Somerset STP

 

The Somerset Sustainability and Transformation Plan (STP)  produced by the Clinical Commissioning Group and Somerset County Council aims to achieve a “sustainable and transformed health and care system for the people of Somerset”.  

The STP currently lacks details, and some of it is obscured by the use of jargon, but the direction of travel is explicit:

  • increasingly putting the onus onto the individual to self care and to self manage long term conditions
  • more care to be provided in own home rather than hospital
  • a reduction in the number of hospital (acute and community) beds
  • concentration of some services onto a single site, 
  • use of technology to replace face to face encounters
  • more integration of health and social care
  • a more generic workforce
  • use of voluntary / charity sector to support communities and individuals
  • an expectation that Somerset will require a smaller workforce

The background for Somerset against which this plan has been devised is as follows.

  • Somerset is the 12th largest county in England
  • 48% live in the countryside
  • there is a higher than average older population, 10.4% over 75 v 7.8% average in England
  • lower % of  working age population especially 20-40 year olds
  • 10% higher than average levels of overweight / obese people, including children
  • higher prevalence of smoking
  • higher than average levels of hypertension, falls and hip fractures diabetes complications
  • significant number of hospital beds days lost  due to delays in being able to discharge people back home / into a community hospital bed due to lack of resources. 2000 acute hospital and 700 community hospital bed days are “blocked” per month
  • the second highest level of GPs aged over 55years in England; 31% of GPs expect to retire in next 3 years, and already 50% of advertised posts  are unfilled
  • shortage of nurses and midwives
  • an increase to 25 neighbourhoods in Somerset categorised as “highly deprived" up from only 14 in 2010  This means that  38,000 people live in one of the 20% most deprived neighbourhoods in England.
  • significantly higher than average attendance at A&E and hospital admission for injuries and substance misuse by children and young people, concentrated in most deprived areas.

Given the rurality and the population age profile it is difficult to understand how the assumptions about closing community hospital beds and shifting care into people’s own homes will be successful in reducing costs.  Is there family support available?  from the demographic profile it looks likely to be very limited. Occasional visits from staff, having to travel significant distances between homes is not likely to prove adequate to keep people at home.  How cost effective  is it in very rural areas where the ratio of time spent travelling v providing care  will be high.  The costs may go down for the NHS / Social  services- but at an increase in costs to the individual and their carers. This assumption is alarming given the  increase in the very old. The concentration of some services into 1 of the 2 hospitals in Somerset takes no account of the knock on costs to the Ambulance Service of having to travel longer distances. There will also be a cost to the individual, and to family / friends visiting.

There is  a systematic undermining by Government actions of  the efforts across the NHS to reduce expenditure. On prevention for example, the Government has recently watered down the proposed obesity strategy and refuses to initiate a minimum price per alcohol unit. It has recently been announced that the Government is selling a majority stake in NHS Professionals (agency for staff) to the  private sector- when with severe challenges to workforce there is already a huge spend on agency staff so losing the one NHS agency into a for profit organisation will not help;  either costs will go up or pay to staff will go down leading to more demoralisation / lack of staff availability. Add Brexit and lack of support for EU staff so retention / recruitment form the EU is also at risk and the already precarious staffing situation can only get worse. There is an increase in the number of Nursing / Residential homes closing because of inadequate funds from Local Authorities to pay  for beds / staff costs. With an increase in the “living wage” this is going to get worse, and the knock on impact is further difficulties in discharging hospital patients who need a nursing home bed.  

Meantime, after no additional funding announce in the Autumn Statement NHS England has advised NHS Trusts to pass on some scheduled surgery to the private sector to ease a potential winter crisis.

To quote Bevan, “The NHS will last as long as there are folk left with faith to fight for it.” Are you willing to fight for it? Are we willing to invest in our NHS? Ask your MP what they are doing about it.

For more detail on the STP see: 

http://www.somersetccg.nhs.uk/news/somersets-five-year-health-and-care-plan-published/

A paper copy of the STP  is available via email from: STPfeedback@somersetccg.nhs.uk