STP S : A NATIONAL PERSPECTIVE Chris Hopson Chief Executive 31 October 2017
What I will cover • Why have STPs? • STP progress • STP areas of focus • What STPs are finding difficult • Five keys to unlocking success?
Why have STPs? (1) The existing model of health and care provision is rapidly breaking down: • Too fragmented • Too focussed on treating illness • Too focussed on acute hospitals • Too oriented to 20th century disease patterns • Too much variation in outcomes • Too much of a gap between rising demand and capped funding rises • Too slow to take advantage of innovation and new technology
Why have STPs?(2) We need to move to a different way of providing health and care: • Integrating physical, mental and social health care: GPs, community care, hospitals, social care services, mental health provision • Much greater emphasis on preventing ill health and supporting citizens to improve / maintain their own health and wellbeing • Moving care closer to home, and keeping acute care only for when it’s needed, shifting resources, redesigning services and repurposing buildings • Supporting citizens to manage own, more prevalent, long term conditions • Improving outcomes and reducing the current wide variation in outcomes • Increasing efficiency and productivity whilst trying to slow down increases or even reduce demand for health and care services • Much better use of IT and quicker take up of new innovations / best practice to support these changes
Why have STPs? (3) Successfully delivering these new models of providing health and care requires local systems to: • come together • change what they do • alter how they work together, and • work towards a different new future. STPs are the vehicle for doing this.
Why have STPs? (4) Though there is a danger of overloading STPs, as some would also like them to focus on: • Fully closing the very large looking 2020/21 NHS financial gap • Creating a new, quasi SHA, pan CCG/trust, financial and delivery performance accountability, structure • Being the new unit / footprint for planning and delivering everything from money and delivery to workforce and specialised service strategies
STP progress and areas of focus If you’ve seen one STP……you’ve just seen one STP! There is significant variation between STPs, which is growing fast • A few rocketing ahead at pace and moving to become accountable care systems or organisations (don’t get hung up on definitions) • Long standing good relationships and system working and/or • A head start • Right size and shape of footprint • A small number stuck and struggling: • Size / shape of footprint and number of players in footprint • Poor relationships and history including tensions / jockeying for position between institutions and / or sectors • Distracted / weighed down by poor day to day performance e.g. A&E performance or the size of task to close the 2020/21 financial gap • A lot in the middle!
STP areas of focus (1) All STPs vary on areas of focus….but there are some common themes • What it takes to work as a single system, not a collection of institutions including new ways of taking decisions and making money/contracts work • Vertical integration: bring together existing fragmented health and care services, run by individual institutions, usually in a sub STP footprint • Move care closer to home: • shrink the acute sector and “swap” for primary care at scale meets bulked up community services; • centre care on more capable, prevention / upstream focussed, community hubs; • develop whole population health approach and risk stratification; • redesign hospital specialist consultant service to support; • strong focus on redesigning frail elderly pathway as driver of current acute volumes; • explicit acute demand reduction to allow bed closure / resource reallocation
STP areas of focus (2) • Horizontal integration: • rationalising number of CCGs; • reconfiguring acute services on a wider footprint e.g. moving to share service lines across neighbouring DGHs and reviewing provision of specialist services • sharing back office services; • stripping out non frontline care cost
What STPs are finding difficult • Relationships and whole system thinking…particularly where there are lots of different players • Matching the STP system idea to long standing legal/cultural focus on individual institutions: avoiding getting stuck on governance • Getting head round the “footprint conundrum”: all roads DO NOT lead to the STP e.g. Accountable Care on sub STP footprint • Properly and fully engaging GPs, local authorities and clinicians…particularly important in delivering service redesign • Moving beyond a focus on the pattern of acute services • Getting anywhere near fully closing the financial gap • Delivering a true focus on prevention
Five Keys to Unlocking STP Success? • Quality of relationships between ALL key players in local system: GPs, local authorities, CCGs, hospitals, community/mental health providers • Unequivocal willingness to prioritise the needs of patients and the system at the expense of the individual institution • Ruthless focus on a small number of practical priorities and not trying to boil the ocean • Driving rapid, on the ground, practical improvements in chosen priority areas…not just trying to build a grand plan • Pragmatism meets continuous improvement. Try new stuff and if it doesn’t work, improve it based on lessons learnt.
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