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, which is a national plan 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, seven Clinical Commissioning Groups (CCGs), six NHS Trusts and 14 local authorities and 175 GP surgeries.

There are a number of health and wellbeing, care quality and financial challenges being faced across the BOB area. For example:

  • increasing demand for services, particularly for over 75s
  • pockets of deprivation causing health inequalities, which are difficult to overcome
  • a population growing faster than expected as a result of significantly increased new housing
  • community hospital buildings that require repair and are not fit for modern needs
  • variable access to some specialised treatments
  • difficulty in recruiting and retaining staff due to the high cost of living
  • specialist mental health services and out of area placements for patients that are not of the standard we’d like them to be.
  • if we carry on as we are, there will be a financial gap of £479m by 2020.

 

Our vision is to improve health outcomes and add value by working together and in doing so close the health and wellbeing, care and quality and financial gaps.

By this, we mean:

  • providing the best quality care for patients as close to their homes as possible
  • healthcare professionals working with patients and carers to ensure quick access to diagnostic tests and expert advice so that the right decision about treatment and care is made
  • ensuring, as modern healthcare develops, our local hospitals keep pace by using innovation to provide high quality services to meet the changing needs of our patients
  • avoiding people being unnecessarily admitted to hospital or having to use A&E services because we can’t offer a better alternative
  • caring for people in their own homes where possible
  • spending funding wisely to ensure the provision of consistently high quality care that supports improved health outcomes.

 

Together we recognise that there are some things that we could do across the BOB area to maximise the value of every pound spent and other changes that are best planned and delivered locally.

Currently, there are eight programmes that will run across the BOB patch. They are:

  • Preventing ill health, by shifting focus from treatment to prevention.
  • Improving access to the highest quality primary, community and urgent care services.
  • Collaborating across acute hospital trusts to improve quality and efficiency by delivering effective clinical networks.
  • Improving the health outcomes of patients using mental health services, ensuring services are operating efficiently.
  • Improving access to specialised services, such as cancer treatments.
  • Increasing efficiency by planning and buying services, where appropriate, at scale across the BOB geography.
  • Increasing our ability to support people in their own homes and avoid an emergency admission to hospital.
  • Improving our workforce offer and increasing staff retention
  • Providing digital solutions for self-care, virtual consultations and interoperability to increase patients’ access to information and reduce duplication and travel.

 

There are also other plans underway to transform some services that have a more local focus. These are already being discussed with patients and the public in Oxfordshire, Buckinghamshire and Berkshire West.

 

 

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 improvement over the next five years as a result of this plan. 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.

 

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.

The challenges facing the NHS are many and complex and the various partners involved are working hard to come up with the best possible proposals for tackling them. This is a new way of working for everyone and it has not been a simple process.

The latest version of the BOB STP was published in December 2016 and a summary document was circulated to all stakeholders across the footprint.

In January 2017, the first public phase of the ‘Big Conversation’ was held in Oxfordshire, asking the public to contribute their thoughts on proposals to change the following local services: changing the way we use our hospital beds and increasing care closer to home; planned care services at the Horton General Hospital; acute stroke services; critical care and maternity services. This was done at a wide range of local event across Oxfordshire, South Warwickshire and Northamptonshire, as well as inviting online and paper responses from the public and voluntary groups.

A summary is produced following the BOB STP Executive board meeting which will be published on this website. You can find the latest summary here 

If you have any questions or comments, please get in touch with us using the below email addresses:

Oxfordshire queries: cscsu.media-team@nhs.net

Berkshire West queries: ppiteam.berkshirewest@nhs.net

Buckinghamshire queries: ccgcomms@buckscc.gov.uk