The questions below represent real questions that have come through to the NHS from a variety of sources. We have conflated some questions where similar issues were raised. We will continue to update the list to reflect common queries, FAQ and issues that people raise with us.
What is the STP?
44 Sustainability and Transformation Plans (STPs) are being produced across England to review how local health and social care services will evolve so they are fit for the future.
This is a key part of delivering NHS England’s Five-year Forward View. This sets out three ambitious aims for the NHS:
- improving population health and wellbeing
- transforming the quality of care delivery
- managing within available funds
The NHS in Devon is working in partnership with local authorities, GPs and others to produce truly integrated plans for health and care services which reflect the long-term needs of our population.
We are developing ambitious plans to improve health and care services for people across Devon in a way that is both clinically and financially sustainable.
The STP provides the framework within which we will develop detailed proposals for how services across Devon will be delivered between now and 2020/21. A key theme throughout the STP is an increased focus on preventing ill health and promoting peoples’ independence through the provision of more joined up services in or closer to peoples’ homes.
Seven priority areas have been identified as key programmes of work:
- Ill health prevention and early intervention.
- Integrated care
- Primary care
- Mental health and learning disabilities
- Acute hospital and specialist services
- Increasing service productivity
- Children and young people.
Why is it important for people to know about this and be involved in the process?
Our doctors, nurses, therapists and other specialists can provide professional views on what services we need to provide for Devon, based on historical data, available staff and funds, and predicted population trends. They can also develop a range of potential solutions to the challenges we face, which may involve changing the way we currently provide services. We need to work out how any changes to existing services would impact on communities across Devon, and find out local people’s views on what is important to them. Any decisions will only be made after rigorous engagement and, where required, formal consultation processes. We hope local people will take a full and active part so that together we can achieve the very best outcomes for our population.
What is the acute services review?
This review is looking at some of the specialist services provided by our four main hospitals, in Barnstaple, Exeter, Plymouth and Torbay. We need to do this review because we are facing critical workforce challenges in some areas and because we want to make sure we can deliver safe and sustainable 7-day services for the whole of Devon. We also need to make best use of our limited resources – both staff and money.
A number of priority services have been chosen for urgent review because of the challenges they face. These include three priority services whose reviews started in November 2016:
- Maternity, new-born babies and children’s services
- Urgent and emergency care services
A number of other reviews are also getting underway in spring 2017. These include:
- Ear nose and throat
- Interventional radiology
- Interventional cardiology
- Vascular services
Does the plan to engage and consult people mean you are planning to close hospitals or services?
No. There are no fixed agendas and no proposals on the table. One outcome of the clinical workshops could be a proposal that nothing changes – although this is unlikely, as the reason for these reviews is that services are at risk of becoming unsustainable.
The purpose of the review is to ensure we are able to provide safe and sustainable services for all our communities into the long-term future. A key principle of the review is to ensure that service changes do not put at risk the safety of any of our four acute hospitals or their populations.
Is the remoteness of some of our communities being taken into account?
Yes. There are clinicians and patients involved in these reviews who are aware what it is like to live in some of our remote communities. Access and travel times are a key consideration and will be part of the criteria used when we come to develop options for future services. At the same time, we also have to make sure that our clinicians see enough cases in order to maintain their skills, and that we can safely staff all our services.
Any options will have to balance these considerations, amongst others. We may need to be creative in order to find the answers. For example, rather than moving patients, could we move our consultants around in certain specialisms so they see more patients? Could we provide more services out of the hospital setting? These are the sorts of conversations our clinicians are having and sharing with the public.
Why has there been such a focus on services being lost from North and South Devon?
There are no proposals on the table to remove services from any of our four hospitals. Each review will discuss the specific service needs and challenges before considering a range of potential scenarios for the future. We will not be producing proposals for change until we have heard people’s views on the criteria for deciding on service change.
Whilst we have been very clear that there are no proposed changes on the table, people are worried about our remote communities and clearly think our smaller hospitals may be vulnerable, so want to protect them. We know people want answers and we are going through a thorough process to make sure we get the best solutions for Devon. We will share any proposals for change as soon as we can, but do not anticipate it will be until at least summer 2017.
How can we realistically expect to increase community services when there is difficulty recruiting staff?
One of the strengths of taking a Devon-wide approach is that we can share information and resources. We also need to review how we currently staff our services. For example, do all our services/clinics need to be led by senior doctors – or could nurse practitioners and therapists run more of them? We are also already working more closely with our partners in the community, voluntary and charitable sectors. They will likely play an important role in providing capacity to deliver more community-based services in future. Whatever proposals emerge from our reviews and our planning work, a key part will be to develop a workforce strategy that supports the safe delivery of 7-day services across Devon.
Staff are our greatest asset and they are dedicated to delivering high-quality care. Whatever their role, they need to have the right skills, experience and tools. Changes to how and where care is delivered will inevitably mean staff will need to work in different ways, developing new skills and competencies and providing care potentially in different places. We will involve and support all our staff as our plans develop. We will also put in place robust assurance processes so that appropriate trained staff are in place before we change any services.
Financial support for healthcare students has been taken away; do you have the power, scope and opportunity to operate independently in the Devon STP to counter this?
We do have some flexibility. For example, our STP is running a pilot for a new assistant nurse role, working both in the hospital service and the care home sector. It has been a challenge for us to recruit locally educated nurses. Until recently, nurse training has only been available in Plymouth. This September Plymouth University will re-open a school of nursing in Exeter, which will mean we have another satellite education and training site to work with. The change in bursaries has impacted the number of applying for nurse training. However, whilst the numbers applying to study nursing have gone down, there are still more applications than the number of places available.
It is important also to continue building our apprenticeship programme, as it offers different routes of access for people who may not feel ready at 16 – 18 to start the full nurse training placement. Or they may need more support to reach the appropriate academic standard. By working together across our STP we can create different opportunities for people to come in to training and improve the access and channels into healthcare professions.
It appears that STPs across the country are working to arbitrary budgets give to them by government. Would it not be preferable to start from the position of need and work out what the costs will be for each STP?
Whilst we would all like to see an unlimited pot of money for the NHS, the government has made it clear that we have to work within our allocated resources.
The NHS receives a set allocation of money each year. This is set by a national funding formula that takes into account factors such as population, deprivation and other criteria like age.
Our job is to make sure we use the money that we receive wisely. When we review services we want to make sure we are meeting people’s needs in the best and most cost-effective way we can.
Is this about saving money?
The review is driven by challenges we are facing in continuing to provide safe 7-day services across our four hospitals in Devon. Our aim is to secure working arrangements which ensure we are able to deliver safe and sustainable services into the long-term future. Whilst there is no requirement to save money, we have to make sure that services are affordable and make best use of the staff and funds we have available to us.
Why are you closing 600 beds?
There are no figures yet for closing a specific number of acute hospital beds. Our aim is to treat people closer to home or in their own homes, and this is likely to lead to a reduction in the beds that are needed. In South Devon, where there is an integrated care organisation, the Trust has already invested in extended community services and is now starting to take some beds out of Torbay Hospital. No services are being cut or reduced: we are just working differently. Across Devon, we are also reducing the number of community hospital beds, after full public consultation, as more services are now being provided to people at home or in their local area.
For our acute services review, we have not yet developed any proposals. The engagement we are currently undertaking is to understand what people think is important when setting criteria for service change. That will feed into our development of options for change – and if there are any proposals that involve significant service change, then we will carry out a formal public consultation.
Will there be enough beds left for winter pressures?
The NHS has to plan for peaks and troughs in activity and each year we carry out a detailed winter planning process. This looks at all our services, not just hospital beds and is based on what we know about historic activity trends and projected changes in population. With our new model of care we are increasing out of hospital capacity, and this will be in place to support winter pressures. This is already working well in Northern Devon. If our hospital capacity comes under severe pressure or if there were a pandemic outbreak then the Trusts and CCGs would work together to make best use of all available NHS space across our estates.
What are the next steps after these events?
Responses and feedback from these meetings will be presented to the STP clinical cabinet and chief executives and shared with our partner organisations.
We are working with the independent body, Healthwatch, to ensure that the views of our wider staff, stakeholder and public are incorporated into our planning and thinking at the earliest stages. For example, people are already telling us they feel strongly about travel times and distances so we expect this will be an important element to consider as we develop our plans.
By summer 2017, we hope we will have had sufficient feedback from clinicians, the public, finance and workforce professionals to draw up proposals about how we make sure Devon’s acute hospital stroke, maternity and urgent care services are fit for the future and provide the best possible care for our patients.
Once we have proposals on options for change, then we will bring these back to the public and staff. We will also follow a rigorous assurance process, which includes submitting any proposals to NHS England for scrutiny, sharing them with the Overview and Scrutiny Committees of our local authorities and formal public consultation where appropriate.
Why did you only hold 12 events in limited areas during March 2017?
The locations for a series of pre-consultation discussion events were chosen specifically to give a fair and equal spread across Devon. The aim of these events was to gather feedback on the criteria we set for making decisions about the future delivery of acute hospital services in Devon.
We understand that people want to be able to take part in discussions in their own community but we chose the venues for these preliminary discussions to give as many people as possible access while making the best use of our resources.
The discussion events are not the only opportunity people will have to be involved. Anyone can sign up at firstname.lastname@example.org to receive regular updates via our STP newsletter and to send us feedback.
If further events are planned in the future as part of the review then locations, capacity and reaching a representative cross-section of our population will always be given careful consideration.
As Cornish Community Hospitals/MIUs close, patients will find it difficult to get from Launceston to Liskeard, at which point isn’t it likley that patients wont think about the boundaries of CCGs but will go straight to acute services in Plymouth?
NHS patients already receive care in settings that are across boundaries. For example, around a fifth of patients who receive care at Plymouth Hospitals come from Cornwall.
The NHS will always support people to choose the most appropriate service for their particular need.
In many cases patients can receive alternative care from a pharmacist or GP. The national 111 service is always available to help people make the best choice.