health hubs”, these will provide extended access to an advanced range of services which will reduce the need for patients to travel to the main hospital.
Increased mobile working and the diital and work force enabling teams will enable to staff to access bases closer to patients, reducing travl and increasing productivity.
24m revenue saving by 2020/21
Enabling programme 9 workforce (p23)
To Create a flexible workforce shared across geographical and organisational boundries with extended skills to deliver core STP programmes. Creating health care roles more attractive to local people enabling a strong community workforce. Also wants to deliver a reduction in agency workers being used. And intends no growth overall in the workforce for 5 years.
Enabling Programme 10 New commissioning Models.
Objective is to adapt our methods for commissioning healthcare, to reduce unnecessary duplication of commissioning work. Also to facilitate the delivery of the STP, and generate cost reductions on continuing healthcare and prescribing
My Life a Full Life are delivering this on the island.
Savings Reduced infrastructure costs 10m per annum by 2020/21, continuing healthcare 36m, prescribing £58m
Enabling Programme 10: New commissioning Models
Objective is to adapt our methods for commissioning health care, reduce unnecessary duplication of commissioning work. To facilitate the delivery of the STP, generate cost reductions on continuing healthcare and prescribing.
“My Life A Full Life” delivering this on the IOW saving through reduced variation in prescribing practices.
Saving: Reduced infrastructure cost £10m per annum by 2020/21, Continuing health care £36m, prescribing £58m
Then we start section 3 “Ensuring Successful Delivery” (p25)
Starts by saying Partnership Behaviours will become the norm. Must ensure adequate time and resource invested in embedding the change needed. Also mentions that a Change readiness assessment will be conducted to outline baseline change rate of the STP.
System Approach To Quality And Equality (p26)
Programme of transformation across HIOW presents clear opportunities, for health and social care to work together to fix current quality challenge:
- More streamlined monitoring
- Increase patient/carer voice
- Better Use Of Data
- New Provider/commissioner alliances
- Focus on health gains.
Engagement and consultation (p27)
Engagement with patients voluntary and community groups, engaging staff, MP’s Councils. It also mentions there is Unlikely to be a formal consultation.
Our Delivery Architecture (p28)
To help the STP steering board Best practice portfolio (MoP) and programme (MSP) management frameworks are being established.
The Financial Gap (p29)
If we do nothing there will be a financial gap of £577m by 2020/21. We’ll close it by transforming services and reducing overall system costs.
Investing In Our future: Revenue (p30)
Plans will require investment in new model of care we want to invest £59m in services to close gap.
We need to invest in our infrastructure and access capital funds.
Closing The Gap: Work To Date (p32)
Through efficiency and transformation, and using £60m of the STP fund, we can close the gap by 2020/21
Specialised Commissioning (p33)
New models of care and commissioning models needed to support networked provision services, requiring specialised commissioning to work closely with STP.
Closing The Gap Further Work Underway (p34)
HIOW system needs to deliver additional £63m savings still to be identified.
Impact On Workforce (p36)
Aim to maintain save levels of staff to same levels for 5 years.
- Planning model assumptions are untested
- Scale and nature of some transformations could have negative effect on outcomes
- Could destabilise Current service provision.
- Potential for judicial review.
The document is very long and repeats itself a lot, I recommend reading it yourself, or at least going to the sections you are most interested in to read them in more detail.
Some of the changes are good for the Island, people have crying out for the medical and social care records to be put together and accessible to all the different doctors/specialists we see. This will be a challenge as all the services currently use different systems, but it will make things run more fluidly and speed up services for people if it can be done.
Also speeding up the process of people being discharged from hospital once they are ready to leave is a no brainer, every NHS Trust must be trying to achieve that one too.
I’m concerned the parts about “Estate Management” seem to suggest that buildings and land are going to be sold off, we need to keep track of where and when this happening, and where the money actually goes.