STP WATCH: NHS plan for future healthcare in 'footprint' that includes Wiltshire is finally published - it's a work in progress
The eagle-sized Sustainability and Transformation Plan (STP) for the footprint made up of Bath & North East Somerset, Wiltshire and Swindon (BSW for short) has landed and is available for all to read here. But note that the cover calls it an "Emergent Plan" - it is not finished and will change over time.
Perhaps it would be best not to try to print it out - it is long with lots of colour, graphs, tables, photos and more tables. And some of it is in a very small typeface and best read on an enlargeable screen.
Much of the thinking behind the plan and most of the aims have already been made public - in the STP summary that was published a month ago.
But if you want a glimpse into the complexity of planning the future of the NHS in such a diverse area, you can read it all here - eight months work by three CCGs, three hospital trusts, three councils and many other NHS organisations, all 'condensed' into 73 pages.
Some of it is good old 'motherhood and apple pie stuff'. One of the six 'design principles that underpin our work' reads: "To transform our services we’ll put people at the centre of our healthcare planning, ensuring they receive the right information and access to services that will help them lead lives free from disease and ill health."
Some of it leans towards the opaque: "The complexity in understanding the capacity and demand of the entire health system is a challenge facing all footprints and our current thinking reflects the need to take a population-based approach to planning."
And some of it is scary: "We expect that we will need to deliver over £200 million savings over the five year period, through transforming clinical services: through planned care, urgent and emergency care, as well as through preventative and proactive care approaches."
Healthcare's financial gap across the BSW footprint is estimated to be £74 million in 2017/18 "...if we continue to provide services in exactly the same way" as now. And by 2020/21 that gap could be £290 million a year.
But it also states: "Our plan doesn't mean doing less for patients or reducing the quality of care provided. Neither does it mean shutting emergency departments." At the same time it wants to "shift the focus of care from treatment to prevention and proactive care."
Much of what the plan calls for is already being carried out by Wiltshire CCG. But there are future changes that will affect local patients.
The merging of Pewsey and Marlborough medical practices fits with one STP aim - with perhaps further mergers to come: "In some cases, General Practices will come together in networks, providing services to 20,000 to 50,000 people. This will enable the practices to share resources and host health professionals and specialist teams working across a wider geographical area."
There is also a warning about the number of places that deliver NHS services. The footprint includes about 200 NHS sites and costs £175million a year to operate: "From a funding perspective, we will simply not have the resource to maintain all our existing sites..."
Something's got to give. In 2017/18 the work plan mentions "Business cases for PFI [private finance initiative] put to NHS Improvement" - so some new building or reconfigurationn of buildings lies somewhere behind some of these plans.
Another main theme of the Plan is that the three acute hospitals that serve the area (Salisbury, Royal United in Bath and Great Western) will be working more closely together and they have formed a Joint Collaboration Steering Board to make sure this happens.
There is one surprise: although BANES (Bath and North East Somerset) is part of our BSW STP footprint it is also part of the West of England Devolution Agreement (agreed in June) so it might not remain part of the BSW footprint.
In the somewhat oblique words of the plan this "has potential implications for B&NES Council and CCG regarding the appropriate STP footprint for those organisations." However the Agreement does not include the devolution of health policy or provision.
The plan is complex and it is full of NHS jargon and acronyms (watch for LTC, SWAG, WRaPT, CCGPPI, CIP, QIPP, S&T funding - oh, and FYFV, which is NHSE's Five Year Forward View which underpins the whole enterprise) and it has no glossary:
"We are publishing it to share our early thinking and to engage our wider workforce and residents inn its future design." It really is still 'emergent' - the next version is due to be published in May 2017.
"How you can give your views
A programme of public events and briefings about our STP will start in January 2017 and will continue over the next three months. Please check on the CCG website for either B&NES, Swindon or Wiltshire for future updates about our engagement programme. We expect that this period of engagement will then inform the next version of the STP to be published in May 2017.
Any future potential NHS service reconfigurations would still require their own case for change and formal consultation process in their local area, in line with NHS statutory duties (and other NHS policy guidance) to engage and consult.
This offers a number of opportunities for local authorities, NHS organisations, community and voluntary sector organisations and other interest groups to consider the draft plans as they develop and for their views to inform the next stages.