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‘Essential’ that people speak up on NHS, campaigner says

By Brian Warwick, Chair, Melksham Seniors Forum

Melksham Senior Forum members have been finding out about the NHS Sustainability and Transformation Plan (STP) and believe that local people should be better informed of the purpose of the plan.

It has become obvious to Melksham Senior Forum members that not many of the public and even local councillors know exactly what STPs are and where they come from and what it will really mean to local communities.

We believe the public had the right to know and should be involved in the future planning of care in their own community as a right and not as an after thought.”

What is an NHSSustainability and Transformation Plan?

The term STP was first coined in NHS England’s delivering the ‘Forward View’: planning guidance 2016/17-2020/21. Essentially, this set out a blueprint for how the NHS in England was going to deliver the key aims of its five-year plan, the ‘Forward View’, which had been published in 2014.

The plan was based on taking a much wider view of health and wellbeing, with an emphasis on a more joined-up, place-based approach. Crucially, these join-ups expressly included collaboration between mental and physical health, and between health and social care, with a view to keeping people healthier for longer; in their homes; and not having to go into hospital unless they absolutely needed to.

It also made specific reference to Care in the Community for older and vulnerable people, presumably to reduce bed blocking by closer and more effective joint collaboration with the local authorities and the need to recognise the continuous care needs for older and vulnerable after discharge.

The planning guidance, published in December 2015, divided England into 44 large areas, called ‘STP footprints’. In each area, the NHS was charged with coming up with an STP, to re-organise healthcare provision and delivery. The aim is for more healthcare to be delivered in the community via primary care and NHS community trusts, with less of the focus on large, central hospitals.

There was also explicit recognition that those involved with putting the plans together needed to include everybody.

Why the plans will affect everybody in the community

It will only be possible to achieve these goals by working together. This means patients, the public, carers, clinicians, stakeholders and individual local health organisations (such as GPs, hospitals and local authorities) joining forces to agree a plan to improve local health and care services.

To succeed, STPs will need to be developed with, and based upon, the needs of local patients and communities and engage clinicians and other care professionals.

What has Melksham Senior Forum found out about progress so far?

Melksham Senior Forum, following a public meeting it organised, is demanding that the explicit recognition by the Government and NHS England that those involved with formulating the B&NES, Swindon and Wiltshire STP plans need to include everybody  including local patients and communities.

That we believe is not yet happening even though the instructions by NHS England to the CCG is quite explicit.

From our perspective, leadership is needed in developing a shared vision…learning and adapting…and having an open and iterative process that harnesses the energies of clinicians, patients, carers, citizens all our local community partners, including the independent and voluntary sectors, and local government.

The STP plan must ensure that at the heart of the plan is far better integration with local authority services, including, but not limited to, prevention, social and mental health care.

What we need to realise is that STPs are here; are happening; and will start being implemented this year. They are likely to have a significant impact on the way that healthcare, in the broadest sense, is organised and delivered in your area. For that reason alone, they will have an impact on social care.

Our argument is that when things start to move from plan to implementation and reality intrudes, is the time for not only CCG, RUH and the Council to be 100% involved, but also the public to show just what it can do and can offer.

Which is exactly why our Senior Forum held this public meeting to enable the public to not only learn about the local STP plan, but to engage with it.  In practice, the links by the authors of the STPs with social care providers have been very patchy, almost to the point of non-existence in many cases across the country, we must not allow that to happen here in Wiltshire

How we can make our voices heard

We now need to assess “where are we” and what can we do to influence what happens and get ours and other community and volunteer voices heard?  Therefore it is now essential we speak up and ensure that our own community is fully engaged in the STP process.

Difficult, but not impossible, we need to follow the example of Lincolnshire, where a strong local care association has insisted they are actively involved in the planning stage, and this is reflected in the quality of the plan.

For example, there is a commitment to working across a shared care plan with information shared across sectors, and with care delivered by a health and care workforce that is equally valued in providing physical and mental health, care and welfare solutions to the communities they serve.

We particularly like the Lincolnshire summary, which states, ‘We will bring together doctors, nurses, mental health practitioners, social care professionals, therapists and other community-based professionals to work as one team in a neighbourhood, linking in with wider services and support… Staff in nursing and residential care homes will be treated as vital members of the wider integrated team, having immediate access to shared care plans. They will have a more proactive role in the care of their residents.’

Their plans are now being assessed by NHS England and NHS Improvement. The likeliest outcome is that in some shape or form, a number will get the green light to proceed to implementation this year, even if much more detailed work needs to be done. There will also be a recognition at local level that much more meaningful involvement by all stakeholders will be needed for implementation to have any chance of success and right levels of funding must be made available.

Thanks to the Senior Forum we have started having the right conversations with people involved in the STP process. This is the first of different ways to explore options of what our community might both give to and get from involvement, and to show people just what we can achieve by better partnership working.

The stakes are high: this could be an opportunity for social care to also demonstrate what truly collaborative systems leadership looks like: and how with close partnership with mental health & social care and the voluntary sector it can transform the lives of people who use the services. That we believe is what we need to aim for and ensure we succeed.