Another deckchair to be rearranged?
Joan Pons Laplana, RGN, Transformation Nurse, James Paget University Hospitals FT*
Twitter: http://@RoaringNurse
* The views expressed here are personal and do not represent those of Joan's organisation
Sustain, Transform and relax....
One of the great triumphs of the last century was that we managed to vastly improved life expectancy, but this success seems to have set us one of great challenges of the 21st century - we are all living longer. Between 2015 and 2020, the general population is expected to rise by 3%, the number of people aged over 65, 85 and 100 are expected to increase by 12% (1.1 million), 18% (300,000), and 40% (7,000) respectively.
It’s not a secret that the new demographics are putting significant pressure on our Health and Social Care System. Not a day goes by without hearing of another care/health service crisis. The current structure and approach of health and social care is unsustainable. Unless health and social care organisations innovate and implement change together, customer orientated, safe and sustainable quality services will disappear.
However, additional funding is available to the NHS; a condition of this funding is using a different approach to care which will be directed by Sustainability and Transformation Plans (STPs).
STP’S aim to change the way we work together to develop a culture of collaboration to achieve integrated compassionate care across the system, to tackle the distress and challenges in the system by developing both sustainable models of care and sustainable financial models across organisational boundaries.
This shift reflects a growing consensus within the NHS that more integrated models of care are required to meet the changing needs of the population. In practice, this means different parts of the NHS and social care system working together to provide more coordinated services to patients – for example, by GPs working more closely with hospital specialists, district nurses and social workers to improve care for people with long-term conditions.
Providers and commissioners will come together to manage the collective resources available for services for their local population. This may lead to ‘system control totals’ (financial targets) being applied to local areas by NHS England and NHS Improvement [3].
The NHS Five Year Forward View identifies three gaps which each STP must address:
- Improving health and wellbeing – we need a “radical upgrade in prevention, patient activation, choice and control, and community engagement”.
- Improving quality and developing new models of care
- Improving efficiency to achieve financial balance
There are also some priorities that we should aim to embed in everything we do:
- We need more care closer to home
- We need a thriving and sustainable acute (hospital) sector
- We must focus on preventing illness and promoting wellbeing
- We can do more by closer and integrated working
- We have got to provide services in the budget we have - affordability is vital
Caveats
But as the NHS battles to meet raising demands, STP should not be used as an excuse to balance the books and cut vital services to the public. As I said before so much of what’s good or bad for the NHS comes back to money and funding – it pays for the staff, the buildings, the medicine, the machines and everything else. But the UK spends a smaller proportion of its GDP on health care than countries such as Portugal, France, Spain or the Netherlands. It has consistently spent less of a share of its GDP on health than either the EU average or that of the member countries of the Organization for Economic Cooperation and Development (OECD).
While I completely agree with the STPs principles, the plans have been developed at significant speed and without the meaningful involvement of frontline staff or the patients they serve. Patients and the public have been largely absent from the STP process so far. STP’s goal should not be used as a smoke screen to save the 22billions that the government is demanding by 2020.
Conclusion
STPs have the potential to be a good thing; however, if their primary purpose in reality is saving money, they will backfire, costing more in the long-term and potentially putting lives at risk.
This is also an excellent resource on STPs: https://ihm.org.uk/wp-content/uploads/2017/01/FULL-REPORT.pdf
STP’S aim to change the way we work together to develop a culture of collaboration to achieve integrated compassionate care across the system, to tackle the distress and challenges in the system by developing both sustainable models of care and sustainable financial models across organisational boundaries.