1. STPs – the future of health and care
Jane Meggitt, STP Engagement Lead
Future East event – Kings House, Bedford
28 March 2017

2. Today’s discussion: An overview of the STP
An overview of the STP
Discussion paper: “Seeking your views”
Engaging with the public
How local people and groups can help shape future plans

3. What are STPs all about?
A national 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 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

4. 16 BLMK STP partners

5. October submission Our October 2016 submission to NHS England set out:
Our October 2016 submission to NHS England set out:
What the STP is all about
The challenges faced by our local health economy
BLMK STP partners’ vision for the future
Five priorities and initial ideas for transforming health and care in BLMK
How we are involving you

6. The challenges we face – a quick recap
Imbalanced healthcare system
Growing, changing, ethnically diverse population
Health inequalities
Rising demand and more pressure on services
Financial challenges
Workforce ageing / difficulty recruiting
Healthcare system. Imbalance, 80% of healthcare delivered in community but 65% of clinical staff and 60% of spend is in hospitals. Only 9% of clinical staff work in primary care.
Growing and changing population. In next 15 years, local population expected to increase by 160,000 (17%), almost double national average = 1.1m people in BLMK by Children in Luton + Beds expected to increase faster than country as a whole. In 5 years’ time, + 1,000 births expected in BLMK.
Ethnically diverse. In 2014, over 1,200 babies were born in BLMK to mothers of white non-British origin. Broad ethnic diversity can have specific consequences for types of health care required and way that care is accessed.
Increasing demand. More people living with LTCs. Depression and severe mental illness on the increase. Lifestyle: 1 in 5 children overweight or very overweight by the age of 6, Alcohol-related hospital admissions rising across BLMK. Smoking remains the single greatest preventable cause of ill health and early death, 1 in 10 expectant mothers smoke, with the figure being slightly higher for Luton at 14%.
Pressure on services. Hospitals struggling to meet demand while maintaining national standards. GPs more registered patients per GP than national average = difficulty getting appointment / more people at A&E.
Financial challenge. Current budget £1.33bn, rising to 1.67bn by 2020/21, an increase of 26%. But if we do nothing, by 2020/21 spending will exceed income by £311m a year.
Workforce. Ageing, problems recruiting and retaining. In BLMK, 1 in 4 GPs (24%) are due to retire in the next 5-10 years (above national average of 21%), 15% of mental health nurses expected to retire in next 5 years.

7. 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.
HIGHLIGHT PROGRESS BEING MADE
Prevention: Falls prevention service at Bedford Hospital from April
Primary, community and social care: Consolidated BLMK GP Five Year Forward View submission sent to NHS England, in bid to secure around £7.2m funding over the next two years
Sustainable secondary care: Saving money by purchasing together, key supporting services, like radiology, are bringing systems together, so a scan can be seen anywhere in BLMK
Technology: BLMK has secured £1.7m for digital improvements to strengthen primary care, to be used to enhance SystemOne, Digital Roadmap created for BLMK area
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.

8. Initial engagement  
100+ GPS and clinicians attended the 3rd BLMK STP Clinical Conversation
186 responses to online
Survey Monkey questionnaire
144 people engaged at ‘What is an STP’ public events hosted by Healthwatch across BLMK
A report capturing initial feedback around the draft STP was published in March -

9. Key feedback themes Plans generally supported but lacking detail
Plans generally supported but lacking detail
Are the timescales realistic?
How will the proposals be funded, especially given council cuts to social care funding?
OK in theory, but implementation and communication will be key
More focus needed on mental health issues, family carers and integration of health and social care
85% of those who responded agreed that the right priorities had been fully or partially identified

10. Current thinking
Services are under significant pressure and, with demand increasing all the time, we must think differently about how those services are delivered
Our 16 STP partners are all agreed that ‘no change’ is not an option
This is not about downgrading hospitals or stopping services  it’s about delivering them differently and having our three hospitals working closely together to provide an integrated service across the three existing sites
No decisions have been made as yet
We will consult formally on any major service changes or decisions that impact on patients or staff

11. Discussion Paper, 1 March
Some more detail on the challenges we face
Main areas we’re considering for primary, community and social care (Priority 2), to support and align with any changes to hospital services
Six key focus areas for transforming hospital services (Priority 3)
How to get involved / give us your views

12. Six focus areas Emergency care Care closer to home Maternity care
Emergency care
Care closer to home
Maternity care
Planned care
Centres of excellence
As we have had these conversations, there have been some themes which consistently come up across all specialities, and some services where there are particular pressures.
We have identified six key areas that we believe we should focus on when we are talking about high quality secondary care that is sustainable for the future.
In my next slides, I will explain each of these areas in a little more detail.
I would stress that this is absolutely not an exhaustive list, and we really welcome other suggestions you might have.
Paediatric services

13. Public engagement Dr Vicky Alner Milton Keynes Hospital
Beryl Adler L&D Hospital
Cathy Jones STP Programme Director, Secondary Care
Dr Ian Reckless Milton Keynes Hospital
Paul Tisi Bedford Hospital
Jane Meggitt STP Engagement Lead
David Kirby L&D Hospital
Dr Rory Harvey Bedford Hospital
Presentations and involvement from 8 local clinicians and the STP programme team at 8 events across BLMK
between March 2017
Jim Gray L&D Hospital
Ed Neale Bedford Hospital

14. Wider engagement opportunities
12 staff events held from 8 – 29 March 2017
We also asked our staff working in health and social care across Bedfordshire, Luton and Milton Keynes for their views and feedback
Conversations in the community
We have talked to faith, carer and patient representatives.
We have also updated at local Board and JHOSC meetings.
Survey Monkey questionnaire responses so far

15. Next steps for engagement
Oct 16 – Feb 17
BLMK STP submission to NHS England
Events and questionnaire to gather your views on BLMK STP plans
March 17
Discussion Paper
Events and questionnaire to gather your views on transforming health and care
April 17
‘What we’ve heard so far’ paper published
Incorporating public, clinical and staff views
May 17
Formal ‘Case for Change’
Followed by further engagement and opportunities to input

16. Your feedback Deadline: 31 March 2017
We want your feedback on the thoughts and ideas contained in the Discussion Paper
What do you think?
Anything else we should be considering?
Call
Online through
By post – write to us or print off a feedback form at and post it to us
Deadline: 31 March 2017