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We need patients and the public to shape local health plans, say NHS leaders

Patients and the public across England are set to be asked to help the local NHS make decisions about how best to develop services.

The NHS in England is today (Thursday) publishing national advice for local health and social care leaders preparing what are known as local Sustainability and Transformation Plans (STPs).  The advice sets out how to put the communities they serve at the heart of their work.

Under a new, collaborative approach announced in January, local leaders have come together in 44 STP areas, covering every part of England, to work through how best to spend funding growth and transform care in the face of rising demand and more complex patient needs.

Although funding is increasing, the NHS needs to ensure its services are as efficient as possible, eliminating waste and duplication, and making sure that patients receive the services they need in the right place and at the right time.

This means fewer hospital stays when care could be given at or closer to home, as patients say they want. It also means tackling the causes of ill health early on, not just treating the symptoms.

This Autumn, every STP area will be developing proposals for how they will use the increased funding over the next few years to improve health and wellbeing, transform care quality and ensure financial sustainability.

Local areas are responsible for involving patients and communities in their draft proposals. Each is working to its own, locally appropriate timetable but many have already carried out extensive engagement with the public. These include:

  • Mid and South Essex local leaders have incorporated feedback from patients, councillors and others about its overview plan since March, resulting in a stronger emphasis on prevention and the development of mental health care. It has also spoken to hundreds of patients and staff about potential options for re-designing local hospital care.
  • In South West London, the NHS is working in partnership with Healthwatch to talk to people whose voices are less often heard in engagement. It expects to hold seven to ten events in each borough, and wrote directly to more than 1,000 local community groups in May to share it emerging thinking and asking people for their views. All feedback is being considered as part of the STP planning process.
  • Plans in South East London build on extensive conversations between the NHS and the communities they serve about local challenges and priorities. This has included large-scale public events in each borough, and involving patients and the public in clinical groups to discuss area-wide strategy.

Proposals for every part of the country are planned for late October/November, with most areas likely to start preparing for more formal local engagement and consultation by the end of the year.

The new guide includes advice on:

  • using lay representatives and establishing patient reference or advisory groups;
  • considering and carrying out formal consultation with enough time for the public to make their views heard;

and

  • testing options with local councils and other important stakeholders, where possible by building on the work of existing bodies such as health and wellbeing boards.

Many local health systems are already publishing summaries of their proposals for patients and the public, with others expected to do so later this year. Relevant organisations such as hospital trusts have also been advised to devote a public board meeting in full to discussing proposals.

The NHS stresses that, in order for conversations with the public to be meaningful, proposals must be practically viable. Plans are understandably at different stages and NHS England and NHS Improvement will help ensure their development is rigorous.

Jo Lenaghan, Project Director for the NHS Five Year Forward View, said: “There is consensus that the NHS needs to change to better meet the needs of today’s patients and we know broadly how it needs to change with more care outside of hospital.

“The issue local health and social care leaders are now grappling with is how to make this real in their part of the country.

“There is a huge prize to be had that includes better joined-up care, services closer to home and improved outcomes for older people. But to achieve those benefits communities will have to confront choices about where to put modestly growing resources.

“Local health and social care leaders know they can only invest funding growth wisely if they understand people’s priorities. So, public engagement is not just a public duty but the prerequisite for a high-quality, viable plan for the future.

“To enable local conversations to work well,  local health and social care leaders are preparing workable proposals for their communities, built on a bedrock of partnership not fragmentation, the only way to succeed in today’s NHS.

“For too long, health and care leaders were asked to draw up plans for single organisations instead of for the whole communities they serve.

“Local proposals need to be viable, real-world propositions. Every part of the country has a unique history so states of readiness vary and geographies will rightly move at different speeds.

“No one should be under illusions that the choices here are easy.  The health and care system we have today was designed for a different age. We hope all those involved will help us get this right – it is critical to the health of our NHS.”

Dr Anita Donley OBE, leader of Mid and South Essex footprint, said: “We made a commitment from the start that clinicians and local people would drive the development of our proposals. The feedback we’ve had so far is rich in important details that will support patients and public in being able to access a very different health and care system in the future.”

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27 comments

  1. Bob Bollen says:

    You say “In South West London, the NHS is working in partnership with Healthwatch to talk to people whose voices are less often heard in engagement. It expects to hold seven to ten events in each borough, and wrote directly to more than 1,000 local community groups in May to share it emerging thinking and asking people for their views. All feedback is being considered as part of the STP planning process.”

    Where is this feedback published, please. I’d like to read it.
    Thank you

  2. EMN says:

    You say Mid Essex CCG incorporated feedback from stakeholders and consulted ‘hundreds of patients…”

    May I ask how they did this? As far as I am aware no proposals other than vague ambitions have been published. In no way does this constitute consultation. If NHS England thinks it does, then be prepared for judicial reviews

  3. PollyD says:

    The open dialogue approach to major mental illness is a community based method for people experiencing their first psychotic event. 72% of people treated in this way respond with higher rates of returning to work, fewer people reporting subsequent psychotic episodes, less if not zero medication and a better experience than being incarcerated in a psych unit. I would like to see groups supporting the open dialogue method and regional training taking place for support workers. Medicating and incarcerating people with mental ill health is Victorian and unkind. It’s time to talk about psychosis and understand it rather than shut it away. Please think about this as a regional plan to transform the care of people with major mental health issues which should reduce expenditure in the future and provide supportive and kind home and community based care.
    It depends on training though [broken link removed] which will be welcomed by people in distress.

  4. Brenda White says:

    If this all works it will be a distinct benefit for users of the health service but no where in this brief does it mention services at home or in homes, hopefully this is also included. If good services are in place it usually results in non admission to hospital or care home. I have been involved as a patient/carer with many health related groups – talking shops with no action as any suggested gets changed/disregarded by those required to implement them. It only makes work, is not understood by the “professionals”, Costs money, too difficult in present circumstances, resistance to change – I could go on for the many groups I have worked with who all these who become frustrated at not seeing anything practical come from all their input as either a patient/carer – those who provide the inadequate services defend their position always quoting costs even if none are involved, just a change of practice.

  5. Paul Conyers says:

    In order to ensure the success of this wide ranging initiative and more importantly to maintain traction, there must be an appropriately articulated roadmap developed that includes a robust capability for effectively identifying, creating, prioritising, regulating and introducing knowledge management linked by up to date technologies. This action seeks to improve the health system’s service effectiveness, reduce cost, improve engagement with people who access health services, promote healthy behaviours and self-management, and aid people-led design.

  6. Gordon Cairns says:

    To all the people mentioned by name in this news bulletin this isn’t happening . I have asked for a list of stakeholders who are taking part in the setting up of Cheshire and Merseyside STP and got no answer .I am ready to say no patient Organisation is involved and no individual Patients .All I got was if needed the finalised plans or parts of them will be put out to consultation and engagement . So no patient involvement in STP planning and although I have sent the September Guidance to all I know in charge of STP by email attachment no one has had the decency to even reply to my email .So you might as well have saved your time and money sending out this guidance as no one listens to you any more . CCG’s were given too much freedom in the 2012 act and they are now thumbing their noses at NHS England and Foundation trusts are doing the same to NHS Improvement who are both ineffectual at Quango’s with no control over their CCG’s or FT’s I I still say STP SILENCE THE PATIENT and PUBLIC

  7. Nick Pizey says:

    A friend of mine keeps telling me that STP is just a subterfuge for thee NHS to encourage privatisation, and that valuable community resources, hospitals and health centres included, will be virtually given away. What assurances can be given that this will not happen? Also, by setting up all these local STP groups and consultations, with locally determined outcomes ultimately decided, not by public consensus but by local CCGs and minimal councils input, is it not more than likely that the future “NHS” will be even more of a postcode lottery than it already is?

  8. We’re really keen to engage with the STP in North Central London but NHS England have delayed the sharing of plans so it’s very hard for local people to engage. How can we engage if there is so little transparency?

  9. WAEL ARAB says:

    You say you need patients and the public to shape local health plans. My experience, as a member of the public who would like to help, is that in reality, you do not want to know. Ideas, suggestions and even complaints about incompetence go unattended to, apart from the false promise that somebody would get in touch with me soon.
    My local area is the London Borough of Camden and my local hospital is The Royal Free Hospital. I do not know whether other areas are better or worse. A lot of money is wasted on new teams, conferences and meetings, that achieve nothing and, of those involved, nobody later wants to know.

  10. Kassander says:

    ​Ode to an Assassinated Forum​
    All is safely Gathered in – and Locked away

    ​Is ​there anybody there? said the Patients
    ​Writing to online Gather​ (Dead)
    And ​their hopes for NHS Citizen’s courage
    Rose ​under Anu’s ​bold new lead
    ​Then​ Tweets flew up out of iPhones​
    But ​way over the Patients’ heads​
    So they wrote upon the site a second time​
    IS anyone in Quarry House? they said​
    But no Mod nor Director deigned to ​Involve the Patients
    ​No Head from ​PPPI sent Twit or Trill
    Nor looked beyond their own ​grey selected guys
    Who supported every word from t’ Mill​
    Only 50 million Patient Petitioners​
    Who’d paid for their NHS​, then
    Stood listening in the quiet of NHS’ twilight
    To the voices from the world of THEM :
    The Marketeers, neo-liberals, privateers, and assorted spivs who pretend they’re running OUR NHS for us, whilst running it into the hands of the Pirates of Nye’s legacy to the nation.

    We want OUR NHS back

  11. John says:

    Lord Prior has stated that he doubts all footprints will be successful or the STP will work
    He is health spokesman in the House of Lords
    Warrington Borough will object to its imposition

    Six months the transform the NHS secretly

    Leave the NHS alone give it back to the clinicians and Community Heatlh Councils and the people no more privatization

  12. The guidance is very welcome,but very late, particularly given the commitment to public and patient engagement when the STP was first launched ( how many months ago ?)One wonders why it has taken until now to publish it ?
    As an STP Programme Board member with a view of the STP planning process I have been pushing for patient and public engagement since day one, as I am concerned that local NHS leaders are being required by NHSE who are driving this to make the big decisions that will determine the shape of our future services NOW as they submit financial plans to balance the books in 2020
    These decisions are being described as ‘proposals or concepts’ to avoid challenge at some future date. Engagement so far, other than to explain a decision, after the proposals have been signed off by NHSE will be to late!

    Can we stop ‘doing things to us and start doing things with us !’

    • Nick Pizey says:

      I agree. This gets to the heart of the real problem. How can a NATIONAL health service be sustained if so much of its resources and responsibilities are devolved to localities? Of course it is right to build into the system going forward, better public consultation and public accountability. However, we should be honest and realistic about how far that approach can take us. The involvement of the public, in particular, the patients, is essential for those charged with delivering the service to be made aware of shortcomings in the system(s) and potential changes for improvement, but the day to day and long term management lies in the hands – and hearts – of highly skilled, well trained individuals who are charged with ensuring that the NHS locally, Regionally and Nationally is given the resources, the leadership and the dedication to sustain and maintain it for years to come.

  13. As a carer I am disillusioned by lack of information available to me with regard to new limits for podiatry help for my disabled husband. He has RA (for over 20 years) is type 2 diabetic, has had major surgery on his left foot (triple fusion which leaves him with limited mobility in that foot) as a result of which he has a growth on the sole of his right foot (because of pressure from using that foot to help his balance and take the weight off his left foot). He has been told that his 6 weekly podiatry service is being reduced to every 12 weeks. The growth has to be cut out and once (when his appointment was cancelled and it became infected) he had to have emergency treatments to cut it and drain the infection. He was told he must have the procedure 6 Weeky. When of the reduction in treatment, my husband explained about the pain and his balance problems but Podiatrist stated this decision is in line with CCG directives? Diabetes,RA, emphysema,now disabled by a growth on his foot.

  14. Kassander says:

    Oh dear
    There go you NaySayers again about not being consulted
    Your problem is that when you get the chance, you don’t use it
    Take LINks: the Govt gave the running of them into the hands of you P&P and what happened?
    You let the Host organization or the Local Council take them over
    The next Govt offered you the chance to bid for and run Local HealthWatch
    Did you do that?
    NO You sat by and let someone else do it, and make a profit
    The CCGs were formed so that the Market could distribute your £70 billion/yr NHS budget
    Did you take the opportunity to be a Lay NED on their Board to represent P&P?
    NO You left it up to the CCG to chose their chums and business associates to speak for you – and get paid handsomely.
    You P&P have shown that you’re not interested so leave it to the experts.
    After all, you have a say on which colour bandage you get today, as long as it’s white.

    NB Less than sensitive persons may miss the satirical nature of this post

  15. Maurice Lewis B.Ed(Hons), FITE says:

    I find all your group leaders short of providing email feedback service, particularly Paul Farmer’s mental health taskforce which doesn’t get through to carers of mental health service users to explain what he’s doing at local authority level. MIND in Bedfordshire is pathetic in helping service-users and there is very little supported accommodation to help adult service users.
    PS I’ve looked in many website places to find contact details but it seems I’m reading all talk and no action.

  16. Disenchanted says:

    Our STP seems intent on implementing plans that are totally opposed by those living in one area. They know this from the Healthwatch engagement activity, public meetings, meetings with patient groups and a large prominent campaign. The service user view seems to have no effect on planning whatsoever – not even when users point out defects in the planning like absence of risk assessments of options or travel time analyses that have not been seen by key decision-makers.
    Being a service user here is like living in a country governed by a colonial power. We have no say in what happens to us and are expected to feel grateful for what we get.
    The catch is, how will the NHS persuade patients to become involved in Integrated Care Communities when they feel so alienated from the system? ICCs are the way to achieve genuine cost savings that benefit patients – but will only work if there is genuine engagement.

  17. Gordon Cairns says:

    I put questions at the NHS Expo last week and I think the amount of people with objections to no patient involvement in STPs around the main stages and I got three questions in at different presentations on the two stages including the HSJ STP summit at end of second day .They might have been rattled into putting out the new guidance on patient involvement in STPs only a week after the Expo . Just a thought that I was thinking about the patient involvement . I wonder if they will release the cctv taken of the presentations where I asked the questions and got the corporate spln answers

  18. The timing of this “advice” (ie, optional) shows that it is a figleaf at best and disingenuous at worst. Service users, carers and the public should have been involved at the outset in STP deliberations, but they were not. Their contribution cannot be retrofitted. No wonder STPs are being derided as “Secret Transformation Plans”. Only a “version” of the full STP has to be published, so the inevitable question will be “what is being held back?” The public should refuse to collude with this sham consultation. All it does is give engagement a bad name and devalue expert lay input. So sad it has come to this and so avoidable.

  19. Kassander says:

    Jo Lenaghan, Project Director for the NHS Five Year Forward View, said: to achieve those benefits communities will have to confront choices about where to put modestly growing resources.
    Growing implies getting larger (in real terms).
    Do tell us about what real recent increases your organisation has received, please.
    RSVP

    • Kassander says:

      SOME people even suggest that:
      ” …the £22bn a year funding shortfall accepted by NHS boss Simon Stevens at the behest of his Tory bosses is going to mean eye-watering cuts to hospital services on the ground. Chris Hopson of NHS Providers admits a ‘glut’ of hospitals could close.”

      (Labour leadership, the NHS, and ‘honest politics’
      CAROLINE MOLLOY 16 September 2016)

  20. Kassander says:

    “Proposals for every part of the country are planned for late October/November, with most areas likely to start preparing for more formal local engagement and consultation by the end of the year.”
    Some clarification is needed (IMO), please.
    1) Which aspect/s will come about ” by the end of the year.”
    2) Might one assume that the Year in Question is 201?

    RSVP

  21. Julie Ingram says:

    Your not letting the patients and the public know what is happening in our nhs and you should do , we don’t need these STPs or the 44 footprints

  22. Anonymous says:

    This is somewhat disingenuous – local plans have been in development for months, with NHS England reviewing them and insisting they remain secret, with no public involvement in their content. The suggestion that following all this work and the millions that have been spent that local people will be able to ‘shape’ them is as fanciful as it is dishonest. If those involved in this exercise had engaged with local people at the start of the process and been open, honest and transparent about the issues and challenges that we face, then the plans would undoubtedly have been more effective and their implementation less problematic. Instead, we will be presented with what officials have decided will be implemented, with any opportunity for ‘shaping’ at the absolute margins. As that is clearly the case, it’s very likely that there will be huge opposition to what is proposed. This is not the way to do business!

  23. Ian says:

    So why are certain areas of the country being held back from being able to run engagement sessions, and others are not??

    Our PRG, the running of which is a contractual requirement to ensure the patient voice is heard, are raring to go – yet we have to wait for further County Council documents to be released, before engagement can start. Surely this is ‘top down’ restructuring rather than ‘bottom up’as was promised?

    Why wait until plans are well developed before asking what patients would wish for in a future ‘sustainable’ system??

  24. Michael Vidal says:

    This seems like an about turn by NHS England. I have seen draft STP’s where it was stated that the plan was not to be discussed in public. If I was a cynic I would think that this advice was to avoid the risk of legal challenge to STP’s on the grounds that there has not been consltation with patients and the public.

    I would also onserve that this advice is with respect about four months too late as this should have been done before the 30 June submission date.

    • Gordon Cairns says:

      I saw the first Community Involvement guidance of 22 pages in December 2015 for STP’s there was another rerun of the December Guidance in May 2016 and This 21 Page Guidance in September is another almost exact copy of the December 2015 Guidance . I sympathise with all else you say as you will see by my 2 pieces in the comments section the second one at todays date but I have to correct you on publishing dates . By the way does anyone look at these comments or replies to comments or are we wasting our time doing this