Frequently Asked Questions
We have put together some initial FAQs which support the publication of the draft plan and other updates. More will be added as we move through this early engagement process.
1. What stage is this plan at?
On November 22 nd 2016 we published a draft of our latest STP which was submitted to NHS England. The initial thoughts have been developed with partners across the health and care system in Herefordshire and Worcestershire and publishing it means we can start the early conversation we need to have with our patients and communities. It has not yet been formally approved by the respective local Clinical Commissioning Groups, which is why it remains in draft form, until they hold meetings to discuss the information, in public, over the coming few weeks.
2. Is the draft STP now out to public consultation?
No. We are in the early stages and while our draft plans do include some modelling and early thoughts, we want the views of local people to help put some of the details behind these. So over the next few months we will be sharing our draft plan and getting some really early feedback on what people think and we will then use that to start developing firmer proposals which could be subject to formal public consultation as we move forward. You can complete the survey (add link) or pop along to one of our drop-in sessions to talk to us about these ideas.
There may be specific changes to some services which we need to make sooner and which would fall outside that timeline, however no significant changes to how services are run will be made without formal consultation with local people and those affected. All consultations will be advertised through these Your Conversation pages.
In Worcestershire we are also expecting changes to local Acute Hospital Services to go out to formal public consultation shortly, but while clearly linked to the broader STP this will be separate from the engagement work on our draft plan.
3. Why this particular footprint, why wouldn’t we work with other counties?
The nature of healthcare is complex and both our counties already work with colleagues from a range of neighbouring areas on our borders. The STP did however have to find a way of segmenting the country to units of a size and demographic practical enough to enable joint planning to occur. The footprint of Herefordshire and Worcestershire was chosen as a realistic size and because there are a number of similarities between our two counties in terms of our health and care challenges and the rural nature of our areas. We will still work with other STP areas and equally with Wales where it makes sense for the benefit of our population.
It is important to remember also that whilst Herefordshire and Worcestershire have developed the ideas and concepts in their STP on where they could do things jointly across the footprint, not everything will be done this way. In some cases, it will still make more sense to design and deliver services on a local level, in conjunction with other partners and even other neighbouring counties. The aim is be able to design the best services for our populations that fit within our budgets.
4. Is this just about saving money?
Our focus will always be on providing safe and effective services for our residents, but we have to be open and honest about the financial challenges we face. We will receive more money to deliver health and care services in Herefordshire and Worcestershire but on current projections this won’t be enough to meet the expected demands in the future, so it is important that we work together to use the resources we will have as well as we can. We have finite resources and want to get the best use from them.
We understand that we need to do more to improve our internal efficiencies as a starting point and we welcome feedback from local people with regard to ideas of how we can do this. This alone however will not be enough so we will need to work together as citizens, communities and organisations to make some changes so we can provide safe, effective services for people within our health and care budgets.
5. Will there be a reduction in beds?
What people have told us is that most would prefer to be cared for at home, or as near to home as possible. We are clear that we want to provide more care closer to home and, where appropriate, in people’s own homes and we want to develop better and more responsive local community services to do this. We are developing community nursing and therapy teams which have social workers and voluntary sector representatives as part of one team supported by a local GP surgery. These teams will will be equipped to provide the majority of the care you need at or close to home.
We will be working with stakeholders to understand how many beds we may need and how community hospitals could offer a broader range of services such as more outpatient or day case activities.
6. Surely we need more beds with demand rising?
At the moment we are assessing how many beds we will need and where for our population and working through some potential new models of care which will see more treatment and services provided at or closer to home. Even with rising demands we know there are too many people in hospital for things which could better be treated at home or in a community clinic. We also recognise that too often people occupy a hospital bed longer than they need or want to. We know we need to improve and strengthen our community services and make them join-up better to the overall quality of care and reduce the demand on our hospitals.
We also need to do more to prevent issues escalating to a point where admission to a hospital is needed, so although demand is rising we know there are better and more effective ways of managing a lot of this demand outside of hospital. This will help ensure that those who really need a hospital bed get the care they need without delay.
7. Is closing hospitals part of your thinking?
We are currently assessing how many beds we will need and where for our population. We have done some initial modelling of bed numbers which now needs testing, but if our model of care is successful we could see more treatment and services provided at or closer to home. This means that the way our acute and community hospitals are used will change over time; so for example we only want those with an acute illness or condition to be seen in an acute hospital, and for staff based there to deliver the specialist or acute care and treatment they are trained to provide. This will enable those who really need acute intervention to receive it as quickly as possible without unnecessary delay. In terms of community hospitals, they could, for example, provide more outpatient and day case activities which would support the aspirations of care closer to home.
It is important to reiterate that we plan to work with our patients and citizens to design services that fit our population based on this principle.
8. Why has the STP been kept secret until this time?
The STP process commenced, in earnest, in March of this year with an initial submission date of 30 June 2016. From the inception of the work to create the STP there have been 16 Herefordshire & Worcestershire health economy partners at the programme board table, including representatives from health and social care the Voluntary and Community Sector (VCS) and Healthwatch from both counties so it really has been a team effort from a lot of partners and not a process that has been completed by a secret select group of individuals or organisations. The initial national timeframe was recognised as unrealistic to produce what was being asked of the partners, and meaningfully engage with wider partners. The June submission outlined the gap we had and the issues we were trying to solve. Since June we have been pulling together an overall view of all our priorities and thinking, which can now be shared to help shape things moving forward.
9. How does the STP link in with the recent changes to Acute Hospital services in Worcestershire, which are due out for public consultation?
The Future of Acute Hospital Services in Worcestershire programme is a key part of the Herefordshire and Worcestershire Sustainability and Transformation Plan. It aims to ensure that we have clinically sustainable hospital services in the county, which is also one of the aims of the Sustainability and Transformation Plan. Public consultation on the Future of Acute Hospital Services in Worcestershire is due to start soon and further information can be found at http://www.worcsfuturehospitals.co.uk
10. Is there any prospect of emergency care being consolidated between the hospital trusts?
As it stands at the moment we plan to retain three A&Es across our patch (Worcestershire Royal, Hereford County Hospital and the Alexandra Hospital in Redditch), however there may be some variation in what each site provides in the future. For some emergency issues, such as a major trauma, stroke or a heart attack we already have specialist sites. Thesewill have the appropriately skilled and trained staff to ensure you get the care needed as quickly as possible. Given some of the recruitment challenges we have, it may make sense to consider centralising other specialist or emergency services so we aren’t spreading our resources too thinly which can be a risk. We will also be working with colleagues across the West Midlands to review our compliance with national best practice on transforming urgent and emergency care. No significant decisions will be made on these issues before we have had the opportunity to get out and talk to our local communities about potential options and participate in the regional review.
11. Have there been any discussions about merging organisations?
We know there is currently too much duplication and we think there are lots of opportunities to work better together. We need to enable the improvements we need to make, and we need organisations and structures to make this easier not more complicated. At the moment though we are focusing on working together in the best way we can without being distracted by major organisational change. We would not rule this out in the longer term if it makes sense but there are some smaller steps we can make straight away, the 3 Worcestershire CCGs working more closely together being one example.
12. What will be the impact on jobs?
There aren’t currently any plans to reduce our workforce through redundancy, but we may need to look at opportunities where we have natural reductions in staff numbers where this makes sense, for example by not replacing staff who leave or retire in a specific area.
At the moment one of our challenges is our difficulty in recruiting to some roles which means that we are relying too much on agency staffing which are expensive. Our plans are about reducing these so we have a sustainable and permanent workforce. We have workforce challenges across a range of areas from medical consultants in certain specialties to domiciliary care. By working together as an STP footprint we hope to find ways to encourage people to come and work in Herefordshire and Worcestershire.
13. Will people from Worcestershire/Herefordshire have to travel further for their care?
We need to ensure services are safely staffed so you can get the right care when you need it. Nationally, it can be really hard recruiting to some specialist roles and so for some specialist conditions it may make more sense to centralise these services so they are safely staffed and we aren’t spreading our resources too thinly which can present risks. Equally for some specialist services the numbers of people who need to access them can be very low and the service therefore needs to be provided on a wider geographical footprint to make it viable. We recognise however that transport is a real issue and people regularly tell us that this needs to be a key consideration when developing proposals. For that reason we want to work on providing a lot more care closer to or in people’s own homes and local communities. We are developing community nursing and therapy teams which have social workers and voluntary sector representatives which are part of one team and are supported by a local GP surgery who will be equipped to provide the majority of the care you need at or close to home. For specialist care however it is the case now and will continue to be that local people will have to travel for some specialist input where that provides the best possible care.
14. Will I still be able to get an appointment with my local GP?
It can be really frustrating ringing for a routine GP appointment and being told you may have to wait two or three weeks. We also know that once you get one, the consultation with your GP is often restricted to just 10 minutes. This is because demand on GPs is increasing too, making it really difficult to get same day appointments in some of our surgeries. We think there are opportunities for local surgeries to work more closely together to share some of the demand and expertise and provide access options.
We also need to think, ‘if I need an appointment, does it really need to be with my preferred GP, or indeed a GP at all’? There may be times and circumstances when that is appropriate, but in lots of cases people have illnesses or conditions which can be just as effectively dealt with by a nurse or other healthcare practitioner if that is appropriate. This is so we can ensure we can use GPs’ time most effectively, and they can see you as quickly as possible for as long as is needed, when you need it.
15. What are you going to do to stop so many people getting ill in the first place?
We want prevention of ill-health to lie at the heart of our health service. The STP gives us a chance to systematise this and take a planned approach to at-scale prevention work, changing staff and services to enable people to stay well.
For general enquiries about the local STP email email@example.com