We aim to help you stay up-to-date and involved with potential changes facing Cornwall’s health and care services.
National Sustainability and Transformation Plans are being determined across the country. In Cornwall, Shaping Our Future (SoF) is the process for our new health and social care plan.
A work-in-progress SoF website is accessible at: shapingourfuture.info/
January 12, 2018
On Wednesday, January 10, we attended the Accountable Care System Inquiry session held by Cornwall Council.
This in public meeting heard evidence from the Council’s Chief Executive Kate Kennally concerning the six options being put forward for the Integrated Strategic Commissioner element of Cornwall’s Accountable Care System proposals.
View the presentation via the following link:
It was confirmed at the session that at the March 28 Cabinet, support for the preferred option (as of this date still to be confirmed) would be sought, along with a mandate to work in shadow form to test the plans with a “fully worked up business case coming back to the September Cabinet for decision”.
There are further two ACS Inquiry sessions on January 15 and 31. We have been asked to present evidence at the January 31 meeting on public perception of the ACS proposals.
Therefore, we want you to share your understanding of, and views on, the potential ACS in Cornwall.
As well as on our website, you can find further information at:
Please call us on 0800 0381 281 or complete a Have Your Say form online before January 30. This information (you can remain anonymous) will be used as part of our presentation to the ACS Inquiry panel on January 31.
You can also send comments to the panel direct, by noon on Jan 17 via firstname.lastname@example.org
January 5, 2018
Academic Dr Peter Levin, has shared his views on his website regarding the potential replacement of Cornwall’s Minor Injury Units (MIU) with Urgent Treatment Centres (UTC).
In this article, which can be read in full via the link below, Dr Levin suggests that there is a disconnect between NHS statements saying no decision has been made on MIU status and proposals to create UTCs, based on his analysis of information in papers relating to the Shaping our Future (SoF) process. He states: “…assurances that no decision has been taken about the future of Cornwall’s MIUs are not consistent with the commitment already created to going ahead with UTCs…”.
NHS Kernow has released a response to Dr Levin’s article, which can also be read in full below, refuting his claims and encouraging people not to be put off using local MIUs.
In the statement, Jackie Pendleton, NHS Kernow’s Chief Officer, speaking on behalf of Cornwall and the Isles of Scilly health and care system, said: “We strongly refute Mr Levin’s claims that we are pursuing a policy to close Cornwall’s MIUs…”.
Healthwatch Cornwall is here to listen to the concerns of patients and the public in relation to the county’s health and social care services. If you have anything to say on the ongoing SoF process, please use our Have Your Say form or call 0800 0381 281 and we will ensure it is forwarded to the SoF Transformation Board to be taken into account.
We will continue to share information as we have it, including any public consultation opportunities.
Peter Levin’s article: http://spr4cornwall.net/nhs-in-cornwall-poised-to-close-minor-injury-units/
NHS Kernow’s Governing Body minutes from December 2017. These include the Director’s report concerning UTC proposals: https://doclibrary-rcht.cornwall.nhs.uk/kernowccg/FolderView.aspx?cID=10090
NHS England’s description of Urgent Treatment Centres can be read at:
January 4, 2018
In reference to the article below of December 20, 2017, Graham Smith, reporter at Cornwall Reports, has provided a link to an interview he conducted with Cllr Rob Rotchell and shared on YouTube on December 16.
The interview discusses the proposed Accountable Care System (ACS). When asked if Cornwall Council will be taking over the NHS (locally), Cllr Rotchell says that, “The bit that will become the responsibility of the local authority, if all goes to plan, would be the commissioning…” and “…the commissioning part, which is currently done by Kernow Clinical Commissioning Group (NHS Kernow), the proposal is to move that under the auspices of the local authority…”.
The full interview can be found at: https://www.youtube.com/watch?v=4gvHG_f9JIA&feature=youtu.be
We have contacted NHS Kernow for their view on these comments.
The next ACS Inquiry Day, which is open to the public, will be held on January 10. This has been created to:
1. Understand the rationale behind the establishment of Accountable Care Systems across the NHS in England and specifically for Cornwall and the Isles of Scilly.
2. Consider the option put forward for integrated strategic commissioning as part of a Cornwall and Isles of Scilly Accountable Care System (including the ones discounted and take a view on which is more likely to achieve the desired outcome) and the route map to achieve it.
3. Ascertain, within the preferred option, how democratic control and clinically led commissioning can be retained.
The agenda and further information can be found at: https://democracy.cornwall.gov.uk/ieListMeetings.aspx?CId=1242&Year=0
A joint Council and NHS explanation of the ACS proposal (uploaded on Dec 14) can be read at: http://www.shapingourfuture.info/plans-shadow-accountable-care-system/
The latest Transformation Board (and first in public session) took place in December. Minutes from this are expected to be shared on the Shaping our Future website in due course.
December 20, 2017
Media reports have prompted NHS Kernow (CCG) to reassure its staff that it is not being ‘taken over’ by Cornwall Council.
This follows the news that Cornwall’s health and social care sectors are working towards creating an Accountable Care System (ACS), which will include an Accountable Care Partnership. An explanation of these can be found below under our December 8 update, and on the subsequent SoF explanation as in the links under December 14.
NHS Kernow has reiterated that the process “will involve Cornwall Council, NHS England, the CCG and NHS provider trusts working in partnership” but will not be “a take over by any one organisation”.
It also confirmed that “Our shadow ACS will operate within the existing statutory framework which means that the Council, NHS England, the CCG and NHS provider trusts will remain the statutory accountable bodies in the system”.
Healthwatch Cornwall has also just learnt of the dates from Cornwall Council regarding its plans to hold a number of ACS Development Inquiry Days. These have come about following a meeting of the Health and Adult Social Care Overview and Scrutiny Committee in late November. They comprise six councillors.
Although the first meeting has taken place, we have been reassured by the Council that the next sessions will take place on January 10, 15 and 31 and we plan to attend these sessions. We understand they are to be open to the press and public.
It is expected that these sessions will predominantly consider the rationale behind the establishment of ACSs across the NHS in England and specifically for Cornwall and the Isles of Scilly; consider the option put forward for integrated strategic commissioning as part of a Cornwall and Isles of Scilly ACS; and within the preferred option, ascertain how democratic control and clinically led commissioning can be retained.
It is expected a report will be made to the scrutiny committee in February, which will then be fed back to cabinet and full council, and NHS Kernow’s governing body.
Details of the future meetings can be found at: democracy.cornwall.gov.uk/ieListMeetings.aspx?CId=1242&Year=0
A statement by Cllr Rob Rotchell can also be seen below under December 15.
Examples of news stories that NHS Kernow feel have misrepresented ACS set up:
Local news article:
December 19, 2017
On December 19, we attended the Transformation Board to deliver our review of the first and second wave of SoF co-production workshops. For the first sessions, we highlighted that although attendance had been high and that presentations were clear with comprehensive local detail, the attendees seemed to be mostly from the health sector with little input from the voluntary sector. Facilitation of discussions varied, with some seeming to be veering towards personal agendas, while it would be wise to encourage people to sit with those they do not know to spark varied conversation and ideas.
The mix on tables was improved for the second wave of meetings, and there was much more representation of social care commissioners and voluntary sectors, which added new discussion perspectives. Local information was also sent out to attendees ahead of the session following our suggestion to do so. Attendance seemed smaller at these meetings and it was noted that there was a lack of social care providers.
We do remain unclear as to how wider voluntary sector and particularly social care providers – key stakeholders who will be delivering services in new model – are to be involved in co-production and will continue to seek clarity on this.
A decision to defer Wave 3 workshops has been taken until further information becomes available, and we welcome this as it will help to provide clarity for future work.
There is still concern for us that there is a vacuum in terms of public information regarding progress/changing timescales etc. and we reiterated Healthwatch Cornwall’s offer to support, where capacity permits, the process of engagement and, in due course, public consultation.
Our volunteer Jeremy Preedy also attended in a personal capacity. He said it was made very clear that the meeting was ‘in public’ but not a ‘public meeting’, meaning people in the public gallery were unable to ask questions. Jeremy said that he felt this prevented deeply-held views to be expressed at the time. However, he confirmed that written questions will be encouraged in advance for future meetings.
He also noted that no effective debate about the issues or implications of the proposals took place and that the session was more to formally acknowledge decisions already taken by officials in their respective spheres of interest. He felt that it is a move in the right direction in helping to put important information in the public domain, and that it could be a good way to inform people who remain unconvinced that an ACS is a worthwhile proposal.
Jeremy personally believes that a move towards and ACS is “vital” but to ensure people are supportive of these changes much more needs to be done to publicise the process and potential change.
Healthwatch Cornwall has continually encourage open and early sharing of options, with full explanation of how they will benefit people and how they will be funded, by the SoF team. This will allow for any public concerns to be addressed and taken into account.
We are aware that the SoF team is working on a number of information sharing ideas and we look forward to seeing them shared with the public in early 2018.
December 15, 2017
Plans for a Shadow Accountable Care System – statement from Cllr Rob Rotchell Cornwall Council Cabinet Member for Adults
The NHS and local government in Cornwall and the Isles of Scilly are agreed that the way services are currently commissioned and provided won’t address the changing the needs of their local communities. Doing more of the same is financially unsustainable and will not guarantee that quality and safety of care will improve.
All agree that the approach needs to change. Our combined view is that they need to work together as an Accountable Care System (ACS) to enable more integrated care that serves the needs of the whole population.
An ACS does not change each organisation’s statutory and legal responsibilities. Instead it describes a way of working together that allows for a one strategy, one budget and one plan approach which puts the person not the organisation first.
As well as being in agreement about the approach, all are signed up to making progress and testing out the practicalities by working in shadow form during 2018/2019.
The shadow ACS will operate within the existing statutory framework which means that the Councils, NHS England, the CCG and provider trusts will remain the statutory accountable bodies in the system.
Work will be supported by an accord which describes the principles of collaboration agreed by all partners involved in the ACS.
Like many other areas across the country, local health and care services are facing a number of challenges – people are living longer, an increasing number of people have multiple, long-term conditions, and when people do need care, they receive it a variety of different ways – in hospitals, from their GPs and primary care staff, in clinics, nursing homes and from home care agencies.
Recent Care Quality Commission (CQC) reports into local health and social care have made it clear that services are not sufficiently or consistently meeting people’s needs. It found that:
• The quality and safety of care services is not consistently good enough
• Patients described their experiences of receiving care as not always good – although they generally had a more positive experience of services provided by their GP surgery
• People often had poor experiences of moving out of hospital and to a care home or back home with social care support – they described coming up against a lack of choice, poor information sharing between organisations and a lack of home care packages
• Patients who were discharged from hospital and needing ongoing support, found the arrangements to try to help them confusing, despite the efforts of frontline staff and care teams
What is being planned and what is the timescale?
We recognise some people are concerned by this proposal but this is not about privatising the NHS. An accountable care system simply means that the overall health and care system works better together in the interests of patients and the wider community.
There is no single model for accountable care systems in England, with different local areas developing their own approaches. We want to work with individuals and organisations to develop a Cornwall and Isles of Scilly model which both co-ordinates care across the whole health and social care system and improves the health and wellbeing of the wider population.
It is proposed that the local shadow ACS will be made up of:
• A small, Integrated Strategic Commissioning Function for health, care and wellbeing services
• One or more Accountable Care Partnerships (ACP), where groups of providers work together as a single network, taking collective responsibility for the effectiveness of service provision, with the ability to design new ways of working and move the money round the system to deliver more joined up, better coordinated and more efficient care.
A guiding principle of the work to develop an Accountable Care System is to be open and transparent and to allow for debate and discussion about proposals as plans progress.
An important part of this work will be a series of three inquiry days in December and January to learn from other areas that are setting up Accountable Care Systems and draw up recommendations on the way forward. These sessions will be open to the public and will be led by a panel of five Cornwall Councillors, chaired by Andy Virr.
The purpose of the inquiry days is to hear from representatives of local health and care organisations and from those areas developing an ACS, NHS England and patient groups such as Healthwatch.
At the end of the inquiry days, the councillor panel will draw up recommendations specifically about the development of the integrated strategic commissioning function of the ACS. These will then be considered at an extraordinary meeting of the Health and Adult Overview and Scrutiny Committee at the end of January, with a report being presented to the Council’s Cabinet in February, followed by full Council. The recommendations will also be discussed by the Kernow CCG Governing Body.
December 14, 2017
The Shaping our Future team has today released an explanation about its Accountable Care System (ACS) plans at: http://www.shapingourfuture.info/plans-shadow-accountable-care-system/
It is also holding its first in public Transformation Board on Tuesday, Dec 19 at New County Hall, Truro, where it will discuss its ACS plans: http://www.shapingourfuture.info/shaping-future-transformation-board-open-public/
December 8, 2017
Accountable Care System in Cornwall
Healthwatch Cornwall has been involved in Cornwall’s Shaping Our Future (SoF) process since February this year (2017) to provide a conduit for public feedback but to also provide oversight of its engagement, both professional and public.
To that end, we have a presence on the Transformation board; we created the first SoF information page on our website (https://www.healthwatchcornwall.co.uk/shaping-our-future/), prior to the evolving SoF website at: http://www.shapingourfuture.info/; we reviewed the co-production workshops for clinicians and professionals; and we attend the Citizen Advisory Panel (which includes lay members) and SoF communications meetings.
Our review of co-production workshops for clinicians and staff has helped to shape their delivery.
In Cornwall, the SoF programme has led health and social care leaders to push forward with an Accountable Care System (ACS).
The aim is to have this in shadow form by April 2018.
It will incorporate an integrated strategic commissioner for health and social care, and a network of providers with a single leadership team that will be known as the Accountable Care Partnership (ACP).
The ACP will involve providers for acute, mental health, community, primary, children’s, ambulance, wellbeing and social services as well as public, independent and voluntary bodies. The ACP will be clinically and professionally led.
Cornwall and Isles of Scilly Councils, NHS Trusts, NHS Kernow and potentially others are currently finalising a commitment document, which will codify the principles of collaboration within the ACS.
At the end of October, Dr Iain Chorlton, Chair of at NHS Kernow, shared his thoughts on accountable care at: http://www.shapingourfuture.info/plans-accountable-care/
NHS England produced a a model contract for accountable care organisations (ACO) in the NHS in August this year. ACOs are currently only an option for consideration when planning health and social care integration.
We are not clear how/if this will be incorporated in future plans if/when a permanent ACS begins.
The King’s Fund provides an overview of what an ACO is at: https://www.kingsfund.org.uk/publications/accountable-care-organisations-explained.
According to the Health Service Journal’s report on NHS England’s ACO document it said the content stated that establishing an ACO can be “lengthy and complex”, and suggested most areas need to move to an “accountable care system” first.
We understand that there have been considerable concerns about how this may affect Cornwall services, as well as questions relating to the legal basis of ACO proposals such as a legal challenge made by a campaign group and backed by law firm, Leigh Day, in October.
The SoF team is discussing Cornwall’s ACS at the first in public Transformation Board meeting on Dec 19 at New County Hall, Truro, TR1 3AY, from 2pm to 4pm.
We encourage people to attend or provide feedback on this topic via our Have Your Say online option.
We will update on our website following this meeting and will do our best to keep you up-to-date on progress as we learn about it.
As part of our involvement in the SoF process, we will continue to encourage the SoF communications team to share regular updates on this process to ensure there can be clarity for all.
We urge anyone to share their view on this with us, and we will pass them anonymously to those involved with the ACS progression to help those voices be heard.
NHS England ACO:
(Health Service Journal is subscription based)
Have You Say: https://www.healthwatchcornwall.co.uk/have-your-say/
December 5, 2017
You can now access the full reports on the Wave Two co-production workshops at: http://www.shapingourfuture.info/engagement-events/wave-two/
November 7, 2017
The anticipated third wave of SoF co-production workshops that Healthwatch Cornwall has been monitoring have been postponed.
This decision has been taken to allow time for the SoF teams to collate the evidence base to support its decisions, and to ensure the work already going on in localities and the suggestions people made during both the July and September meetings are fully reflected.
They will reconvene in the New Year “with a fully rounded set of considerations”.
In the intervening period the SoF teams will be attending local community network and GP locality meetings to ensure there is a full understanding of what specific localities are already working on, and to help widen the range of experts that help develop local models of care where there are gaps.
Feedback from the September co-production workshops will be published soon, including Healthwatch Cornwall’s comments.
Dates and venues of the third phase of workshops will be made available as soon as possible.
October 17, 2017
The latest guide to the system transformation plan:
Or download – Our system transformation plan slide
Healthwatch Cornwall staff and volunteers attended the first wave of the SoF co-production workshops to oversee how public feedback is taken into account and how decisions made that may impact on services will be shared with the public on an ongoing basis.
We are continuing to attend the next rounds of co-production workshops. If you have any comments to make on them, please call us on 0800 0381 281 or leave feedback via our Have Your Say page. #ItStartsWithYou
Have you taken a look at the current SoF website? You can find the minutes there from the Transformation Board meetings and other info too.
Healthwatch Cornwall is also taking part in the process to create a new SoF website and will let you know when this goes live.
On our Word of Mouth blog this month, Peter Levin, who has a seat on the SoF Citizen Advisory Panel, has written an article about his views on the importance of including the patient/public voice during the planning process.
A PETITION to secure Launceston Community Hospital’s future has almost reached its support target.
Joan Heaton, who is a councillor on St Stephen by Launceston Rural Parish Council, said that based on her personal experiences and the needs of the community “we desperately need adequate health provision in the Launceston area”.
A Cornish and Devon Post story highlighting the petition stated that Phil Confue, chief executive at Cornwall Partnership NHS Foundation Trust, suggested at Launceston Town Council’s June meeting, that the hospital could potentially offer more services, and as the Shaping Our Future process is looking at establishing a number of urgent care centres, local people could make the case for Launceston as a base in East Cornwall for one.
Read the full article at: thepost.uk.com
Statement issued on behalf of Cornwall and the Isles of Scilly health and care system:
“Our health and care system has received two ratings about its performance and the progress that is being made to develop more integrated services and create opportunities to improve services through our Sustainability and Transformation Partnership (Shaping Our Future).
“Cornwall and the Isles of Scilly has been recognised alongside health and care systems in the South West as making progress. This is the first time STPs have been rated and we are really pleased that our approach to work collaboratively to work together in the best interests of the people we serve has been recognised as the right approach.
“We do still face considerable challenges – from increased demand on services to our significant financial pressures and for this reason NHS England has rated the CCG as inadequate. We are awaiting further information on what this means for Cornwall and the Isles of Scilly.
“We are pleased, however, that there has been a recognition of areas where the NHS in Cornwall and the Isles of Scilly is excelling, such as being rated as providing outstanding cancer care. Our focus on supporting people with cancer also means our one year survival rates are better than the national average. We are really proud of our work to support people living with diabetes to manage their condition, including monitoring their blood pressure, blood sugar and cholesterol levels to reduce the risks of complications. We have relatively high uptake of these key tests and our participation rates for the National Diabetes Audit exceeds the national average.
“We have also secured additional national funding of £12million of social care funding in year to enhance the care home market and reduce delayed transfers of care and get people home from hospital with the right package of support in place; but we know we cannot solve our issues as individual organisations and are pleased that NHS England has recognised our collaborative approach to partnership working to develop and realise our Shaping Our Future vision to create a sustainable and joined up health and care system based on our community’s needs.
“We are confident that as our ambitious plans to integrate health and social care services gather pace and become firmly embedded, people will benefit from an improved service and demand on some services will ease, which will also help improve our finances. This will ensure an improved position for the CCG when the next assessment is published in 2018.”
Kate Kennally, Chair of the Shaping Our Future Transformation Board added: “The Transformation Board met on Friday (July 21) and were pleased to hear that the Shaping Our Future work has been recognised nationally as ‘making progress’. We are fully committed to working together to transform our health and care services. The Board recognised the important role that the Clinical Commissioning Group has played in the progress made to date.”
NHS England’s annual assurance ratings are based on an assessment of system-wide performance, quality of services in providers and the financial position rather than just actions within the CCG itself. For this reason, NHS England has rated the CCG as inadequate.
NHS England noted the CCG has strong and robust leadership; has robust governance arrangements; actively involves and engages patients and the public and works in partnership with others, including other CCGs and as such, no changes are being made within the organisation’s leadership.
“As part of our legal directions, NHS England requires us to have a Turnaround Director to help the organisation deliver plans which return the system to financial balance. Our turnaround directors have supported us to develop a robust financial recovery plan and deliver savings. This is good news for the whole health and care system as we strive towards making financial efficiencies and delivering sustainable, high quality care.
“The successful implementation of our financial recovery plan has seen us achieve a significant amount of work to improve patient safety and reduce costs. We are reviewing all areas of commissioning expenditure, improving service efficiency through redesign, decommissioning services which do not sufficiently add to the health of the population, and reviewing access criteria, to ensure that we can afford to fund care for those who most need it in a sustainable way. Last year we achieved savings of £21.4million which is almost three times the savings recorded in the previous financial year.”
Healthwatch Cornwall attends the Transformation Board to enable a conduit for the sharing of personal experiences. It is a means for us to show those working to improve the county’s health and social care sector how decisions made have, or may have, an effect on people’s lives. Our #ItStartsWithYou campaign is a call to action for anyone using publicly-funded NHS services in the county to add their voice, and their experience, to our feedback so we can continue to provide challenge when needed.
We have also attended the first stage of the SoF clinician and expert-by-experience workshops to provide comment on the process and participation. We are pleased to have seen much passion and innovative ideas at these events from attendees. We will continue to provide feedback on this engagement to the SoF team until the third stage workshops have been concluded.
The March Shaping Our Future minutes are now available via the link below:
Shaping Our Future is now seeking Clinical/Care (Expert) Practitioners for its workstream overseeing Integrated Care and for lay Experts by Experience members of it Urgent and Emergency Care workstream. Full details of what is required and how you can share your expertise can be found in the document links below:
The deadline to apply is June 19.
You can also email Louise Moore at email@example.com to discuss in more detail.
Have you had a hip or knee replacement due to arthritis and do you live in West Cornwall, Mid Cornwall or the Isles of Scilly?
Shaping Our Future wants people with this experience and from these areas to apply to join its Musculo-skeletal (MSK) Pathway Improvement Group as a volunteer.
The role of the lay representative on the MSK Pathway Improvement Group is to promote the viewpoint of the public and those who use related services such as physiotherapy and hospital orthopaedic services so this informs the development of transformation options.
Read the job description for more information: MSK Pathways role description (FINAL)
It is expected the group will meet every four to six weeks and people will be able to attend virtually if travel is a barrier to applying.
The deadline for applications is May 26 and interviews will be on May 31 and June 1.
To receive further details and/or to apply, please email Louise Moore at firstname.lastname@example.org or call 01726 627897.
The March Shaping Our Future minutes are now available via the link below:
The Shaping Our Future Transformation Board minutes from February 17, 2017 can be accessed in the following link:
The March board meeting minutes are expected for publication after April 21 and we will share on this page.
If you want to ask any questions about the Shaping Our Future plans, please complete a Have Your Say form or call us on 0800 0381 281.
This week has seen the publication of the Shaping Our Future engagement and feedback report and the position statement made on Wednesday, March 15, by the Health and Social Care Overview and Scrutiny Committee (OSC) STP sub-committee following its evidence gathering sessions to determine adequacy of process to date.
The former considers the comments received from the public and staff between November 2016 and February 2017, acknowledging the less than positive feedback, while the latter provides a more scathing view of how the engagement process was delivered and challenges ongoing plans.
Healthwatch Cornwall attended an evidence gathering session with the OSC STP sub-committee to provide its own view of the process and share feedback it had received from the public about their STP concerns.
Read both in full via the links below:
With our place at the Shaping Our Future (STP) Transformation Board, and the next meeting taking place tomorrow, we aim to ascertain the board’s response to the OSC STP sub-committee’s concerns and determine its next steps to address these comments. We will also look to how we can assist with future public engagement.
Local media has shared news of the OSC STP sub-committee statement online:
Healthwatch Cornwall is awaiting sign-off of the Shaping Our Future Transformation (SOF) Board February 17 minutes and will upload here as soon as received.
We are very keen to hear from people about what they think of the process and what ideas they have that may enable more people to have their say. By attending the board, we can take this information direct to those overseeing the process and influence decision-making.
Call 0800 0381 281 or got to Have Your Say to tell us your views.
As mentioned previously, Healthwatch Cornwall had been invited to attend the Transformation Board for the STP, now being referred to as Shaping Our Future, and we took part for the first time on Friday, February 17.
Board director, and our Shaping Our Future representative, Jayne Howard said: “We are pleased to join the Transformation Board for Shaping our Future and look forward to strengthening the public and patient voice as the plans develop.
“This is one of the most significant opportunities for decades to ensure that our health and social care services are fit for the future and it is essential that local people understand, and are able to contribute to, the proposed changes.”
It is crucial to us that people tell us what they think of the Shaping Our Future process, and how it may effect their own health and/or social care services. It is this feedback we need to take back to the Transformation Board – it provides a direct means for the public to reach the oversight group for this monumental planning task.
The minutes from these meetings will be made public and we will share details on this page as soon as the latest are published.
Overall, we felt there was genuine commitment to ensuring that the local plan is one that is appropriate for Cornwall and the Isles of Scilly, that it is not just ticking a national box, and it also allows for the exploration of opportunities via the Devolution Deal.
It is apparent to Healthwatch Cornwall that the aimed for consultation on any proposals may need to occur later than the hoped for June deadline, with fuller clinical engagement being put in place along with the three-month secondment of NHS England personnel to oversee stakeholder engagement.
The One Vision Children’s Education, Health and Social Care Plan and a document on transforming Adult Care were also discussed in relation to how they will feed into Shaping Our Future.
The Transformation Board is looking to improve public engagement for Shaping Our Future. It has asked Healthwatch Cornwall to help with this. We will review what we can do and will update here.
We also went along to the Patient Reference Group (PRG) on February 17. This group represents patient/lay members from Patient Participation Groups. It was felt that a mapping of existing public involvement/engagement networks and mechanisms would be a useful way to discover where there are gaps, and rectify these, and that the PRG would be a good tool to implement this. The PRG will also be encouraged to be more involved in the detail of Shaping Our Future, with other patient/lay members encouraged to take part. Work is now being done to update the group’s terms of reference and appoint a Chair.
The next Transformation Board is scheduled for March 17. Get in touch by March 14 to enable us to share your input.
Call us on 0800 0381 281 or visit our Have Your Say page to share your views.
We will also be commenting at the Overview and Scrutiny STP sub-committee on March 6 and will share the outcome from this on this page.
Have you seen Healthwatch Harriet from Healthwatch Essex try to work out what an STP is? See how she gets on in this film, What on earth is STP?
We attended all of the STP pubic engagement events to garner a view on public perception and feeling surrounding STP proposals.
The headlines taken from the comments forwarded by staff and volunteers are:
- The draft Outline Business Case put forward in these events is too ‘woolly’. Ideas such as ‘achieving better care’ and ‘redesigning pathways of care’ are, in principle, suggestions that everyone would sign-up to. Therefore, without further meat on the bones it is unrealistic to expect the public to make informed or tangible comment.
- The events, in the main, were not well planned in regard to funnelling people towards tables to comment on only two of the plans priorities. Most events called for extension of the Q&A element as attendees felt this would allow for views to be heard openly.
- There is growing call for the STP to be rejected.
- People are sceptical that more thought through plans are not already in place, and about how the feedback given will influence any decisions to be announced in the summer.
- Where were MPs?
Healthwatch Cornwall is to meet with the representatives from the Transformation Board about our attendance at its meetings. This will be dependent on retaining our independence and feeding in and out of the discussions. We also aim to put forward queries relating to the above feedback.
We have received an invite to provide feedback to the Overview and Scrutiny Committee’s (OSC) STP sub-committee. This sub-committee is tasked to “critically scrutinise and provide oversight of the development of the work of the STP programme”. It will also focus on whether feedback from the engagement process has been acted on, if there has been effective patient, user and carer involvement and the involvement of clinicians, and if Cornwall’s overall resources reflect the national picture. Further public events are hoped to take place in February and March.
We would like to hear you views on the STP process, including the possibility of an accountable care organisation being created to administer the changes, so that we can feed them into the Transformation Board and the OSC. Call us on 0800 0381 281 or visit our Have Your Say page.
A Health Service Journal (HSJ) story today has highlighted that a document produced following an IT/data summit in November last year is proposing that regional STPs/Accountable Care Organisations (which is being considered for Cornwall) may take on responsibility for patient data collection. Stakeholders have been asked to comment on the draft report but need to do so by Jan 20.
Former Lib Dem MP Andrew George has organised a meeting in Penzance for tomorrow evening to discuss the STP. You can find out more on his Facebook page.
As the county’s health and social care watchdog and representative of the patient/public voice, Healthwatch Cornwall has been closely following the development of Cornwall’s Sustainability and Transformation Plan (STP).
In a nutshell, the STP aim is to improve health and care services while addressing financial constraints.
According to the latest STP Outline Business Case (on which the current public engagement is based) if changes are not made locally the county’s health and social care deficit will grow to £264million by 2020/21.
The business case highlights a number of stats and makes claims that millions of pounds can be saved if changes are made, yet it hasn’t added any meat to the potential change bones. And this is causing anxiety and frustrations as seen at the first few STP public engagement meetings that began on Jan 9.
Our staff and volunteers have so far attended (in a personal capacity) the sessions in Bude, Penzance, Bodmin and Falmouth . This is enabling us to build a picture of how effective this engagement is and the obstacles that may hinder gathering a clear picture of public feeling.
It appears that the biggest concerns have been around whether the STP process has to be initiated at all, the lack of detailed proposals and that the outline is only a wish list of ideas, while the ability to participate at feedback tables and acoustics in venues have caused difficulties.
Healthwatch Cornwall appreciates these concerns. In November last year, we attended a dummy run of the proposed style of the public engagement. We informally suggested the need for greater detail on specifics and more clarity about how the plans would work financially; that the process required people to already have a fairly well-developed understanding of the issues and current systems and that the round-table conversations would be difficult for many people to engage in; that the process allowed everyone to hear what was being said and contribute effectively, mainly relating to multiple conversations happening in the same room causing problems, particularly for people with hearing difficulties; that there would not be enough time to have a proper discussion about a range of complex issues; and that the format did not allow for people to contribute to more than two issues which could prove frustrating.
We know how much work has gone into organising these events, and it is good to see so many people attending. Nevertheless it is disappointing to see our initial concerns played out. We will continue to attend the subsequent meetings but anyone who feels they have not been able to have their say fully can leave feedback with us via https://www.healthwatchcornwall.co.uk/have-your-say/ or 0800 0381 281.
You can also complete the survey online at https://www.netigate.se/a/s.aspx?s=353286X74497942X74284. The deadline for which has now been extended. The list of events and Community Network Panel meetings can be seen below under November 28.
It is understandable that until actual detailed proposals are fleshed out, people will struggle to comment in a way that can guide final decisions. But comment we must.
Last week, we were informed by Iain Chorlton, Chair at NHS Kernow that the generalities and principles of the business case are all that is proposed for engagement at the moment, with more detailed plans not forthcoming until after the local elections.
It is vital therefore that people feedback their thoughts on the STP as is. This opportunity is what will fuel choices for potential major change from the summer.
In November, Healthwatch Cornwall was informally invited to sit on the STP Transformation Board. This was set up to assist in the collaborative process to ensure all parties involved in the STP worked together to implement it constructively. As our independence is important to us we wanted to consider whether this would be beneficial to those we serve – the public. It could be a good opportunity to directly input into STP proposals on your behalf and to oversee and scrutinise the patient and public engagement and consultation plans. While we are still waiting for confirmation of a formal invite from NHS Kernow, what do you want us to do? Take part to have direct impact and involvement or remain impartial with a continued emphasis on feeding back your opinions?
Email email@example.com with your preference and reasons or call 0800 0381 281.
We also understand that work is beginning to look at the creation of an Accountable Care Organisation and we will be keeping any eye on progress with this and its implications for commissioning and provision of services.
Our board members have also attended the Health and Wellbeing Board and the Overview and Scrutiny Committee, which has a STP-specific sub-committee reviewing ideas and plans on an ongoing basis.
Have you read communications officer Josie Purcell’s blog post on STP yet? Visit our Word of Mouth blog page to find out more.
The public engagement events began today. We will be attending these to find out what people are saying first hand and to ensure that people feel they have had the opportunity to be heard.
Read the latest about Fowey Community Hospital on our News page.
According to a Newquay Voice article the communications lead for the STP, Garth Davies has said that the plan will focus on more services in the community with people cared for at home that will “enable us to not have as many community hospitals”.
He added that some will stay open but people needed to share their views so those in charge of the STP could determine if they have “the right approach”.
In the article Mr Davies was also quoted as saying that urgent care units, based on the West Cornwall model, at fewer locations and integrated with GPs, are the preferred option to the current 14 minor injury units on different sites. He said these will provide “enhanced services where there will be senior clinical input where a doctor will be present and a greater range of services offering diagnostic tests”.
In his comments he noted the financial element, with demand for emergency departments and hospitals growing but funding not increasing.
“We think we can provide better services on less sites but we want to hear from the local community on our approach. No decisions have been made about locations or closures and we will consult fully on any major service changes,” he concluded.
If you want to make an impact on these long lasting decisions, please share your views with us via Have Your Say or 0800 0381 281, attend an STP meeting (see Nov 28 below for current/upcoming events) or take the survey (details below under Nov 28 or via: http://www.cornwall.gov.uk/shapethefuture).
What change would worry you the most? What ideas do you have to make things work with the money available?
November 30, 2016
Staff and volunteers attended a run-through of the STP planned public engagement session on November 29. The aim of this was to check that the engagement techniques to be used in the January community engagement events will enable people to effectively have their say. Healthwatch Cornwall gave constructive feedback to the STP engagement team that more time may be needed to deliver and collect feedback at the ‘physical’ public events. There was concern that participants at these events will be invited to comment on only two chosen topics out of five, that rating services may be difficult, while clarification was sought as to how will they encourage and attract people from a wider audience to get involved and input into such a major decision-making process. The STP team will review this input and, we hope, make adjustments that will enable fuller comment collection.
Anyone who cannot attend in person is encouraged to complete the online survey or freepost form – see below.
Health and care organisations in Cornwall and the Isles of Scilly have now published their outline proposals for service transformation over the next five years as explained in their press release below.
The local Sustainability and Transformation Plan (STP) is a response to the NHS England Five Year Forward View and Devolution Deal for Cornwall to achieve three aims:
- Improve the health and wellbeing of the local population.
- Improve the quality of local health and care services.
- Deliver financial stability in the local health and care system.
Click this link – http://www.cornwall.gov.uk/media/22984634/cornwall-ios-stp-draft-outline-business-case.pdf – to read/download the full draft outline business case.
The Transformation Board, which is made up of all the leaders from the major public sector health and care organisations, is engaging with clinicians, practitioners, stakeholders and, most importantly, citizens to shape future services.
In the latest plans (Draft Outline Business Case), health and care leaders set out the priorities, principles and actions for the next five years and seek the views of the local population on the work so far.
From Monday November 28 until Friday January 20, citizens will have a chance to have their say on the local draft plans through a survey or series of community events. Following this period of engagement, detailed plans will be developed with consultation on any major service changes taking place from the summer 2017.
The focus within the latest STP document is on preventing ill health and providing as much care as possible at home or in the community. At the moment care is too reactive, not achieving best outcomes and based on an expensive hospital based model that is now outdated.
On preventing ill health, we know that today 5 lifestyle behaviours – alcohol, smoking, physical inactivity, diet and social isolation – contribute to 5 diseases which cause 75% of premature death and disability. In Cornwall and the Isles of Scilly too many of us are not living well and 20% of NHS costs are associated with these harmful lifestyle behaviours.
We also know that we need to provide more care at home. Right now around 60 people each day are staying in a bed at Royal Cornwall Hospitals and they don’t need to be there. 35% of community hospital bed days are being used by people who are fit to leave. A third of people in a community hospital or nursing/residential care are not in an appropriate place. Much of this is because we have our resources and money in the wrong place and sadly this is affecting older people the most.
Phil Confue, Senior Responsible Officer for the Sustainability and Transformation Plan and Chief Executive of the Cornwall Partnership NHS Foundation Trust says:
“In the next five years, we have a once in a generation opportunity to change the way we provide health and social care services for the people of Cornwall and the Isles of Scilly.
“The current health and social care system needs reform and we must seize the moment. Lifestyles, communities and technology have changed and our approach has become outdated, fragmented and reactive.
“Local services must adapt to meet the needs of the current and future population – including those who visit our region each year. We must put more focus and resources into preventing ill health, keeping people in their homes or communities and adapting services for a growing, ageing and technology enabled population.
“We want to continue to involve the local community in developing the solutions in the months ahead and we want to hear from as many people as possible on the priorities and approach we are taking. The time and opportunity has come to take control and shape our own future.”
To read more about the local health and social care plans and all the related documents, including survey and community engagement events visit:
Or download the form here: STP SURVEY FORM
Or attend one of these events:
Tuesday, January 17, 3pm – 4.30pm: Liskeard Public Rooms
Wednesday, January 18, 3pm – 4.30pm: Truro Health and Wellbeing Centre
Thursday, January 19, 7pm – 8.30pm: Heartlands, Pool.
Monday, January 23, 5pm – 7pm: Newquay, Hotel Bristol (additional event)
Please register in advance to guarantee a place at the event. For more information and to register to attend please contact KCCG.Engagement@nhs.net or phone 01726 627897.
Or join in at a Community Network Panel:
- Thursday, 1 December 6:30 – 8:30pm – Wadebridge & Padstow CNP
- Monday, 5 December 7:00 – 9pm – Hayle & St Ives CNP
- Wednesday, 7 December 6:00 – 8:00pm – Helston & the Lizard CNP
- Monday, 12 December 7:00 – 9:00pm – China Clay (Roche) CNP
- Tuesday, 13 December 7:00 – 9:00pm – Camelford CNP
- Tuesday, 13 December 7:00 – 9:00pm – Falmouth and Penryn CNP
- Tuesday, 15 December 7:00 – 9:00pm – Launceston CNP
- Monday, 9 January 7:00 – 9:00pm – Bude CNP
- Wednesday, 11 January 7:00 – 9:00pm – Bodmin CNP
- Thursday, 12 January 6:30 – 8:30pm – Cornwall Gateway CNP
- More details at – http://www.cornwall.gov.uk/communitynetworks
This follows on from the summary of the draft Strategic Outline Case published earlier this year, which stated the STP aims to create, “one plan, one budget and one system to better serve the local community within the resources available”.
It also highlighted changes to the workforce, including less jobs; replacing “unsustainable Minor Injury Units” with effective Urgent Care Centres; switching to more early intervention and prevention care; and reducing acute and community sector hospital beds for care-at-home (which could mean hospital closures), as part of potential amendments.
Healthwatch Cornwall (HC) is determined to ensure that the patient voice is listened to. We will continue to share what we know about the STP for Cornwall so that people feel they are well-informed and can have their views heard by those making these difficult decisions.
We attended a national STP event for the Healthwatch network on November 28, with the overall feedback showing a need to ensure its independence is not compromised throughout this process by continuing to call for effective public engagement opportunities. Healthwatch Cornwall will be attending an STP session on November 29 to run through the public engagement techniques to be used at the local events starting in January so that it can help guide and inform if improvement is needed.
Visit Cornwall Council’s Shaping the Future web page to read the draft summary in full.
To help us ensure your opinion on your health and care services is noted in this process, please complete a Have Your Say form online or call us on 0800 0381 281.
We also hope to be able to support any future public engagement events relating to this topic.
November 18, 2016
Jackie Pendleton, Interim Managing Director at NHS Kernow, attended HC’s in public board meeting on November 16 to present the current local situation. She spoke frankly about the fact that, as yet, there is no detail other than an outline of aims for the plan to achieve.
Adding to this she spoke about the challenges of involving various partners with different structures, the need to work closely with Devon’s STP, that care work needs to become an attractive career choice to bolster the workforce, and that fresh thoughts are needed to tweak current processes in areas such as hospital discharge.
She was also clear that throughout this opportunity to make services better “we can’t get away from money”, and that there is a major challenge to make millions of pounds in savings by March end 2017.
Jackie also took on board input from attendees, including our request that people need to be provided with examples of what differing changes could lead to so they are not left feeling as though they are only being asked to comment on predetermined solutions or major changes to provision.
We know that the STP process, which will influence the next four years of the county’s care system, may include painful decisions about how services are delivered and it is ensuring everyone has the opportunity to input into this that is paramount for us.
The Transformation Board for the STP is aiming to publish further details about the plan and public engagement on November 28. We understand that events to collect public opinion, feedback and ideas will take place from early January 2017 and will confirm and promote dates once finalised.
In the meantime, a number of STP presentations are to be made as part of Cornwall Council’s Community Network Panels. You can find out more at: http://www.cornwall.gov.uk/communitynetworks
October 26, 2016.
The STPs could fundamentally change the way the NHS works. With the first full plans now being published (Cornwall’s expected on November 9), Healthwatch England’s Interim Chair Jane Mordue calls on the NHS to work hand-in-hand with communities to get these reforms right – a sentiment echoed by us.
She has said that “…when professionals and policy makers sit down to talk about how things might be done differently there is often a strong sense of fear that whatever they propose they will face an army of activists campaigning to stop them. This fear can then translate into people being brought in only at the very end of the process to simply ‘rubber stamp’ over-simplified plans”.
It is essential that the public are involved as early as possible to avoid creating misunderstanding or a them and us mentality in our local NHS. Our health and care services are there to provide support in times of need – yes, they need to be delivered within the confines of budgets available but the public may have a few ideas that could help solve or improve this balancing act and their input needs to be heard early rather than late.
Read Jane Mordue’s full article: Fear Public Engagement is Holding NHS Back
The Health Service Journal (it is a subscription publication) also ran an article about Jane’s comments and highlighted the views of Healthwatch England’s acting national director Susan Robinson. Susan has said that Healthwatch “will do what we can with the role that we have… and make sure that the public are adequately involved in any kind of changes in their local services”.
It also mentioned a Healthwatch England update paper she authored and submitted to the Care Quality Commission board meeting in September which pointed out the awareness that “good public engagement requires time and needs to be in at the beginning of the change process as well as throughout”. Her report also indicated that the speed of the STP process “has moved so fast that this has been a challenge” but that all local Healthwatch were doing their best to ensure people’s voices are “heard in this big thinking about future services”.
What do you think of the local STP process so far? Has your organisation asked for a presentation to be made or have you signed up to the “citizen panel”? – (see below) – share your views with us via our Have Your Say or call us on 0800 0381 281.
October 21, 2016.
Cornwall Council and NHS Kernow want to hear from people who traditionally are not heard and are setting up local stakeholder workshop events across the county for people to contribute to the conversation about how to build up the detail in the STPs.
Their plans are in their early stages, and they are also using feedback from their public engagement in the spring about what people want in relation to health and care integration.
In November and December 2016, they would like to get the STP onto the agenda of as many existing meetings as possible. They would like to extend an offer of field staff, from the organisations involved, to talk about shaping the future of local health and care, and to get people’s early views on what they should be focusing on.
If you represent a group of people, or know of meetings they can get involved with, let them know by emailing firstname.lastname@example.org. Please include full details of the meeting you would like a member of the team to attend and they will contact you to discuss it further.
They are also looking for new members for the Patient Reference Group, which will act as a citizens’ panel. Its role will be expanded into this transformation work and they would like to improve the level of representation and diversity. If you are interested in being a part of this panel please email Carol Steer at email@example.com.
An update from yesterday’s presentation to Healthwatch Cornwall volunteers will follow shortly but it is expected that the full STP Business Case should be made public on November 9, with subsequent engagement events happening quickly thereafter.
October 20, 2016
Healthwatch Cornwall’s Advisory Forum (volunteers who help determine the work we progress) will be joined by one of Cornwall’s STP communications lead.
Discussions will focus on STPs in general, what local plans are known now, and what the timescale of implementing these plans is likely to be. Healthwatch Cornwall will also use this as an opportunity to decide how it can assist the promotion of the local STP agenda, and deliver its own independent feedback gathering events.
October 14, 2016
The Health Service Journal (subscription based service) has revealed today in an article by Lawrence Dunhill that NHS England is providing a checklist to STPs in regard to making their plans public.
The article also claims that NHS England has said it is important for plans to “articulate tangible benefits for patients” in language that is “clear and compelling”; that regional leads will work with local STP groups to plan publication schedules; and that it aims to provide an update on the national STP process and broader context. It cited that the plans must bear in mind national and local financial targets.
Earlier this week Chris Hopson, the head of NHS Providers which represents NHS trusts, told MPs on the Commons health committee that the STP process is forcing local decision makers to make plans they believe cannot be delivered.
Take our poll on the Home page and tell us how you feel about the future of Cornwall’s health and care sector.
38 Degrees meeting – Oct 7, 2016:
One of the STP leaders Phil Confue (Senior Responsible Officer) and St Ives Constituency MP Derek Thomas are taking part in a 38 Degrees meeting on Friday, October 7, in St Ives to talk about the plans.
Find out more at: you.38degrees.org.uk/events/cornwall-nhs-meeting-1
Local news updates:
National news updates:
Health Service Journal
NHS England STP Guidance:
The King’s Fund:
King’s Fund STP events: London and Leeds.
Healthwatch Cornwall is attending Healthwatch England’s STP information event on November 28. The day will look at approaches that have worked for other NHS reforms and to agree a common way forward for STP areas and local Healthwatch to work together.
We will update following this event with outcomes.