Your guide to Sustainability and transformation partnerships (STPs) · 2018-02-12 · Your guide to Sustainability and Transformation Partnerships (STPs) Page 3 Introduction Ever

Your guide to Sustainability and transformation partnerships (STPs)

Your guide to Sustainability and Transformation Partnerships (STPs) Page 3

Introduction

Ever since its creation in 1948, the NHS has constantly adapted.It has adapted to growing birth rates, rising patient expectations, people’s busy 24/7 lifestyles, and advances in medicine and technology.

Some of these advances have been relatively small – changes to a local GP surgery opening times, for instance – while others have been larger in scale, such as the creation of trauma networks, or the introduction of clot-busting drugs in the treatment of stroke.

But they all started with an idea, a sense of purpose, and an ambition to improve things, so that the NHS can better serve its patients and the public.

Now, more than ever, the NHS needs to adapt once again. It needs to meet the challenge posed by the fact that we are all, thankfully, living longer, but often with a range of complex and chronic conditions.

Many of us do not require medical treatment alone, but also need help with daily living. This means that NHS staff need to work more closely with their colleagues in local councils who provide social care, so that all an individual’s needs are met.

Many people can now be better cared for in their own home, so the NHS needs to meet the growing and changing

needs of patients by expanding its community and primary care services. It needs to do this against a background of financial constraint.

Sustainability and Transformation Partnerships (STPs) bring together all of the NHS and local authorities in a particular geographical area, to enable the sharing of ideas, resources, expertise and money. By working together, they have a greater chance of improving services in a way that makes sense for that individual locality.

Closer collaboration between patients, carers, the public, hospitals, GPs, local authorities, commissioners, and the voluntary sector, will result in better and more effective services for patients, making the most of every pound that is spent.

STPs are evolving. Some are ready to become Accountable Care Systems. To keep up to date, please visit the NHS England website for more details - www.england.nhs.uk/stps/

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Sustainability and Transformation Partnerships (STPs)

Cheshire and Merseyside STP Page 6

Durham, Darlington, Teesside, Hambleton, Richmondshire & Whitby STP Page 8

Greater Manchester STP Page 10

Humber, Coast and Vale STP Page 12

Lancashire and South Cumbria STP Page 14

Northumberland, Tyne and Wear STP Page 16

South Yorkshire and Bassetlaw STP Page 18

West, North and East Cumbria STP Page 20

West Yorkshire and Harrogate STP Page 22

Bedfordshire, Luton and Milton Keynes STP Page 26

Birmingham and Solihull STP Page 28

Cambridgeshire and Peterborough STP Page 30

Coventry and Warwickshire STP Page 32

Derbyshire STP Page 34

Herefordshire and Worcestershire STP Page 36

Hertfordshire and West Essex STP Page 38

Leicester, Leicestershire and Rutland STP Page 40

Lincolnshire STP Page 42

Mid & South Essex STP Page 44

Norfolk and Waveney STP Page 46

Northamptonshire STP Page 48

Nottingham and Nottinghamshire STP Page 50

Shropshire and Telford & Wrekin STP Page 52

Staffordshire and Stoke on Trent STP Page 54

Suffolk and North East Essex STP Page 56

The Black Country & West Birmingham STP Page 58

North London STP Page 62

East London STP Page 64

North West London STP Page 66

South East London STP Page 68

South West London STP Page 70

Bath and North East Somerset, Swindon and Wiltshire STP Page 74

Bristol, North Somerset and South Gloucestershire STP Page 76

Buckinghamshire, Oxfordshire and Berkshire West STP Page 78

Cornwall and the Isles of Scilly STP Page 80

Devon STP Page 82

Dorset STP Page 84

Frimley Health & Care STP Page 86

Gloucestershire STP Page 88

Hampshire and the Isle of Wight STP Page 90

Kent and Medway STP Page 92

Somerset STP Page 94

Surrey Heartlands STP Page 96

Sussex and East Surrey STP Page 98

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Population: 2.6 million

Cheshire and Merseyside STPConstituent organisations Clinical Commissioning Groups (CCGs): Knowsley; South Sefton; Southport and Formby; Eastern Cheshire; Wirral; Liverpool; Halton; St Helens; South Cheshire; Vale Royal; West Cheshire; Warrington

Local Authorities: Knowsley; Sefton; Liverpool; Halton; St Helens; Cheshire East; Cheshire West and Chester; Warrington; Wirral

Providers: Liverpool Heart and Chest Hospital NHS Foundation Trust; Alder Hey Children’s NHS Foundation Trust; Royal Liverpool and Broadgreen University Hospitals NHS Trust; Countess of Chester NHS Foundation Trust; St Helens and Knowsley Teaching Hospitals NHS Trust; The Walton Centre

NHS Foundation Trust; Bridgewater Community Healthcare NHS Foundation Trust; Wirral University Teaching Hospital NHS Foundation Trust; Mersey Care NHS Foundation Trust; East Cheshire NHS Trust; Cheshire and Wirral Partnership NHS Foundation Trust; Wirral Community NHS Foundation Trust; Liverpool Women’s Hospital NHS Foundation Trust; Warrington and Halton Hospitals NHS Foundation Trust; 5-Boroughs Partnership NHS Foundation Trust; Mid-Cheshire Hospital NHS Foundation Trust; North West Ambulance Service NHS Trust; Aintree University Hospitals NHS Foundation Trust; Clatterbridge Cancer Centre NHS Foundation Trust; Southport and Southport and Ormskirk Hospital NHS Trust; Liverpool Community Health NHS Trust

Priorities

There are four strategic priorities that partners are committed to delivering together:

• Support for people to live better quality lives by actively promoting the things that will have a positive effect on health and wellbeing and reduce reliance on services.

• Working together with partners in local government and the voluntary sector to develop joined up models of care, outside of hospital, to give people the support they need in the right place, from the right professionals at the right time.

• Designing hospital services for communities that meet modern clinical standards, reducing variation in quality and ensuring a clinical and financially sustainable hospital system.

• Becoming more efficient by reducing costs in corporate services and maximising the efficiency and patient benefits of clinical support services.

STP leader:Louise Shepherd, Chief Executive, Alder Hey Children’s NHS Foundation Trust

Contact details:Email: [email protected]

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Your guide to Sustainability and Transformation Partnerships (STPs)

Durham, Darlington, Teesside, Hambleton, Richmondshire & Whitby STPConstituent organisationsNHS Durham Dales; Easington and Sedgefield CCG; NHS Darlington CCG; NHS Hambleton; Richmondshire and Whitby CCG; NHS Hartlepool and Stockton-on-Tees CCG; NHS South Tees CCG County Durham and Darlington NHS Foundation Trust; North Tees and Hartlepool NHS Foundation Trust; South Tees Hospitals NHS Foundation Trust; Tees Esk and Wear Valleys Foundation Trust North East Ambulance

Service NHS Foundation Trust; Yorkshire Ambulance Service NHS TrustDarlington Borough Council; Durham County Council; North Yorkshire County Council; Hartlepool Borough Council; Stockton Borough Council; Middlesbrough Council; Redcar and Cleveland Council

Priorities

• Preventing ill health and increasing self-care. Helping to stop people from becoming poorly and helping to manage their health and any medical problems they already have.

• Health and care in communities and neighbourhoods. Supporting people to stay well and independent for as long as possible by improving health and care services within their area.

• Through the Better Health Programme, improving the quality of care in hospital and making sure that people get the best treatment and see the right specialist.

• Use of technology in health care - improving the ability to diagnose and develop more convenient treatment options for patients.

STP leader:Alan Foster, Chief Executive, North Tees and Hartlepool NHS Foundation Trust

Contact details: Email: [email protected] Web: www.nhsbetterhealth.org.uk


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Greater Manchester STP

Constituent organisationsBolton CCGBolton Hospital NHSFoundation TrustBolton Metropolitan Borough CouncilBridgwater Community Healthcare NHS TrustBury CCGBury Metropolitan Borough CouncilManchester CCGs (North, South and Central) Central Manchester NHS Foundation TrustGreater Manchester Mental Health NHS Foundation TrustHeywood, Middleton and Rochdale CCGManchester City CouncilNorth West Ambulance Service NHS Foundation TrustNorth West Boroughs Health Care NHS Foundation TrustOldham CCGPennine Acute NHS Hospitals TrustPennine Care NHS Foundation Trust

Rochdale MetropolitanBorough CouncilSalford City CouncilSalford CCGSalford Royal NHS Foundation TrustStockport CCGStockport Metropolitan Borough CouncilStockport NHS Foundation TrustTameside and Glossop CCGTameside Hospital Foundation TrustTameside Metropolitan Borough CouncilThe Christie NHS Foundation TrustTrafford CCGTrafford Metropolitan Borough CouncilUniversity Hospitals of South Manchester NHS Foundation TrustWigan CCGWigan Borough Metropolitan Borough CouncilWrightington, Wigan and Leigh NHS Foundation Trust

Priorities

VisionGreater Manchester aims to deliver the greatest and fastest possible improvement to the health and wellbeing of the people of Greater Manchester.

Objectives • Transform the health and social care system.

• Align health and social care systems to wider public services such as education, skills, work and housing.

• Create a financially balanced and sustainable system.

• Make sure services are clinically safe throughout.

This means• Fewer people will die early from diseases like

cardio-vascular disease, cancer and respiratory disease.

• More children will reach a good level of social, cognitive and emotional development.

• Fewer babies will have a low birth weight and have better outcomes.

• More people staying well and living at home as long as possible.

• Taking better care of those who are ill.

STP leader:Jon Rouse - Chief Officer, Greater Manchester Health & Social Care Partnership

Contact details: Email: [email protected]


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Humber, Coast and Vale STPConstituent organisationsEast Riding of Yorkshire CCGHull CCGNorth Lincolnshire CCGNorth East Lincolnshire CCGScarborough and Ryedale CCGVale of York CCGHull and East Yorkshire Hospitals NHS TrustNorthern Lincolnshire and Goole NHS Foundation TrustYork Teaching Hospitals NHS Foundation TrustHumber NHS Foundation TrustTees, Esk and Wear Valleys NHS Foundation TrustRotherham, Doncaster and South Humber NHS

Foundation TrustCity Healthcare Partnership CICNavigoCare Plus GroupCity of York CouncilEast Riding of Yorkshire CouncilHull City CouncilNorth Lincolnshire CouncilNorth East Lincolnshire CouncilNorth Yorkshire County CouncilNHS EnglandNHS ImprovementFocus, Yorkshire Ambulance Service NHS Trust and East Midlands Ambulance Service NHS Trust

Priorities

Humber, Coast and Vale STP has a shared vision for its local health system: for everyone in the area to start well, live well and age well.

• Improved health and life expectancy of the population.

• Better ‘out of hospital’ care – services that are more joined-up so people only go into hospital when it is absolutely necessary and do not stay longer than they need to.

• More efficient and joined-up hospital services.

• Better care and support for people with mental health problems.

• Improved cancer survival rates.

• Making the most of every penny to deliver good quality local services within the funding available.

STP leader:Emma Latimer – Chief Officer, NHS Hull CCG



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Lancashire and South Cumbria STP

Constituent organisationsBlackpool Teaching Hospitals NHS Foundation TrustEast Lancashire Hospitals NHS TrustLancashire Care NHS Foundation TrustLancashire Teaching Hospitals NHS Foundation TrustUniversity Hospitals Of Morecambe Bay NHS Foundation TrustNHS Cumbria CCGNHS Morecambe Bay CCG

NHS Blackburn with Darwen CCGNHS Blackpool CCGNHS Chorley and South Ribble CCGNHS West Lancashire CCGNHS East Lancashire CCGNHS Greater Preston CCGNHS Fylde & Wyre CCGNorth West Ambulance Service NHS Trust; Lancashire County Council; Cumbria Council; Blackburn with Darwen Council; Blackpool Council

Priorities

• A strong focus on population health, mobilising community assets to enable people to stay well for longer and have greater control over their health and wellbeing.

• Mobilising technologies to reduce demand on services and support the self-care/prevention agenda.

• A clear focus on improving health and wellbeing outcomes for the Lancashire and South Cumbria population.

• Making best use of resources to ensure we deliver quality outcomes and value for money.

• Improving and extending community and primary care services.

• Facilitate and support local health systems to progress to Accountable Care Systems – with a focus on the Fylde Coast initially, quickly spreading to the whole STP patch.

• A focus on holding the system to account for delivery of national clinical priorities.

• Developing and implementing an integrated health and care strategic commissioning function.

Population: c.1.7 million

STP leader:Dr Amanda Doyle (Chief Clinical Officer, Blackpool CCG)

Contact details: Email: [email protected] more information, go to www.healthierlsc.co.uk

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Northumberland, Tyne and Wear STP

Constituent organisationsGateshead CouncilNewcastle City CouncilNewcastle Gateshead CCGNewcastle upon Tyne Hospitals NHS Foundation TrustNHS England (Cumbria and North East)North East Ambulance Service NHS Foundation TrustNorth Durham CCGNorth Tyneside CCG

North Tyneside CouncilNorthumberland CCGNorthumberland County CouncilNorthumberland, Tyne and Wear NHS Foundation TrustSouth Tyneside CCGSouth Tyneside CouncilSunderland CCGSunderland City Council

Priorities

• Reduce the prevalence of smoking and obesity, and reduce the impact of alcohol.

• Collaborate with North East Combined Authority partners to support the long term unemployed back into work.

• Enhance people’s ability to self-care, increase their independence, self-esteem and self-efficacy.

• Drive change to the Out of Hospital system through recognised Local Health Economy programmes (New Care Models, GP Forward View).

• Develop alternative closer to home service models that improve productivity and create value by working with communities to provide need based support and reduce the reliance on hospitals and care homes.

• Support all Foundation Trust Providers to achieve a rating of outstanding by 2021.

• Delivery of milestones in Mental Health Five Year Forward View and reduction in demand for secondary and tertiary children and young people’s services and reduction in waiting times.

• Reductions in admissions and length of stay due to more effective integrated management of co-existing physical and mental health conditions.

• Reduction in inappropriate A and E attendances.

• Close c.£385m (60%) of the 2020/21 funding gap.

STP leader:Mark Adams (Chief Officer, Newcastle Gateshead CCG)



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South Yorkshire and Bassetlaw STPConstituent organisationsNHS Barnsley CCG Barnsley Hospital NHS Foundation Trust Barnsley Metropolitan Borough Council NHS Bassetlaw CCGBassetlaw District Council Chesterfield Royal Hospital NHS Foundation Trust Doncaster and Bassetlaw Teaching Hospitals NHS Foundation TrustDoncaster Children’s Services Trust NHS Doncaster Clinical Commissioning GroupNHS EnglandEast Midlands Ambulance Service NHS Trust Nottinghamshire Healthcare NHS Foundation Trust Nottinghamshire County Council

The Rotherham NHS Foundation Trust NHS Rotherham CCG Rotherham, Doncaster and South Humber NHS Foundation TrustRotherham Metropolitan Borough Council Sheffield Children’s Hospital NHS Foundation Trust Sheffield City Council NHS Sheffield CCG Sheffield Health and Social Care NHS Foundation Trust Sheffield Teaching Hospitals NHS Foundation TrustSouth West Yorkshire Partnership NHS Foundation Trust Yorkshire Ambulance Service NHS Trust

Priorities

• Reducing inequalities for all and help people live well and stay well for longer.

• Joining up health and care services so they are responsive to people’s needs and are accountable.

• Investing in primary and community care, with general practice at the centre.

• Treating the whole person, looking after their mental and physical health.

• Standardising acute hospital and specialised care – improving access for everyone, reducing inequalities and improving efficiencies.

• Simplifying urgent and emergency care, making it easier for people to access the right service closer to home.

• Developing the right workforce, in the right place with the right skills – for now and in the future.

• Using the best technology to keep people well at home, to support them to manage their own care and to connect staff so they can provide jointed up care.

• Creating a financially sustainable health and care system.

• Working with local communities to do this.

STP leader:Sir Andrew Cash – Chief Executive, Sheffield Teaching Hospitals



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West, North and East Cumbria STP

Constituent organisationsNorth Cumbria University Hospital TrustCumbria Partnership Foundation TrustNHS North Cumbria CCGCumbria County CouncilNHS EnglandNorth West Ambulance ServiceHealthwatch CumbriaHealth Education EnglandPrimary care (practices)Tertiary providers in north east and southern Scotland

Priorities

To implement decisions made through the Healthcare For The Future consultation:

• Develop eight integrated care communities to move care out of hospital and into the community.

• Deliver financial efficiencies to get the system back to living within its means.

• Develop co-production as the way to do things across the system harnessing the energy, ideas and support of local communities.

• Focus on population health and mobilise local communities around prevention and self- care.

• Improve links with and support the care sector which is under pressure.

• Develop links with tertiary centres in the North East of England around cancer and children’s acute care.

STP leader:Stephen Eames – Chief Executive, North Cumbria University Hospitals NHS Trust


Population: c.0.3 million

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West Yorkshire and Harrogate STP

Constituent organisationsNHS Airedale, Wharfedale and Craven CCG NHS Bradford City CCG NHS Bradford Districts CCG NHS Calderdale CCG NHS Greater Huddersfield CCG NHS Harrogate and Rural District CCG NHS Leeds North CCG NHS Leeds South and East CCG NHS Leeds West CCG NHS North Kirklees CCG NHS Wakefield CCG Bradford Metropolitan District Council Calderdale Council Craven District Council Harrogate Borough Council Kirklees Council Leeds City Council North Yorkshire County Council Wakefield Council Airedale NHS Foundation Trust

Bradford District Care NHS Foundation Trust Bradford Teaching Hospitals NHS Foundation Trust Calderdale and Huddersfield NHS Foundation Trust Harrogate and District NHS Foundation Trust Leeds Community Healthcare NHS Trust Leeds and York Partnership NHS Foundation Trust Leeds Teaching Hospitals NHS Trust Locala Community Partnerships The Mid-Yorkshire Hospitals NHS Trust South West Yorkshire Partnership NHS Foundation Trust Tees Esk and Wear Valleys NHS Foundation Trust Yorkshire Ambulance Service NHS Trust

Priorities

• Make more cancer curable from 40% of patients to 60%.

• Increase the one-year survival rate from all cancers to 75%, potential to save 700 lives each year.

• Sustain and further improve A&E performance through 2017-18 – building on the 8% improvement achieved through a national pilot around rapid improvement.

• Local service framework for mental health, including: A 40% reduction in unnecessary A&E attendance A zero suicide approach to prevention Elimination of people being placed out of their local area for non-specialist hospital care A reduction in waiting times for autism assessment

• Improve access to general practice - increase in people who can access services on evenings and weekends from 27% to 48% within the year.

• Further improve the stroke pathway from prevention to recovery – to support an ambition to reduce cardiovascular events by 10% by 2021.

Obesity: 50% of the 226,000 people at risk of diabetes are offered prevention support, with a 50% success rate. Alcohol: reduce alcohol related hospital admissions by 500 a year.Smoking: reduce smoking prevalence to 13%, more than 125,000 fewer smokers.

STP leader:Rob Webster, West Yorkshire and Harrogate Sustainability and Transformation Partnership lead and Chief Executive for South West Yorkshire Partnership NHS Foundation Trust.


Population: 2.6milion


New ways of working across Blackpool and Fylde Coast

Part of the Lancashire and South Cumbria STP, the community-based Extensive Care Service, has cared for more than 2,000 people across Blackpool and the Fylde Coast, supporting patients over the age of 60 with multiple long-term conditions.

Multi-disciplinary teams including consultants, GPs, nurses, wellbeing support workers, pharmacists, and other supporting staff, operate from four sites across the patch, serving all 40 local GP practices. The aim of the service is to help patients understand and manage their conditions better. As a result the amount of times these people need to access hospital services, GPs, ambulances and other services has fallen. The latest data, at February 2017, showed, for this group of patients:

• 4% fewer A&E attendances

• 23% fewer unplanned hospital admissions

• 18% fewer planned hospital admissions

• 4% fewer out-patient attendances

Peter Greenwood sustained a stroke in 2011. Limited communication and changes in his personality left him, and his wife Lily, socially isolated. He was prone to falls and suffers from dementia.

The Extensive Care Team has supported the couple in sourcing other forms of help which have made a big difference to their daily lives, such as community physio for Peter, and specialised respite care in a service looking after individuals with dementia. Help was also found for Lily, in the shape of the Carers Trust. She completed a dementia education course, which has helped her communicate more effectively with Peter, and enabled her to socialise with other carers. This has opened up a new social circle and increased her confidence massively.

Following the input of the service Peter has been able to continue living at home with Lily. Due to the successful completion of their goals, Peter has now been discharged back to the care of his GP.


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Bedfordshire, Luton and Milton Keynes STPConstituent organisations Bedfordshire CCG, Luton CCG, Milton Keynes CCGBedford Borough Council, Central Bedfordshire Council, Luton Borough Council, Milton Keynes Council Bedford Hopsital NHS Trust, Luton and Dunstable Hospital NHS Foundation Trust, Milton Keynes University Hopsital NHS Foundation Trust

Cambridgeshire Community Service NHS Trust, Central and North West London NHS Foundation Trust, East of England Ambulance Service NHS Trust, South Central Ambulance Service NHS Foundation Trust, South Essex Partnership University NHS Foundation Trust and East London NHS Foundation Trust.

Priorities

• XX

STP leader:Pauline Philip (Chief Executive, Luton & Dunstable University Hospital NHS Foundation Trust)


Population: 1 million


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Birmingham and Solihull STP

Constituent organisationsBirmingham City CouncilSolihull Metropolitan Borough CouncilBirmingham Cross City CCGBirmingham South Central CCGSolihull CCGBirmingham and Solihull Mental Health Foundation TrustBirmingham Women’s and Children’s Hospitals Foundation TrustBirmingham Community Health Care Foundation TrustHeart of England Foundation TrustRoyal Orthopaedic Hospital Birmingham Foundation TrustUniversity Hospitals Birmingham Foundation Trust

Priorities

• To develop joined up care out of hospitals. The STP aims to deliver improved access to local services for everyone when their need is urgent, and more supportive and consistent care which aims to keep people well for those who need more support including social care.

• Closer working between hospitals to develop a joined up system of hospital services through Birmingham and Solihull will improve efficiency and delivers better outcomes.

• We will establish a Maternity, Children and Young People programme to focus upon issues faced by children within Birmingham and Solihull.

• To give those with mental health services the same priority as other areas.

• Improve the health and wellbeing of the population by working with local partners, particularly focussing on employment, education, housing and work.

• To work together on key enablers which will help the STP deliver better health and care including the STP’s approach approach to an accountable care system which will include new payments and measures of success as well as joint workforce developments, digitalisation and estates.

STP leader:Dame Julie Moore – Chief Executive, University Hospitals Birmingham NHS Foundation Trust




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Cambridgeshire and Peterborough STP

Constituent organisationsCambridge University Hospitals NHS Foundation Trust NHS Cambridgeshire and Peterborough CCGHinchingbrooke Health Care NHS Trust Cambridgeshire Community Services NHS Trust Cambridgeshire and Peterborough NHS Foundation Trust Peterborough and Stamford Hospitals NHS Foundation Trust Papworth Hospital NHS Foundation Trust

Priorities

At home is best • People powered health and wellbeing

• Neighbourhood care hubs

Safe and effective hospital care, when needed• Responsive urgent and expert emergency care

• Systematic and standardised care

• Continued world-famous research and services

Partnership working

Supported delivery • A culture of learning as a system

• Growing the local workforce

• Better use of land and buildings

Using technology to modernise health

STP leader:Tracy Dowling (Accountable Officer, Cambridgeshire and Peterborough CCG)




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Coventry and Warwickshire STP

Constituent organisationsCoventry City CouncilCoventry and Rugby Clinical Commissioning GroupCoventry and Warwickshire NHS Partnership TrustGeorge Eliot Hospital NHS TrustSouth Warwickshire Clinical Commissioning GroupSouth Warwickshire NHS Foundation TrustUniversity Hospitals Coventry and Warwickshire NHS TrustWarwickshire County CouncilWarwickshire North Clinical Commissioning Group

Priorities

• Proactive and preventative care - ensuring people have better general health regardless of where they live, and require fewer visits to hospital, and shorter stays if they need inpatient care. Making more services available closer to people’s homes.

• Urgent & emergency care - ensuring urgent and emergency care is easy to use with one point of access, and that all stroke patients receive initial care in a specialist unit.

• Planned care - reducing the number of times patients have to go to hospital before and after hospital treatment.

• Maternity and paediatrics - offering increased choice around where to give birth.

• Productivity & efficiency - making organisations more financially secure, which would make services more secure. Spending less money on expensive agency staff - improving quality and releasing money to spend on patient care.

• Mental health - the mental health workstream is the most recently developed, and focuses on improving access to high-quality inpatient and community mental health services for both adults and children.

STP leader:Brenda Howard, Programme Director, Better Health, Better Care, Better Value

Contact details: More information is available at: http://www.uhcw.nhs.uk/about-us/stp



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Derbyshire STP

Constituent organisationsNHS Southern Derbyshire CCGNHS North Derbyshire CCGNHS Hardwick CCGNHS Erewash CCGDerbyshire Community Health Services NHS Foundation Trust Derbyshire Healthcare NHS Foundation Trust Derbyshire Health United Derby Teaching Hospitals NHS Foundation Trust Chesterfield Royal Hospital NHS Foundation Trust Derby City Council Derbyshire County Council

Priorities

• Over the next five years Derbyshire STP will put £6.5 million into making sure people can access services when they need them, including evenings and weekends, and see a doctor, advanced nurse practitioner or other appropriate clinician.

• Give patients who have lots of health needs the support they need to stay well at home so they recover fully and more quickly.

• Work towards supporting 2,500 health and social care staff to focus more care out in communities, where it is needed, in GP practices, pharmacies, social care, mental health, opticians, and other providers.

• Offer more support to approximately 50,000 people across the city and county who have the greatest health needs, so they get extra help from professionals.

• Give better care to approximately 150,000 patients who have ongoing issues such as high blood pressure, asthma and diabetes.

• Reduce the number of people being unnecessarily treated in hospital, community or residential care when it is not best suited to their specific needs – instead giving them appropriate services, closer to home.

STP leader:Gary Thompson (Accountable Officer, Southern Derbyshire CCG)




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Herefordshire and Worcestershire STP

Constituent organisationsWorcestershire Acute Hospitals NHS Trust Worcestershire Health and Care NHS TrustWye Valley NHS TrustNHS Herefordshire CCGNHS South Worcestershire CCGNHS Wyre Forest CCGNHS Redditch and Bromsgrove CCGHerefordshire County CouncilWorcestershire County Council

Priorities

The STP is a collaborative between all local health and care organisations working across the area, supported by Voluntary Sector and Healthwatch representatives.

Current plans set out a direction of travel for the next four to five years. Priorities include:

• Doing more to prevent illness and encouraging people to live healthier lives

• Encouraging people to self-care or self-manage more of the routine aspects of their conditions

• Improving access to GP appointments

• Improving community services which care for people at home, including making better use of technology

• Changing the role of community hospitals so more care and treatment is available closer to home

• Easier access to emergency/urgent care

• Making acute and specialist services more sustainable

STP leader:Sarah Dugan (Chief Executive, Worcestershire Health and Care NHS Trust)

Contact details: For more information visit www.yourconversationhw.nhs.uk



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Hertfordshire and West Essex STP

Constituent organisationsEast And North Hertfordshire NHS TrustHertfordshire Community NHS TrustHertfordshire Partnership NHS Foundation TrustWest Hertfordshire Hospitals NHS Trust The Princess Alexandra Hospital NHS Trust NHS Herts Valleys CCGNHS East and North Hertfordshire CCGNHS West Essex CCG

Priorities

• Help people to make the right choices about their health, living as independently as possible and accessing support at the right time and place.

• Improve support to people through partnerships with district councils, third sector, employers and community organisations.

• Integrate primary, community, mental health and social care teams around defined communities and their needs.

• Introduce consistent best- practice pathways, supported by integrated models of delivery.

• Ensure people are admitted to hospital at the right time for the right reason, and only when hospital is the right place for them.

• Put in place support to enable people to be quickly discharged from hospital when they are ready.

• Make effective and efficient use of available resources across the STP area.

STP leader:Tom Cahill (Chief Executive, Hertfordshire Partnership University NHS Foundation Trust) Contact details: Email: [email protected]



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Leicester, Leicestershire and Rutland STP

Constituent organisationsUniversity Hospitals of Leicester NHS TrustLeicestershire Partnership NHS TrustEast Leicestershire and Rutland CCGLeicester City CCG West Leicestershire CCGEast Midlands Ambulance Service NHS TrustLeicester City Council Leicestershire County Council Rutland County Council

Priorities

• Leicester, Leicestershire and Rutland STP believes in ‘Home First’, which means being at home with support is the best place for many people to stay well, and manage their conditions or illnesses. This overall approach enables people to receive the rehabilitation and support they need to get back to their normal lives quickly, and reduce their stay in hospital.

• The STP wants to want to create specialised integrated teams in the community, to keep people well at home, while reducing unnecessary hospital stays and ensuring those who do need to be admitted to hospital do not stay longer than necessary.

• The STP is working to improve the way its services are structured so that it can provide the best possible medical services with the resources (money, staff and buildings) it has available. The overall result is that the STP wants hospitals to become more specialised and to concentrate on services that cannot be provided in the community.

• The STP is redesigning current care services and treatment pathways for patients so that it can deliver consistently high quality services that provide equal access for everyone.

STP leader:Toby Sanders (Accountable Officer, West Leicestershire CCG) Contact details: Email: [email protected]



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Lincolnshire STP

Constituent organisationsLincolnshire West Clinical Commissioning Group, South Lincolnshire Clinical Commissioning Group, South West Lincolnshire Clinical Commissioning Group, Lincolnshire East Clinical Commissioning Group, United Lincolnshire Hospitals NHS Trust, Lincolnshire Partnership NHS Foundation Trust Lincolnshire Community Health Services NHS Trust

Priorities

• Neighbourhood teams will focus on prevention and proactive care, with several services in the community coming together to reduce unnecessary hospital admissions.

• Community hospitals and primary care hubs will be part of the neighbourhood team network in delivering care in the community and closer to home.

• Keeping people well and healthy by raising awareness of the importance of self-care and leading healthy, independent lives is key to much of the Lincolnshire STP. Social prescribing will help people access services to support them in their own personal health and wellbeing and a directory of services will also signpost people to useful community groups.

• Hospitals will primarily support those patients who require emergency or planned care. Simplified routes for specific diseases based on what works well will be implemented to increase the number of patients who can be cared for in county.

• Resilient specialist mental health inpatient facilities are already being developed, including a psychiatric intensive care unit, to reduce the number of patients who need to travel out of county for appropriate care.

STP leader:John Turner (Chief Officer South Lincolnshire CCG)




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Mid & South Essex STP

Constituent organisationsBasildon & Brentwood CCG Thurrock CCG Southend CCG Castle Point & Rochford CCG Mid Essex CCG Essex County Council Southend-on-Sea Borough Council Thurrock Council Mid Essex Hospital Services NHS Trust Basildon and Thurrock University Hospitals NHS Foundation Trust Southend University Hospital NHS Foundation Trust Provide Essex Partnership University NHS Foundation Trust East of England Ambulance Services NHS Trust

Priorities

• Implement the urgent and emergency care delivery plan

• Deliver the GP Forward View alongside the roll out of the locality model

• Refine proposals for acute services reconfiguration

• Fully implement elective and non-elective demand management plans

• Establish the CCG Joint Committee to strengthen out of hospital delivery

STP leader:Anita Donley (Independent Chair, Success Regime)

Contact details: Email: [email protected] http://www.successregimeessex.co.uk/



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Norfolk and Waveney STP

Constituent organisationsNHS Great Yarmouth and Waveney CCGNHS North Norfolk CCGNHS Norwich CCGNHS South Norfolk CCGNHS West Norfolk CCGEast of England Ambulance Service NHS TrustNorfolk and Suffolk County CouncilNorfolk and Norwich University Hospitals NHS Foundation TrustJames Paget University Hospitals NHS Foundation Trust

Queen Elizabeth Hospital Kings Lynn NHS Foundation TrustNorfolk and Suffolk NHS Foundation TrustEast Coast Community Healthcare CICNorfolk Community Health and Care NHS TrustNorfolk Independent CareNorfolk and Waveney Local Medical CommitteeDistrict, borough and city councilsHealthwatch NorfolkHealthwatch SuffolkIC24

Priorities

• Preventing illness and promoting well-being People supported to live longer, healthier lives by targeting lifestyle risk factors. Community services aligned with local authorities and the third sector, supporting independence.

• Care closer to home People living independently, with better access to primary and secondary care, and the third sector. Community care reduces demand on hospital and residential services. End of life care allows patients to die in their place of choice. A system-wide strategy improves services for children and young people.

• Integrated working across physical, social and mental health Integrated working across the system delivers holistic care, improved patient experience and better outcomes. Services focus on social care and mental health parity of esteem.

• Sustainable acute sector Hospital services are sustainable. Out of hospital care reduces demand and supports discharge.

• Cost-effective services Delivered within the funds available – providers and commissioners working together to deliver savings and release organisational efficiencies, whilst maintaining quality.

STP leader:Wendy Thomson (Managing Director, Norfolk County Council)




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Northamptonshire STP

Constituent organisations3SixtyGeneral Practice Alliance LtdKettering General Hospital NHS Foundation TrustLakeside Healthcare GroupNHS Corby CCGNHS Nene CCGNorthampton General Hospital NHS TrustNorthamptonshire County CouncilNorthamptonshire Healthcare NHS Foundation TrustPML – Principal MedicalVoluntary Impact Northamptonshire

Priorities

• Prevention and keeping people well.

• Making sure that people are able to access the right care when they need it.

• Providing effective wraparound health and social care outside hospital to individuals with complex needs.

• Hospitals working more closely together sharing clinical expertise.

• This will be supported by investment in staff so that teams across health and social care are able to work differently to provide the care that is needed, and by engaging with and listening to local communities as the STP continues to develop services.

STP leader:John Wardell (Accountable Officer, Nene CCG)




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Nottingham and Nottinghamshire STP

Constituent organisationsNHS Mansfield and Ashfield CCGNHS Newark and Sherwood CCGNHS Nottingham City CCGNHS Nottingham North and East CCGNHS Nottingham West CCGNHS Rushcliffe CCGNottingham University Hospitals NHS TrustSherwood Forest Hospitals NHS Foundation TrustNottinghamshire Healthcare NHS Foundation TrustNottingham City CouncilNottinghamshire County CouncilMansfield District Council on behalf of Nottinghamshire District and Borough Councils

Other organisations which are involved:Healthwatch NottinghamHealthwatch NottinghamshireNottingham CityCare PartnershipCircle Nottingham LimitedVoluntary and community sector organisations represented by Nottingham CVS, Nottinghamshire Together and TEAMNottingham Emergency Medical ServicesEast Midlands Ambulance NHS TrustLocal Medical CommitteeNHS England

Priorities

• Organise care around individuals and populations – not organisations - and deliver the right type of care based on people’s needs.

• Help people remain independent through prevention programmes and offering proactive rather than reactive care, which will also reduce avoidable demand for health and care services.

• Support and provide care for people at home and in the community as much as possible – which implies shifting resources into those settings - and ensure that hospital, care home beds, and supported housing are available for people who need them.

• Work in multi-disciplinary teams across organisational boundaries to deliver integrated care as simply and effectively as possible.

• Minimise inappropriate variations in access, quality, and cost, and deliver care and support as efficiently as possible so that the proportion of the budget spent on improving health and wellbeing can be maximised.

• Maximise the social value that health and social care can add to local communities.

STP leader:David Pearson (Corporate Director – Adult Social Care, Health and Public Protection & Deputy Chief Executive, Nottinghamshire County Council)

Contact details: Email: [email protected] For more information visit www.stpnotts.org.uk



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Shropshire and Telford & Wrekin STP

Constituent organisationsShropshire Clinical Commissioning Group Telford & Wrekin Clinical Commissioning Group Shropshire Community Health NHS Trust Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Foundation Trust South Staffordshire & Shropshire Healthcare NHS Foundation Trust

ShropDoc (GP out of hours service) Shropshire Council Telford & Wrekin Council Powys Teaching Health Board Healthwatch Shropshire Healthwatch Telford & WrekinVoluntary Sector (soon to join) Shropshire Partners in Care

Priorities

• Focus on neighbourhoods to prevent ill health and promote the support that local communities offer to help people lead healthier lives and encourage them to care for themselves where appropriate.

• Multi disciplinary Neighbourhood Care Teams to work closer together supporting local people with long term health conditions and those who have had a hospital stay and returned home needing further care.

• Ensure all community services are safe, accessible and provide the most appropriate care.

• Redesign urgent and emergency care, creating two vibrant ‘centres of excellence’ to meet the needs of local people, including integrated working and primary care models.

• Make the best use of technology to avoid people having to travel large distances where possible, especially important to people living in the most rural communities in Shropshire and Powys.

• Involve local people in shaping their health and care services for the future.

• Support those who deliver health and social care in Shropshire, Telford and Wrekin, developing the right workforce, in the right place with the right skills and provide them with local opportunities for the future.

STP leader:Simon Wright (Chief Executive, The Shrewsbury and Telford Hospital NHS Trust)




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Staffordshire and Stoke on Trent STP

Constituent organisationsCannock Chase CCGEast Staffordshire CCGNorth Staffordshire CCGStafford and Surrounds CCGStoke-on-Trent CCGSouth East Staffordshire and Seisdon Peninsula CCGStaffordshire County CouncilStoke-on-Trent City CouncilUniversity Hospitals North Midlands NHS TrustBurton Hospitals NHS Foundation TrustRoyal Wolverhampton

Hospitals NHS TrustSouth Staffordshire and Shropshire Healthcare NHS Foundation TrustNorth Staffordshire Combined Healthcare NHS TrustStaffordshire and Stoke-on-Trent Partnership NHS TrustNHS EnglandHealthwatch StaffordshireHealthwatch Stoke-on-TrentSupport StaffordshireVAST

Priorities

• Focused prevention - identify where downstream investment in prevention and early intervention will have a positive impact on both the health of the population and reduce high cost care.

• Enhanced primary and community care - enhance and integrate primary and community care to enable frail elderly and those with long-term conditions to live independent lives and avoid unnecessary, costly and upsetting emergency episodes.

• Effective and efficient planned care - reconfigure planned care service to meet patient needs, improve productivity and remove duplication and over capacity.

• Redesign emergency and urgent care services across the system to reduce avoidable A&E attendances and non-elective admissions.

• Reduce cost of service - accelerate the delivery of productivity and efficiency plans. Reduce total bed capacity and rationalise estates. Provider collaboration to reduce management costs.

STP leader:Penny Harris, Programme Director, Staffordshire and Stoke on Trent STP

Contact details: Email: togetherwe’[email protected]



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Suffolk and North East Essex STP

Constituent organisationsSuffolk and Essex county councilsMid Suffolk, Forest Heath, Tendring, St Edmundsbury, Suffolk Coastal, Colchester, Ipswich and Babergh District and Borough Councils North East Essex, Ipswich and East Suffolk and West Suffolk CCGsSuffolk GP Federation and GP Primary ChoiceSuffolk Community Healthcare and Anglian Community EnterpriseNorth Essex Partnership NHS Foundation TrustHealthwatch Suffolk and Healthwatch EssexEast of England Ambulance Service NHS TrustSuffolk and Essex Local Medical Committees

Priorities

• Suffolk and North East Essex STP will collaborate; be innovative, and will inspire clinical and community leadership. STP partners want the best for local people.

• Over the next five years the STP will improve care for its public; the quality of services on offer; support for its workforce; and how the STP spends public money within budgets.

• The public, clinicians, the voluntary sector and other partners expect the STP to join forces to reduce duplication, inefficiency and make services easier to navigate.

• By linking up services, the public will see GP surgeries, mental health and social care services, acute hospitals and community health professionals all working together, moving care closer to people’s homes and improving their outcomes.

STP leader:Nick Hulme (Chief Executive, Ipswich Hospital NHS Trust)




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The Black Country & West Birmingham STP

Constituent organisationsDudley Metropolitan Borough CouncilDudley CCGDudley and Walsall Mental Partnership NHS TrustThe Dudley Group NHS Foundation TrustCity of Wolverhampton CouncilWolverhampton CCGThe Royal Wolverhampton NHS TrustWest Midlands Ambulance Service NHS Foundation TrustNHS EnglandBlack Country Partnership NHS

Foundation TrustBirmingham Community Healthcare NHS Foundation TrustBirmingham City CouncilSandwell and West Birmingham Hospitals NHS TrustSandwell and West Birmingham CCGSandwell Metropolitan Borough CouncilWalsall Metropolitan Borough CouncilWalsall CCGWalsall Healthcare NHS Trust

Priorities

• Maternal and infant health Reduce current high levels of infant mortality to bring it in line with the national average, avoiding the death of 34 babies a year.

• GP and community services With an extra £25m invested in GP services by 2021, an extra 25,000 GP appointments a year will be made available.

• Hospital services The new Midland Metropolitan Hospital will bring hospital services together in one place to treat over 570,000 people in a state of the art building.

• NHS 111 By ringing one telephone number the people of the Black Country will be able to book a doctor’s appointment, in evenings and at weekends, get dental advice, order a repeat prescription, or get urgent advice.

• Mental health services Changes to how health and care services work together will mean those suffering early psychosis will get access to therapy within two weeks.

STP leader:Andy Williams (Accountable Officer, Sandwell and West Birmingham CCG)




An alternative to A&E for those in crisis

Part of the Hampshire and Isle of Wight STP, North East Hampshire and Farnham Vanguard is focussing on bringing local primary, community, acute, mental health and social care services together to work as one team, supporting people to better manage their own care.

The Safe Haven in Aldershot provides a service for people with mental health problems. This jointly run initiative has crossed traditional agency boundaries and geographical borders and provides a real alternative to A&E for those in crisis. This has resulted in a 33 per cent reduction in acute psychiatric admissions locally.

Seven days a week, with no appointment needed, service users can go to the Safe Haven to talk to staff who can: support them when they are in crisis; access community information on mental health and wellbeing; get peer support and feel more integrated with their local community and learn self-management skills to break the cycle of crisis.

This has been viewed very positively by patients who have described the importance of being able to access help when they needed it and that the Safe Haven has helped them to avoid further crisis, self-harm or going to A&E.

One service user said:

“ If I hadn’t come in to Safe Haven tonight I would have self-harmed, but talking to someone has relieved my crisis and helped me understand my situation and what I need to do.”

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North London STP

Constituent organisationsBarnet, Camden, Enfield, Haringey and Islington CCGsBarnet, Camden, Enfield, Haringey and Islington CouncilsCamden and Islington NHS Foundation TrustBarnet, Enfield and Haringey Mental Health NHS TrustRoyal Free NHS Foundation Trust Whittington Hospital NHS TrustNorth Middlesex University Hospital NHS Trust

University College London Hospitals NHS Foundation TrustTavistock & Portman NHS Foundation TrustMoorfields Eye Hospital NHS Foundation TrustCentral London Community Healthcare NHS Trust Central and North West London NHS TrustRoyal National Orthopaedic Hospital NHS Trust

Priorities

• Helping people stay healthy and well

• Involving local people as partners in health and care

• Building health and care services near to where people live

• Services people can rely on in an emergency

• Planning and delivering the care people need, when they need it, and in the right setting

• Supporting people to stay mentally well and to recover from mental ill health and thrive

• Helping people and families survive the impact of cancer

• Giving mothers-to-be more choice and better support

• Giving children and young people the best start in life

• Creating a caring and compassionate health and care workforce

• Making the best use of buildings owned by partners and making sure they are fit for purpose

• Harnessing the power of technology

• Balancing the books

STP leader:Helen Pettersen, Chief Officer and Accountable Officer for the North Central London Clinical Commissioning Groups (Barnet, Camden, Enfield, Haringey and Islington).



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East London STP

Constituent organisationsBarking, Havering And Redbridge University Hospitals NHS TrustBarts Health NHS TrustEast London NHS Foundation TrustHomerton University Hospital NHS Foundation Trust East London NHS Foundation TrustNHS Barking & Dagenham CCGNHS City and Hackney CCGNHS Havering CCGNHS Newham CCGNHS Redbridge CCGNHS Tower Hamlets CCGNHS Waltham Forest CCGBarking & Dagenham; City of London Corporation; Hackney; Havering; Newham; Redbridge; Tower Hamlets; Waltham Forest

Priorities

Healthy & independent local people• Good mental well-being and preventing ill health and loss

of independence

• Tackling inequalities

Improving services• More services out of hospital and integrated in primary,

mental, social & community care

• Improved priority services: maternity, mental health, cancer, urgent & emergency care with strong hospital & specialist services

Right staff with the right technology in the right place• Skills & career development, recruitment & retention

• Housing for key workers

• Digital & online services

• Healthy work places and better buildings

Well run partnership• Building partnerships

• Productivity – value for money and living within our means

• Better organised - new organisations bringing together providers & commissioners

STP leader:Jane Milligan (Chief Officer, Tower Hamlets CCG)



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North West London STP Constituent organisationsCentral London Community Healthcare NHS TrustCentral And North West London NHS Foundation TrustChelsea And Westminster Hospital NHS Foundation TrustImperial College Healthcare NHS TrustLondon North West Healthcare NHS TrustRoyal Brompton And Harefield NHS Foundation TrustThe Royal Marsden NHS Foundation TrustWest London Mental Health NHS Trust

The Hillingdon Hospitals NHS Foundation TrustNHS Hillingdon CCGNHS Harrow CCGNHS Hounslow CCGNHS Ealing CCGNHS Brent CCGNHS Central London (Westminster) CCGNHS Hammersmith and Fulham CCGNHS West London (London Borough of Kensington and Chelsea and Queen’s Park and Paddington) CCG

Priorities

• Focus on prevention – more support for people with diabetes to manage their conditions; tackling alcohol misuse reducing attendances at A&E; investing in early diagnosis of dementia; and 200 lives a year being saved by detecting illnesses like cancer earlier.

• Big improvements in primary care by increasing out of hours and weekend appointments, and bringing in additional workforce like clinical pharmacists into GP surgeries. By March 2019, patients who want to will be able to have virtual GP Skype appointments.

• Enhanced home care to support older people in the place they live, including rapid assessment at time of need supported by the speedy implementation of the right care package.

• A 24/7 pathway in North West London for those in a mental health crisis – this includes a 24-hour telephone line staffed by clinical specialists and crisis teams to support people in their homes day and night.

• Our investment in diagnostics in 2017/18 will mean patients in hospital will be able to get home on average one day earlier.

STP leader:Dr Mohini Parmar (Chair, Ealing CCG)



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South East London STP

Constituent organisationsGuy’s And St Thomas’ NHS Foundation TrustKing’s College Hospital NHS Foundation TrustLewisham And Greenwich NHS TrustOxleas NHS Foundation TrustSouth London And Maudsley NHS Foundation TrustNHS Bexley CCGNHS Bromley CCGNHS Greenwich CCGNHS Lambeth CCGNHS Lewisham CCGNHS Southwark CCG

Priorities

• We are extending GP appointments, with an extra £7.5m investment a year, so that residents will be able to access bookable GP services 8am-8pm, seven days a week.

• Better cancer treatment, including a new £160 million purpose-built Cancer Centre at Guy’s Hospital opened in September 2016 and a cancer centre is being developed as part of the £30 million redevelopment at Queen Mary’s Sidcup.

• Improving access to perinatal mental health services. This is already underway in Lambeth, Southwark & Lewisham after funding was secured to expand specialist perinatal services. More staff are being recruited this year and the service will be evaluated 2018/19.

• Changes to non-emergency orthopaedic surgery services will ensure fewer cancelled operations, shorter waiting times and more procedures carried out.

• Spending our money wisely includes reducing the numbers of patients going to A&E with better access to non-hospital services and prevention and more collaboration between different health services on “back office functions” and better use of collective buying power.

STP leader:Amanda Pritchard (Chief Executive, Guy’s and St Thomas’ NHS Foundation Trust)



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South West London STP

Constituent organisationsCroydon Health Services NHS TrustEpsom And St Helier University Hospitals NHS TrustHounslow And Richmond Community Healthcare NHS TrustKingston Hospital NHS Foundation TrustSouth West London And St George’s Mental Health NHS TrustSt George’s University Hospitals NHS Foundation TrustNHS Croydon CCGNHS Kingston CCGNHS Richmond CCGNHS Merton CCGNHS Sutton CCGNHS Wandsworth CCG

Priorities

• Supporting people with long term conditions - better support in the community for people with long-term conditions.

• Prevention and early intervention – keeping people well and supporting them sooner will be central to new ways of delivering care.

• Treating people out of hospitals and closer to home – more patients to be treated for their conditions ‘on the spot’ without requiring an overnight hospital stay.

• More care in the community for people in crisis and an improved 111 service, as well as access to GPs from 8am to 8pm, seven days a week.

• Making the most of digital innovation - virtual teams of GPs, nurses, pharmacists, social care staff and other professionals will work with patients to keep them well.

• South West London STP will continue to need all of the hospitals it currently has, but does not believe that every hospital has to provide every service. At this early stage, the STP is considering how services should be organised in each area, but has not yet reached the stage of making any recommendations on this. The immediate focus is on getting primary care and services in the community right.

STP leader:Sarah Blow, South West London Alliance of CCGs




Acute Response Team helps patients get better care

A new service launched in the Kent and Medway STP area is helping sick people in Thanet get better care and support while reducing demands on the busy local hospital.

The Thanet Acute Response Team (ART), brings together GPs, hospital doctors, nurses, therapists, carers and volunteers into a single team for the first time. The team is focussed on supporting people who have fallen ill and who are at risk of being admitted to hospital. Instead of a hospital admission, the team treats and cares for the patient in their own home or in a community care facility.

Dr Ash Peshen, a local GP and clinical lead for the ART, said: “We know our hospitals are under huge pressure and that many patients in hospital would recover far better in their own home if they had the right care and support.

“ ART is about providing the right care for the individual in the right place – and most of the time that place is at home rather than in a hospital bed. ART also ensures hospital care is available for people who are very unwell and need it most.”

It’s estimated that ART - part of Thanet’s Award-winning Primary Care Home programme - resulted in 200 avoided hospital admissions over the winter, meaning positive outcomes for patients and for stretched local services. ART is a partnership between NHS Thanet CCG; East Ken Hospitals University NHS Foundation Trust; Kent Community Health NHS Foundation Trust; Kent County Council; Primary care in Thanet; Age UK Thanet, and All Seasons.

Colin Boarer was supported by ART at his home in Westgate-on-Sea after falling ill on Boxing Day. He said:

“ It’s the first time in my life I have needed care support like this, and I can’t fault it.”

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Bath and North East Somerset, Swindon and Wiltshire STP

Constituent organisationsBath & North East Somerset CCGSwindon CCGWiltshire CCGBath and North East Somerset CouncilSwindon Borough CouncilWiltshire CouncilGreat Western Hospital Foundation NHS TrustRoyal United Hospitals Bath NHS Foundation TrustSalisbury NHS Foundation TrustAvon & Wiltshire Mental Health Partnership NHS TrustWiltshire Health & CareSouth Western Ambulance Service NHS Foundation TrustVirgin Care

Priorities

• Create locality-based integrated teams supporting primary care

• Shift the focus of care from treatment to prevention and proactive care

• Develop an efficient infrastructure to support new care models

• Establish a flexible and collaborative approach to workforce

• Enable better collaboration between acute providers

STP leader:James Scott, Chief Executive, Royal United Hospitals Bath NHS Foundation Trust


Population: 900,000

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Bristol, North Somerset and South Gloucestershire STPConstituent organisationsBristol CCGSouth Gloucestershire CCGNorth Somerset CCGSouth Gloucestershire, Bristol Local Authority North Somerset Local AuthorityWeston Area Health NHS TrustNorth Bristol NHS Trust University Hospitals Bristol NHS Foundation Trust Avon and Wiltshire Mental Health Partnership NHS Trust Sirona Care and Health, Bristol Community Health, North Somerset Community Partnership South Western Ambulance Service NHS Foundation Trust

STP leader:Robert Woolley, Chief Executive, University Hospitals Bristol NHS Foundation Trust


Population: 1 million Priorities

• Preventing illness and injury

• Providing care closer to home

• Personalised care

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Buckinghamshire, Oxfordshire and Berkshire West STPConstituent organisationsAylesbury Vale CCGChiltern CCG Buckinghamshire Healthcare NHS TrustBuckinghamshire County CouncilAylesbury Vale District CouncilChiltern District CouncilSouth Bucks District CouncilWycombe District CouncilOxfordshire CCGOxford University Hospitals NHS Foundation TrustOxford Health NHS Foundation TrustOxfordshire County CouncilCherwell District CouncilOxford City Council

South Oxfordshire District CouncilWest Oxfordshire District CouncilVale of White Horse District CouncilNewbury & District CCGNorth and West Reading CCGSouth Reading CCGWokingham CCGRoyal Berkshire NHS Foundation TrustBerkshire Healthcare NHS Foundation TrustSouth Central Ambulance Service NHS Foundation TrustReading Borough CouncilWest Berkshire CouncilWokingham Borough Council

Priorities

• Shift the focus of care from treatment to prevention.

• Access to the highest quality primary, community and urgent care.

• Acute Trust collaboration to deliver equality and efficiency.

• Mental health development to improve the overall value of care provided.

• Maximize value and patient outcomes from specialised commissioning.

• Establish a flexible and collaborative approach to workforce.

• Digital interoperability to improve information flow, efficiency and patient care.

STP leader:David Smith, Chief Executive, Oxfordshire CCG

Contact details: Oxfordshire queries: [email protected] West queries: [email protected] queries: [email protected]


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Cornwall and the Isles of Scilly STP

Constituent organisationsNHS Kernow CCG Cornwall CouncilCouncil of the Isles of Sicily Cornwall Partnership NHS Foundation Trust Kernow Health CICRoyal Cornwall Hospitals NHS Trust Plymouth Hospitals NHS Foundation TrustSouth Western Ambulance Service NHS Foundation Trust

Priorities

• Prevention and improving population health

• Integrated care in the community

• Transforming urgent and emergency care

• Redesigning pathways of care

• Improving productivity and efficiency

• System reform to achieve better care

STP leader:Kathy Byrne, Chief Executive, Royal Cornwall Hospitals NHS Trust

Contact details: Email: [email protected]: www.shapingourfuture.info


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Devon STP

Constituent organisationsNorthern, Eastern and Western Devon CCGSouth Devon and Torbay CCGPlymouth Hospitals NHS TrustRoyal Devon and Exeter NHS Foundation TrustNorthern Devon Healthcare NHS TrustTorbay and South Devon NHS Foundation TrustDevon Partnership NHS TrustSouth Western Ambulance Service NHS Foundation TrustDevon County Council Plymouth City Council Torbay Council Livewell Southwest CIC

Priorities

• Prevention and promoting health

• Integrated models of care

• Primary care

• Mental health and learning disabilities

• Acute hospital and specialist services

• Productivity

• Children and families

STP leader:Angela Pedder OBE, Chief Executive



“ The STP is about transforming our services so that we can achieve improved wellbeing, better health and better care for the populations we serve, as well as improved efficiency so that we can continue to offer the services that people need within the budget available.”

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Dorset STP

Constituent organisationsDorset CCGBournemouth Borough CouncilDorset County CouncilDorset County Hospital NHS Foundation TrustDorset HealthCare University NHS Foundation TrustBorough of PoolePoole Hospital NHS Foundation TrustThe Royal Bournemouth and Christchurch Hospitals NHS Foundation TrustSouth Western Ambulance NHS Foundation Trust

Priorities

• The Prevention at Scale programme will help people to stay healthy and avoid getting unwell.

• The Integrated Community Services programme will support individuals who are unwell, by providing high quality care at home and in community settings.

• The One Acute Network programme will help those who need the most specialist health and care support, through a single acute care system across the whole county.

STP leader:Tim Goodson, Chief Officer, Dorset CCG



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Constituent organisationsNHS Bracknell and Ascot CCGNHS North East Hampshire and Farnham CCGNHS Slough CCGNHS Surrey Heath CCGNHS Windsor, Ascot and Maidenhead CCGFrimley Health NHS Foundation TrustFrimMental health providersBerkshire Healthcare NHS Foundation TrustSurrey and Borders Partnership NHS Foundation TrustSussex Partnership NHS Foundation TrustSouthern Health NHS Foundation Trust

South Central Ambulance Service NHS Foundation TrustSouth East Coast Ambulance Service NHS Foundation TrustBracknell Forest CouncilGuildford Borough CouncilHampshire County CouncilHart District CouncilRoyal Borough of Windsor and Maidenhead CouncilRushmoor Borough CouncilSlough Borough CouncilSurrey County CouncilSurrey Heath Borough CouncilWaverley Borough CouncilVirgin Care

Priorities

• Making a substantial step change to improve wellbeing, increase self-care and early detection to prevent ill health.

• Action to improve long term condition outcomes including greater self- management and proactive management across all providers for people with single long term conditions.

• Frailty Management: proactive management of frail patients with multiple complex physical & mental health long term conditions, reducing crises and prolonged hospital stays.

• Redesigning urgent and emergency care, including integrated working and primary care models providing timely care in the most appropriate place.

• Reducing variation and health inequalities across pathways to improve outcomes and maximise value for citizens across the population, supported by evidence.

STP leader:Sir Andrew Morris, Chief Executive, Frimley Health NHS Foundation Trust



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Gloucestershire STP

Constituent organisationsNHS Gloucestershire Clinical Commissioning GroupGloucestershire Care Services NHS Trust2gether NHS Foundation TrustGloucestershire Hospitals NHS Foundation TrustSouth Western Ambulance Service NHS Foundation TrustGloucestershire County Council

Priorities

• Enabling active communities

• One Place, One Budget, One System

• Clinical Programme Approach

• Reducing clinical variation

STP leader:Mary Hutton, Accountable Officer, Gloucestershire CCG



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Hampshire and the Isle of Wight STP

Constituent organisationsFrimley Park Hospital NHS Foundation Trust Hampshire Hospitals NHS Foundation Trust Isle of Wight NHS Trust Portsmouth Hospitals NHS Trust Solent NHS Trust South Central Ambulance Service NHS Foundation TrustsSouthern Health NHS Foundation Trusts University Hospital Southampton NHS Foundation Trust

Fareham and Gosport CCG Isle of Wight CCG North East Hampshire and Farnham CCG North Hampshire CCG Portsmouth CCG Southampton City CCG South Eastern Hampshire CCG West Hampshire CCG Hampshire County Council Isle of Wight Council Portsmouth City Council Southampton City Council

Priorities

• Deliver a radical upgrade in prevention, early intervention and self-care.

• Accelerate the introduction of new models of care in each community in Hampshire and the Isle of Wight.

• Address the issues that delay patients being discharged from hospital.

• Ensure the provision of sustainable acute services across Hampshire and the Isle of Wight.

• Improve the quality, capacity and access to mental health services in Hampshire and the Isle of Wight.

STP leader:Richard Samuel, Senior Responsible Officer for the Hampshire and Isle of Wight STP



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Kent and Medway STP

Constituent organisationsAshford CCGCanterbury and Coastal CCGDartford, Gravesham and Swanley CCGMedway CCGSouth Kent Coast CCGSwale CCGThanet CCGWest Kent CCGDartford and Gravesham NHS TrustEast Kent Hospitals University

NHS Foundation TrustMedway NHS Foundation TrustMaidstone and Tunbridge Wells NHS TrustKent County CouncilMedway CouncilKent and Medway NHS and Social Care Partnership TrustKent Community Health NHS Foundation Trust Medway Community Healthcare CICSouth East Coast Ambulance Service NHS Foundation Trust

Priorities

• Prevention of ill-health

• Local care

• Hospital care

• Mental health

“ The Kent and Medway health and care system is seeking to deliver an integrated health and social care model that focuses on delivering high quality, outcome focused, person centred, coordinated care that is easy to access and enables people to stay well and live independently and for as long as possible in their home setting. More than that, the system will transform services to deliver proactive care, and ensure that support is focused on improving and promoting health and wellbeing, rather than care and support that is solely reactive to ill health and disease.”

STP leader: Glenn Douglas, Chief Executive, Maidstone and Tunbridge Wells NHS Trust



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Somerset STP

Constituent organisationsSomerset Clinical Commissioning GroupSomerset County CouncilSomerset Partnership NHS Foundation TrustTaunton and Somerset NHS Foundation TrustYeovil District Hospital NHS Foundation Trust

Priorities

• Drive improvement in the in-year system-wide financial and performance position

• Focus on prevention to develop a sustainable system

• Redesign Out of Hospital services

• Address clinical and financially unsustainable acute service provision

• Develop an accountable care system for Somerset

STP leader:Pat Flaherty, Chief Executive of Somerset County Council



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Surrey Heartlands STP

Constituent organisationsSurrey Downs CCGGuildford and Waverley CCGNorth West Surrey CCGAshford and St Peter’s Hospitals NHS Foundation Trust CSH SurreyEpsom and St Helier University Hospitals NHS Trust Royal Surrey County Hospital NHS Foundation Trust South East Coast Ambulance NHS Foundation Trust Surrey and Borders Partnership NHS Foundation Trust Surrey County Council Virgin Care

Priorities

• Creation of a Surrey Heartlands clinical academy to enable clinicians to work together and agree common standards so that all local residents have access to the same high quality standards of care.

• Promote self-care and encourage and support residents to take more responsibility for their own healthcare.

• Improve the way we provide services – with more care in the community, and single centres for some of the most specialist hospital services (creating expertise and improving outcomes).

• Working as one – moving towards one budget and one overall plan for the Surrey Heartlands area.

STP leader: Contact details:Email: [email protected]


Sou

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Sou

thSussex and East Surrey STP

Constituent organisationsEast Surrey CCGCrawley CCGHorsham and Mid Sussex CCGCoastal West Sussex CCGBrighton and Hove CCGHigh Weald Lewes Havens CCGEastbourne Hailsham and Seaford CCGHastings and Rother CCGSurrey County CouncilWest Sussex County CouncilBrighton & Hove City CouncilEast Sussex County CouncilFirst Community Health and CareQueen Victoria Hospital NHS Foundation Trust

Surrey and Sussex Healthcare NHS TrustSussex Community NHS Foundation TrustSussex Partnership NHS Foundation TrustSouth East Coast Ambulance Service Foundation NHS TrustSurrey and Borders Partnership NHS Foundation TrustIntegrated Care 24Western Sussex Hospitals NHS Foundation TrustBrighton and Sussex University Hospitals NHS TrustEast Sussex Healthcare NHS Trust

Priorities

• Improved health and wellbeing, preventing illness and enabling people to live well.

• More care provided closer to home, integrated around the needs of individuals.

• The highest quality acute care, provided through specialist clinical networks.

• Improved services and outcomes for mental health, emergency and urgent care and cancer.

• Making the best use of the resources available.

STP leader:Michael Wilson, Chief Executive, Surrey and Sussex Healthcare NHS Trust Contact details: Email: [email protected]


Documents

Your guide to Sustainability and transformation partnerships (STPs) · 2018-02-12 · Your guide to Sustainability and Transformation Partnerships (STPs) Page 3 Introduction Ever