The NHS and local authorities across Buckinghamshire, Oxfordshire and Berkshire West (BOB) are working together to support delivery of NHS England’s Five Year Forward View, along with the Next Steps on the NHS Five Year Forward View to deliver better health, better patient care and improved NHS efficiency.
An STP is a five-year Sustainability and Transformation Partnership, or STP for short. STP can also stand for ‘sustainability and transformation plan’.
Plans drawn up in each of these areas, setting out practical ways to improve NHS services and population health in every part of England. For BOB, this plan will describe how health and social care will work together to transform the way in which we provide local services and care, ensuring local communities are the healthiest they can be whilst maximising the budgets available to us.
Our plan describes our ambitions, the intended benefits for patients and how local organisations will work together to achieve this. The BOB constituent organisations have agreed that joint work (and therefore the focus of the overarching BOB STP) should be on those areas where the benefits of working at a larger scale can bring added value.
At the same time, it builds on the work we are already doing across Buckinghamshire, Oxfordshire and Berkshire West, using patient feedback and insight from past engagement and consultation activity, views from local Healthwatch organisations and clinical best practice to inform key areas of focus.
An STP footprint is the term being used to describe the geographic areas on which the plans are based. In our case that is Buckinghamshire, Oxfordshire and Berkshire West. There are 44 STP footprints across England in total.
The BOB STP footprint covers a population of 1.8 million, three Clinical Commissioning Groups (CCGs), six NHS Trusts, 14 local authorities and 175 GP surgeries.
You will also see references on our website to BOB STP + or ‘plus’. This refers to the BOB STP area plus Frimley.
There are a number of health and wellbeing, care quality and financial challenges being faced across the BOB area.
- Significant increases in population
- Pockets of deprivation
- Increases in demand for services, particularly for over 75s
- Ageing buildings that require repair and are not fit for modern needs
- Some patients having to travel out of the area to receive specialist mental health services
- The need to recruit and retain a workforce to help us deliver the care people in our area need developing a comprehensive workforce
- improving health outcomes for patients by increasing out ability to help people be cared for at home and avoid unnecessary hospital admissions
We also need to:-
- Share learning and best practice across the BOB STP area
- Plan more capacity for maternity care
- increase access to primary care services
- improve access for cancer treatment
- understand how we meet the challenge of providing health and care to residents living in new housing developments planned for the BOB STP area
Our vision is to achieve the 'triple aim' set out in the Next Steps On The NHS Five Year Forward View and close the health and wellbeing, care and quality and financial gaps by:
- working together across the STP, and with partners beyond the STP, to commission and provide health and care services to deliver benefits that cannot be achieved by one organisation or system acting alone
- supporting further development of the Integrated Care Systems in Buckinghamshire and Berkshire West
- enabling the Oxfordshire health and care system to become an integrated health and care delivery system, by sharing learning from the first two wave shadow Integrated Care Systems in Buckinghamshire and Berkshire West
Our partnership focus is on the following priority areas:
- preventing ill health, by shifting the focus from treatment to prevention and adopting a population health management approach to strategic planning and service delivery
- collaborating across acute trusts and with other partners, to improve efficiency and optimise available capacity across the system
- enhancing cancer treatment and care to improve outcomes
- providing digital solutions for self-care, virtual consultations and interoperability to increase patients' access to information and reduce duplication and travel
- improving our workforce offer and increasing staff retention by working with Health Education England Thames Valley (TV) to develop staff
- developing a strategic investment programme for our estates and the use of capital to enhance the health and care environment
and sharing the learning across our three systems to:
- increase our ability to support people in their own homes and avoid an urgent and emergency visit to hospital
- plan for more capacity and enhance the quality of maternity care for our growing population
- improve the health outcomes and increase the access of patients using mental health services, ensuring services are operating efficiently
- improve access to the highest quality primary care services
The STP is supported by world leading strengths in life sciences, with major University-NHS partnerships including two bio-medical research centres and the Oxford NIHR
Oxford University has major strengths in health data and informatics with the Big Data Institute and designated Health Data Research Centre. The region includes 500 life sciences businesses with major strengths in medical diagnostics and digital innovation.
The financial challenges faced by the NHS nationwide are well documented and difficult decisions about how we are more efficient in the way we deliver healthcare do need to be made.
Although the NHS in the BOB area is expected to receive a 12% increase in funding in the next five years , we know that expenditure is growing at a faster rate than the money that will be available to us.
If we do nothing different, rising costs, inflation and increasing demand for NHS services will lead to a financial gap of £479m by the end of 2020/21.
We aim to close this gap through efficiency savings; delivering services in more different and cost effective ways, maximising the benefits that working at scale across a large area can bring and using national sustainability and transformation funding.
People will see practical and important improvements over the next five years.
A more efficient system designed to encourage the integration of health and social care will allow resources to be put to better use on providing local services, reducing the need for patients to travel for treatment and enabling elderly people to stay in their own homes for longer.
There will be better access to mental health services; the introduction of digital solutions (such as virtual consultations) and self-management tools making it easier for people to access advice and care 24/7 and, with a focus on prevention, a healthier population with less health inequalities across the Buckinghamshire, Oxfordshire and Berkshire West footprint.
For example, we have secured £11.43 million from NHS England , which is being matched by BOB STP, creating a total budget of £23 million to develop digital technology to support the delivery of health and care.
This will include a new pathology IT system for Oxfordshire, improvements to maternity electronic records in Berkshire West and using technology to support more flexible staff working and ways for patients to access information to help them look after their health in Buckinghamshire.
We have also, as part of our estates strategy, secured £12.921 million funding from Matt Hancock MP, Secretary of State for Health and Social Care, for three new health schemes in the BOB STP area.
This includes a :-
- 12-bed mental health unit for children within Berkshire’s mental health in-patient site at Prospect Park in partnership with Berkshire Healthcare Foundation Trust and Berkshire West Integrated Care System (ICS)
- 10-bed unit for patients with learning disabilities based at Oxfordshire Health Foundation Trust, designed to provide accommodation for patients with autism and learning disabilities
- new delivery suite for planned (elective) caesarean-sections at John Radcliffe Hospital, Oxford University NHS Foundation Trust
We are also prioritising how we can improve urgent and emergency care, so patients can get the right care, in the right place, whenever they need it.
A major part of the BOB STP plan focuses on making improvements for staff across the area. As well as specific aims to improve workplace wellbeing there are ambitions to build leadership capability, upskill the workforce and a shared workforce plan to increase opportunities for rotation across organisations – giving staff greater experience and enabling them to deliver better care.
All aspects of what goes into delivering healthcare have been examined and as part of the wider plan and some ideas about how to be more efficient in recruiting, utilising and developing our workforce have been put forward.
They seek to address long-standing difficulties in recruiting and retaining staff by making improvements to training, terms and conditions and by taking a shared approach to recruitment from overseas.
Another suggestion is to introduce a ‘bank’ of staff available to work across the whole patch and save money on expensive agency staff, up skill the workforce, enabling them to deliver better care. A shared workforce plan will increase opportunities for staff, including specialist doctors, to rotate across organisations and in doing so gain greater experience and deliver better care.
If all these ideas were put into place, savings of some £34m would be realised across the Buckinghamshire, Oxfordshire and Berkshire West (BOB) patch over the five year lifespan of the plan and would result in workforce numbers increasing by a predicted 978 posts.
The BOB STP expects to increase nursing numbers as we move towards 2020/21. We are exploring skill mix opportunities to ensure people are working to the top of their licence and we are optimising nursing time spent on direct patient care. We anticipate that current challenges around recruitment and retention of nursing staff generally, but particularly within some specialist areas, will prevail in the short to medium term. Therefore, our aim is to ensure that our future nursing workforce, which is highly valued, is better equipped and supported to work flexibly across our various healthcare settings.
Clinicians have been, and will continue to be, involved at all levels of the plans: at a local level, where GPs with expert knowledge of the health needs of their local populations lead on planning and decision-making about services for their local communities; at a county-wide level, through NHS providers; and at the wider STP footprint level, through independent and expert input from the Clinical Senate, for example.
The STP builds on the work already happening across Buckinghamshire, Oxfordshire and Berkshire West, using patient feedback and insight from past engagement and consultation activity, views from local Healthwatch organisations and clinical best practice to inform key areas of focus.
70 per cent of the plans that make up the STP are not new: these are existing plans drawn from local primary care strategies, frail older people’s strategies and health and wellbeing strategies – plans which we’ve been talking to staff, the public and stakeholders about for some time.
The STP is simply an “umbrella” plan which brings together these existing local plans and a small number of things where it makes sense to work on a wider regional scale, such as planning very specialised services, or ensuring our computer systems share information so we can work as efficiently as possible.
However, we do want to do more to engage and communicate with the wider NHS and social care workforce about how all this fits together, particularly as we develop these initial proposals into firm project plans over the coming months. This will be a key focus for the next phase of our engagement work.
Our proposals have been informed by a range of activities, such as ‘Your Community, Your Care’ in Buckinghamshire, the ‘Big Conversation’ in Oxfordshire and Call To Action events in Berkshire West; feedback and insight from our clinicians; and strategic health needs assessments and health and wellbeing strategies from across BOB. We have also benefitted from the clinical expertise of the Thames Valley Clinical Senate, the Oxford Academic Health Sciences Network (AHSN) and the Thames Valley Urgent and Emergency Care Network.
Public engagement is critical and no changes to current services will occur without local engagement and, where required, full public consultation.
Information about current priorities and discussions at the Chief Executive Strategy Group are in the STP Bulletins