1. Introduction to the STP
Nicky Poulain
Director of Commissioning and Integration
Luton Clinical Commissioning Group
Healthwatch Luton Open Public Board meeting January 2017

2. What is an STP?
An NHS England initiative, enabling local NHS organisations and councils to work together to transform local health and care services, to meet the NHS ‘triple aim’
44 STPs in England – regional ‘footprints’
Our ‘footprint’ is Bedfordshire, Luton and Milton Keynes (BLMK)
Covers all publicly-funded health and care services including community and social care, GP services, hospital and specialist care, ambulance services, urgent and emergency care
NHS triple aim

3. 16 BLMK STP partners

4. The BLMK area More than 1 million people live in BLMK
Bedford Borough and Central Bedfordshire - a population with a higher than average number of people aged over 75
Milton Keynes - one of the fastest growing populations in the country
Luton - one of the most ethnically diverse populations in the country
More than 1 million people live in BLMK

5. Why an STP?
Mark England
Chief of Staff (Sustainability and Transformation Plan - Bedfordshire, Luton and Milton Keynes)

6. A quiz…
How much do you know about health and social care in BLMK?

7. Q1.
What % of NHS Clinical Staff in BLMK work in primary care? (eg. GP surgeries, community clinics etc) 9%
29%
49%

8. Q1.
What % of NHS Clinical Staff in BLMK work in primary care? 9%

9. The % of NHS Clinical Staff in BLMK work in Acute Care

10. Q2.
For every acute care bed, how many care home beds do we have in BLMK?
1 acute to 1 care home
1 acute to 2 care home
1 acute to 4 care home
1 acute to 5 care home

11. Q2.
For every acute care bed, how many care home beds do we have in BLMK?
1 acute to 5 care home

12. 2-4 years 0-2 years 6-8 years 12 years Q3.
Luton, what is the gap (in years) in healthy life expectancy from the best to worst area?
2-4 years
0-2 years
6-8 years
12 years

13. >12 years

14. Increased by 16% Increased by 46% Increased by 67% Q4.
By how much have emergency admission to LDUH per year (excluding mothers and babies) changed over the last 6 years?
Increased by 16%
Increased by 46%
Increased by 67%

15. 46%

16. Q5.
What percentage of all contacts between people and the NHS take place away from hospitals?
0-25 %
26-50 %
51-75%
76-100%

17. Q5.
What percentage of all contacts between people and the NHS take place away from hospitals?
80%

18. Detail within the STP Nicky Poulain
Director of Commissioning and Integration
Luton Clinical Commissioning Group
Healthwatch Luton Open Public Board meeting January 2017

19. Why is change needed?
Our staff and population are proud of our services, but we know we can make them much better
There are significant differences in health, wellbeing and life expectancy across BLMK, depending where people live
We have a growing and ageing population which will increase demand for health and social care services
If we do nothing, by 2020/21 the cost of meeting that demand will far outweigh the money available to us
(forecast to be -£311 million across BLMK if nothing changes)
Our workforce is ageing and we face challenges recruiting health professionals in primary, community and social care

20. Health and wellbeing
Large inequalities in life expectancy across BLMK, depending where people live
One in five children overweight by the age of five, rising to one in three by the age of 11
Smoking remains the single greatest preventable cause of ill health and early death; 1 in 10 expectant mothers smoke
Alcohol-related hospital admissions are rising across BLMK
The four main causes of early death are diabetes, cardiovascular disease, cancer and chronic obstructive pulmonary disease (COPD)
Depression and severe mental illness rising
85+ age group predicted to grow faster than the rest of the population in the next 20 years

21. Care and quality
GP practices have more registered patients per GP than the national average, which can mean some patients have difficulty getting an appointment
Our workforce is ageing and we face challenges recruiting health professionals in primary, community and social care
Patients not always clear how to access urgent care services, with a number of different organisations operating NHS 111 and GP out-of-hours services across BLMK
Hospitals struggling to meet demand while maintaining national standards
Ambulance performance under severe pressure

22. Funding and finance
Current combined annual budget for health and social care in BLMK = £1.33bn
Funding is expected to rise by 26%, to 1.67bn by 2020/21
But
If we don’t change anything, this increase will be absorbed by rising demand for services
If we don’t change, by 2020/21 our spending will exceed our income by £311m a year

23. Funding and finance
Luton CCG has an allocation of £268m in 2016/17 and an historic deficit of £24m brought forward. This has to be repaid in full.
At the start of the year the CCG planned a surplus of £3m but it has now been agreed with NHS England that we will breakeven financially
The main reasons for the movement are additional activity within the acute sector, above planned levels, and savings plans have not delivered to the level expected.
The CCG is required to comply with NHSE business rules and set aside reserves, which it is not allowed to commit.

24. Funding and finance
Luton CCG has an allocation of £268m in 2016/17 and an historic deficit of £24m brought forward. This has to be repaid in full.
At the start of the year the CCG planned a surplus of £3m but it has now been agreed with NHS England that we will breakeven financially
The main reasons for the movement are additional activity within the acute sector, above planned levels, and savings plans have not delivered to the level expected.
The CCG is required to comply with NHSE business rules and set aside reserves, which it is not allowed to commit.

25. Our vision for the future
People know what services are available, how to access them and can make informed choices about their own health and wellbeing.
GPs act as gatekeeper for people needing to access physical and mental health services. GPs lead specialist teams of health professionals and spend their own time with those most in need.
Community physical and mental health services are given equal focus, working with GPs for better patient care. Care is co-ordinated to avoid multiple home visits to patients. Mobile technology and shared care plans allow community care workers to spend more time with their patients.

26. Our vision for the future
Care home staff are vital members of a wider integrated team with immediate access to shared care plans. They proactively care for residents, supported by community clinicians. Local NHS bodies and councils work together to meet demand for care home places and home support.
Urgent care is well signposted with networks of walk-in centres and community paramedics / emergency response teams reaching into people’s homes. Only those with serious illness or injury feel the need to go to A&E.
BLMK’s three hospitals work together and use their resources to deliver high quality care and the very best clinical outcomes on all three hospital sites. People don’t stay in hospital any longer than they need to and more people are treated in community settings, with hospitals reaching beyond their walls to support patients and clinicians in the community.

27. Five priorities have been identified
Two ‘behind the scenes’ priorities
Three ‘front line’ priorities
Technology
Prevention
Transform our ability to communicate with each other, e.g by having shared digital records that can be easily accessed, using mobile technology for better co-ordinated care.
Encourage healthy living and self care, supporting people to stay well and take more control of their own health and wellbeing.
Primary, community and social care
System redesign
Improving the way we plan, buy and manage health and social care services across BLMK to achieve a joined up approach that puts people’s health and wellbeing at the heart of what we do.
Build high quality, resilient, integrated primary, community and social care services across BLMK.
Taken together, these five priorities signal an ambitious and far-reaching overhaul of the health and social care landscape in BLMK  
Sustainable secondary care
Make our hospital services clinically and financially sustainable by working collaboratively across the three hospital sites, building on the best from each and removing unnecessary duplication.

28. Supporting the patient/family
Some examples
At Home First Creating the shared vision requires on-going engagement and resourcefulness from everyone – a major iterative cultural and behavioural change programme
30 member practices
Patient groups
Voluntary
sector
Home care
staff
CCS
Virgin Healthcare
Ambulance
Trust
LDFT
Luton Borough Council
ELFT
111/OOH
STP
Partners
Live Well Luton
At Home First Team
Supporting the patient/family
(1) At Home First was trialled in Larkside Cluster in 2014 and full implementation commenced October 2015 to all 4 clusters with on-going lessons learnt
(2) Primary Care Home: Pilot commenced in April 2016 (Kingsway & Medics Cluster)
Service SpecificationEnsure that all core partners have information and resources.
Co-ordination of the At Home First team
Working with practices/clusters to identify patients who through frailty; the effects of long term conditions; risk stratification or by social deprivation/isolation need a multi-disciplinary approach to intensive case management
Deliver care co-ordination tools and techniques
Clinically assess patients for intensive case management and develop a anticipatory care plan for discussion at the MDT
Engage with providers and key stakeholders in the development of integrated working – sharing learning across the system and joint problem solving
Innovative ways of improving efficiencies through joint working (for example; development of joint posts, integrated clinics) including use of the voluntary sector and supporting self-management by patients – exploring co-location opportunities
Scoping national, regional and local best practice to support commissioning proposals
developed – AH1

29. { Some examples At Home First – Integrated Health and Social
At Home First – Integrated Health and Social
Care Service {

30. Primary Care Home
Luton CCG/CCS is one of 15 rapid test sites for the National Association of Primary Care (NAPC) Primary Care Home Model and being reviewed with Vanguards
Aligns with the At Home First model but allows us to ‘test’ 2 sites with in depth working on a small cohort to see what impact integrated working can have on a household or individual
Our test sites are within the clusters (Kingsway and Medics) to test improving diabetes outcomes and use of medicines

31. How you can get involved
Do you have any local events coming up to talk about STP? Or contact with local organisations?
Come along to future STP events – register on to keep updated
Complete our feedback survey by 10/2/16 – ongoing opportunity to feedback at any time
No decisions have been made or will be made without further discussions with the public, staff, politicians and voluntary sector organisations
We will consult formally on any major service changes or decisions that impact on staff
Online at
Call
By post –print off a feedback form at and post it to us, or send a letter to Bedfordshire, Luton and Milton Keynes STP, Milton Keynes University Hospital, H8 Standing Way, Eaglestone, Milton Keynes MK6 5LD

32. Thank you for listening! Any questions?