Herefordshire and Worcestershire Sustainability and Transformation Plan Update 27.6.17

Work continues on Herefordshire and Worcestershire’s Sustainability and Transformation Plan STP).  Some work on the plan was delayed during the General Election period, but has now resumed.  With Jeremy Hunt reinstalled as Secretary of State for Health, and Simon Stevens still leading NHS England, it appears that the plans will continue to form the basis for planning health services across England for the foreseeable future.

Locally, the STP has been updated to incorporate the feedback from the engagement process earlier this year, and the key themes are:

Out of hospital care
Many respondents support the idea of having well-publicised, local services provided by a range of health care professionals who are available at known community bases/health hubs. Decisions around which service/professional a patient should access should be made by clinical, not administrative staff.  There is strong support for much routine, non-urgent and non-specialist care to be provided at home/in the community/out of hospital.  Many respondents would like to see many more services provided locally and support the idea of local health teams caring for patients at home. 

General Practice
Access to services at present is not straightforward and is more complex for particular groups.  Many respondents believe that access to GP services needs to be changed with good support for the idea that some might see a professional other than a GP, and the proposal that GP appointments should be kept for those who really need them.  Respondents support the suggestion that GPs should support local health teams and believe that more professional time should be allocated to those who need it.  However, many do not support the idea of Skype being used for routine appointments. 

Accident and Emergency services
A lack of 24/7 local options and out of hours GP services are seen as key contributors to the challenges being faced by A&E.  Respondents want A&E to only treat those who need to be in A&E and many people support the proposal to re-direct people to more appropriate sources of treatment.  Whilst some respondents feel that information could help in this regard and offer suggestions where and how this could be provided, others believe that the issue is more about education that needs to be provided at the point of access so that people start to learn what is provided where. 

Prevention and self-care
Most people recognise they have a responsibility to look after their own health but currently, information about health and services and what people can do for themselves is difficult to access, sometimes contradictory, and often confusing.  Respondents want clear information about all services/conditions provided in one trusted place or by trusted individuals or organisations that are known to them and their community. Some respondents recognise that information is not enough for those with entrenched or habitual behaviour, calling for health coaching/motivational interviewing support.  Much more prevention and self-care information should be communicated through schools and workplaces. 

Views on technology are mixed; some people like it, some do not, and this engagement would suggest that preferences do not reflect gender or age variables.  However, in Worcestershire, it would suggest that preferences are linked to ethnicity, with minority ethnic groups much less supportive of technology than White British groups.  The feedback across the footprint indicates that overall, different people like different IT solutions.  The perception of whether or not it is useful, often depends on the service/groups it is being proposed for and many respondents felt they had insufficient detail at this stage to comment more fully. 

Transport and Travel 
For the majority of people who responded through the Your Conversation engagement transport and travel was not a issue but the data does suggest that transport remains a challenge for some particular groups.  In Worcestershire this seems to include some patients in the North of the county, as well as some carers, both of whom indicate that they do not have access to transport options.  Similar concerns were expressed by some Herefordshire residents who are concerned that they will not be able to access appointments when they no longer drive as there are reduced or no public transport options in some places. It is suggested that greater flexibility and a broader system response is taken to address the issues identified around travel and transport challenges and that these are considered early in relation to specific STP proposals.  

Bed reductions
There is concern about reducing the number of beds, based on the view that beds are still needed and a lack of knowledge/understanding about the alternatives on offer. This was mainly relating to Community Hospital bed reductions and limited detail around the skills and capacity required  to support and care for people in their home.

If carers are going to be asked to do more and to become care partners, more work is required to identify, support, train and involve them.  Many carers asked for breaks or respite periods. 
Better use of resources Many respondents were keen to offer views around how services could be made more efficient; including better use of resources like pharmacists, mobile units and community venues.

The revised version of the STP will be published shortly when it is presented at the Worcestershire Health and Wellbeing Board on 11th July.

In the meantime, discussions continue about VCS involvement in the plan.  Following the presentation on the VCS at the STP Programme Board at the end of April, further meetings have been held to discuss how this involvement should happen in practice.  There is a recognition that VCS involvement to date has not been embedded across work streams and priorities, and that those involved must do better. The Board will be asking workstream leads for assurance that that it takes place in reality, and the means of monitoring this is being developed.  More information about this will follow in the next edition of CLiCK.