The NHS has been tasked with spending the next six months delivering core access, quality and financial standards while planning properly for the next 5 years with a focus on:
- Developing a high quality and agreed Sustainability and Transformation Plan;
- Returning the system to aggregate financial balance. This includes secondary care providers delivering efficiency savings. CCGs will additionally be expected to deliver savings by tackling unwarranted variation in demand through implementing the RightCare programme in every locality;
- Developing and implementing a local plan to address the sustainability and quality of general practice, including workforce and workload issues. Get back on track with access standards for A&E and ambulance waits, ensuring more than 95% of patients wait no more than four hours in A&E, and that all ambulance trusts respond to 75% of Category A calls within eight minutes; including through making progress in implementing the urgent and emergency care review and associated ambulance standard pilots;
- Implementing improvements against and maintenance of the NHS Constitution standard that more than 92% of patients on non-emergency pathways wait no more than 18 weeks from referral to treatment, including offering patient choice.
- Delivering the NHS Constitution 62 day cancer waiting standard, by securing adequate diagnostic capacity; continuing to deliver the constitutional two week and 31 day cancer standards and make progressing in improving one-year survival rates by delivering a year-on-year improvement in the proportion of cancers diagnosed at stage one and stage two; and reducing the proportion of cancers diagnosed following an emergency admission.
- Achieving and maintaining the two new mental health access standards: more than 50% of people experiencing a first episode of psychosis will commence treatment with a NICE approved care package within two weeks of referral; 75% of people with common mental health conditions referred to the Improved Access to Psychological Therapies (IAPT) programme will be treated within six weeks of referral, with 95% treated within 18 weeks. Continue to meet a dementia diagnosis rate of at least two-thirds of the estimated number of people with dementia;
- Delivering actions set out in local plans to transform care for people with learning disabilities, including implementing enhanced community provision, reducing inpatient capacity, and rolling out care and treatment reviews in line with published policy; and
- Developing and implement an affordable plan to make improvements in quality particularly for organisations in special measures. In addition, providers are required to participate in the annual publication of avoidable mortality rates by individual trusts.
5 Year Sustainability and Transformation Plan (STP)
Perhaps the most significant aspect of the guidance however is the requirement for system level plans for the period 2017/18- 2020/21 which address the ongoing need to transform and thereby sustain local services in the light of the tightening financial position and other constraints. Put simply, there is clear recognition that an annual process of incremental one year planning with a focus on transactional savings between commissioners and providers will fail and agreement to change is required at scale.
Linked to the production of STP’s there is national Transformation Funding which systems access by virtue of the quality of the STPs. There is clear indications that those systems who are most prepared to embrace change will fare the best in terms of funding.
Whole Norfolk Working
All Norfolk CCGs, NHS and Foundation Trusts, Norfolk County Council, and Norfolk Independent Care have met on three occasions since the Autumn facilitated by Sir John Oldham, former national QIPP Long Term Condition workstream lead, to address exactly the same challenges as those facing the STP and also to consider how public services in Norfolk may wish to respond to the current policy interest around the devolved management of health and care services across large areas, such as that seen in the Manchester Devolution Pilot.
North Norfolk CCG are ‘ahead of the curve’ in terms of its progress towards implementation of many aspects highlighted in the guidance, particularly in relation to our current principles and work streams that fit well with our local strategies and should therefore only support our existing programme of work, for instance on integration, rather than compete or duplicate it.
Additionally, the three acute trusts in Norfolk and Norfolk Community Health and Care (NCH&C) recently announced that they had agreed a Memorandum of Understanding for greater co-operation and joint working so as to aid clinical and financial sustainability. This is a welcome development.
The Group also discussed the issue of what footprint an STP should take. There was a strong majority view which favoured this being for all of Norfolk and Waveney so as to incorporate the James Paget University Hospital's catchment area.