Northumberland, Tyne and Wear, and North Durham

Draft Sustainability and Transformation Plan (STP)

Report on engagement activity around the vision, principles and approach of the draft STP 23 November 2016 – 20 January 2017

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1. Background

In November 2016 health and social care partners in Northumberland, Tyne and Wear, and North Durham published a draft sustainability and transformation plan (STP)

This was one of 44 plans developed across England to enable the implementation of NHS England’s Five Year Forward View.

On 23 November 2016 the partners launched a period of engagement to raise awareness of the draft plan and address any concerns about the proposed vision, ambitions and approach to improving the health of 1.7m people living in Northumberland, Tyne and Wear, and North Durham, which was set out in the plan.

In line with best practice guidance this phase of engagement was specifically targeted at civic engagement, which aims to seek the views of community, charity and third sector groups and individuals with an influence on local civic life.

While not the primary focus of this phase of engagement, comments were also welcomed from of individual members of the public, patients and staff who choose to share their views on the draft plan.

The health and social care partners who led the development of the draft STP were clear that this phase of engagement would help to inform the development of the final STP.

2. Approach to Engagement

Each partner organisation took responsibility for engaging with their staff and key stakeholders around the detail of the draft plan. The full plan, a summary document and survey were posted on each organisation’s website and publicised via:

Engagement launch and reminder media releases that were used by the regional media

information sent directly to community and voluntary/third sector organisations

details circulated in partner organisations’ communication tools for staff eg newsletters, e.bulletins

information sent to people who had signed up to various patient and public engagement channels run by each clinical commissioning group in the area.

At the same time as this phase of engagement around the draft STP, a number of other engagement and consultation activities were being carried out in the region around other change programmes. This included the future of community hospitals in Northumberland and service change at City Hospitals Sunderland NHS Foundation Trust and South Tyneside NHS Foundation Trust. Engagement activities to support

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these change programmes were also used to share information and seek views about the draft STP.

In those areas were other engagement activities were taking place five public meetings were held to give local people the opportunity to discuss the draft plan.

A total of 96 individuals and organisations responded to the survey, which asked the following questions:

What do you think about the draft STP vision for our area? Is there anything missing or more we should aim for?

What do you think about our ambitions for what health, well being and services should look like by 2021? Is there anything missing or more we should aim for?

The Five Year Forward View identifies three main gaps – health and wellbeing, care and quality, funding – what do you think about the proposed actions to address those gaps locally? Is there anything missing or other actions we should take?

What do you think about the scale of the challenge facing us in making significant improvements to health and well being, services and efficiencies? Are there any actions we could take to make these changes or speed up the rate of improvement?

We will only achieve these ambitions for our area by engaging local populations, the people who use our services, and the staff that provide care. Have you any ideas of who we can effectively engage with the 1.7m people in Northumberland, Tyne and Wear, and North Durham?

A total of 165 people attended the five public meetings. Each started with a presentation about the draft STP by a senior manager or clinician from the health and social care partners that developed the draft plan. The presentation was followed by facilitated round table discussions that focused on the key questions asked in the survey. This format also gave attendees the opportunity to make any other comment on the draft STP. Detailed notes were made of all the questions, comments and responses given during the meetings.

A further 55 written responses were also received from individuals and the following organisations:

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North Durham Clinical Commissioning Group Alzheimer’s Society British Medical Association South Tyneside Health and Wellbeing Board Great North Air Ambulance Newcastle’s Elders Council Gateshead Health NHS Foundation Trust Durham County Carers Support Keep Our NHS Public North East Royal College of Physicians Newcastle Community and Voluntary Service Sunderland All Together Better Board Unison Royal College of Nurses Women’s Voluntary and Community Service Clinical Council for Health Commissioning Local Medical Councils for Gateshead and South Tyneside, and Newcastle

and North Tyneside North Durham Clinical Commissioning Group’s Patient, Public and Carers

Engagement Committee Tyne and Wear Fire and Rescue Service ACORN patient participation group. Gateshead Council Durham County Council

3. Key themes

This report aims to highlight the main themes that were raised during the engagement for consideration by the health and social care partners responsible for developing the final STP. Full details of all the comments received throughout this phase of engagement are contained in the appendix.

The Vision

The draft STP vision for the area was described as:

Everyone who lives, works, learns in or visits the area will realise their full potential and equally enjoy positive health and well being

Safe and sustainable health and social care services that are joined up, closer to home and economically viable

Local people are empowered and supported to play a role in improving their health and well being.

The engagement phase emphasised that delivery of the draft STP would mean that by 2021:

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the health inequalities in our area will have reduced to be comparable to the rest of the country

we will have thriving out of hospital services that attract and retain the staff they need to best support their patients

there will be high quality hospital and specialist care across the whole area, seven days a week.

Few people, who contributed to the engagement, disagreed with the vision and a number commented that the vision was laudable. Some even suggested that the area should aim higher and strive for better health and wellbeing than other parts of the country rather than just working towards the comparable levels.

However there were many questions about how the area’s health and social care partners would achieve the vision within the timescales of NHS England’s Five Year Forward View (5YFV).

The Engagement Process

Many people seemed unclear about the purpose of the engagement process and a number expressed frustration that the draft STP did not include more detail about how the vision and aspirations for the regional would be achieved.

The majority of people who took part in this phase of engagement wanted to debate the detail of how implementing the vision would affect particular services, with concerns raised about potential changes or loss of current services that they value.

There were a number of negative comments about the format of the full STP with many commenting that it was written in jargon, much of which was not easily understood by people who did not work in health and social care.

There was a clear message from many respondents about the need for an open, transparent and inclusive consultation process that enabled people to be involved in shaping services for the future and able to contribute to an informed debate about the options for the future of the local health and social system.

There were also many offers of help - particularly from third sector and community organisations - to support any future consultation process.

Finance

The greatest level of feedback was around finance and the strongest view expressed by many who commented on the financial aspect of the draft STP, was that the vision and aspirations were unachievable within the current resources available in the region.

There was scepticism from some responders evidenced by claims that the aim of the draft STP was simply to cut services to save money. Even those people who accepted that the area was facing particular challenges in terms of managing

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increasing demand for services, stated that more should be done at a national level to challenge the growing funding gap.

A number of responders who accepted that services needed to change suggested that double running costs would be needed to operate existing services while changes were made, particularly in relation to investment in health promotion and education.

There were also a number of questions about the detail of how the draft STP would make the required savings.

Tackling health inequalities

Mirroring the support for the draft STP’s overall vision responders also acknowledged the need to tackle health inequalities in the region, with a particular focus on smoking, obesity and exercise.

However even those supportive of such initiatives stressed that such lifestyle changes were unlikely to positively impact on the health of the population and, in turn reduce demand on services, within the timescales of the Five Year Forward View (5YFV).

While there was clear support for the need for initiatives to improve the underlying health of the population, there were questions about the available funding for such initiatives, as well as calls for organisations to work more closely together to learn from successes elsewhere.

Workforce

Concern was expressed by some respondents about the impact of changes in the health and social care workforce impacting on the area’s ability to achieve the draft STP’s vision.

This included the end of nursing bursaries potentially resulting in fewer people training to be nurses, an ageing workforce, not enough GPs to meet demands, and a perceived lack of quality care staff to support an increasing elderly population.

People were particularly concerned about how the health and social care system could achieve the ambitions of care closer to home and seven day working with the many pressures facing the workforce.

A number expressed fears that if there were workforce gaps the system was unable to fill then greater demands would be put on carers and the voluntary sector, who were also under increasing pressure. These groups asked for the final STP to address those concerns

Geography and access to services

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Not unsurprisingly those respondents who lived in rural parts of Northumberland and North Durham raised the ability to easily access services. They were particularly concerned about any service that may move or be centralised as a result of the draft STP, citing very real transport issues for people needing to travel from rural to urban areas and the potential demand on an already stretched ambulance service.

In North Durham respondents also commented on the perception of services in the county being split between two STPs areas – one for the north and other for the south of the county. They raised concerns about services on the borders of the two areas and some were unconvinced about the arguments put forward to justify the separation.

The role of local authorities

A number of respondents perceived the draft STP to be a document focused on health services and questioned the level of involvement of local authorities in its development.

They also raised concerns about the ability of the local health and social care system to be able to achieve the draft STP vision at a time when care budgets were also facing significant pressures.

What does it mean for me?

As described earlier many people who took part in the engagement activity appeared to expect the draft STP to be more detailed in describing changes to services and they wanted to know what it would mean for them and their individual health and social care needs.

Some people highlighted that the draft STP was not specific about meeting the needs of certain groups in society, including people with mental health problems or learning disabilities, young people and carers.

They were explicit in wanting to see the draft STP’s impact on those services explained in the next iteration of the plan.

4. Conclusion

This phase of engagement was relatively successful in reaching its core audience – those involved and influencing civic life.

Those that took part raised a number of common themes that should be carefully considered in the development of the final draft of the STP.

Any future consultation should embrace the offers of support made by community, charity and third sector organisations to ensure that a broad a reach of those people living in the area and working in the health and social care system have an opportunity to comment on the final STP.

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It would also be helpful to consider the many questions raised by those who took part in this phase of engagement and look at ways of answering those concerns either before or during any planned formal consultation.

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Appendices

1. Written responses

2. Public events – Durham, Newcastle x 2, Gateshead, Whitley Bay

3. Engagement activity in Northumberland

4. Engagement activity in Sunderland & South Tyneside

5. Survey responses

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