The Southampton City Council Website holds a document titled, “Hampshire and Isle of Wight Sustainability and Transformation Plan” (STP), marked final version and dated 30th June 2016.
It sets how Hampshire and the Isle of Wight health bosses are actively forming an alliance to work together in the future to rationalise health provision across the area.
Some services moving to the mainland
What may concern residents the most from the report is the prospect of several specialist services being transferred from St Mary’s hospital to the mainland.
In order to meet future demand of the Island, whilst trying to cope with less funding, changes to provision will need to be made:
In developing the alliance model at a speciality level, we will in turn resolve the sustainability issues on the Isle of Wight. To do this we will review all clinical services on the Island and identify what can safely be delivered there and what can’t, and we will work with local people to co-design acute services.
This will involve some patient care being repatriated to the Island, but other specialities being delivered on the mainland.
One of the first priorities for resolution by the alliance will be to resolve Urology services, where integrated services are needed as a matter of urgency on the Island.
Lack of consultation
Ed Gouge, the Island Labour Party Secretary (who discovered the document) told OnTheWight,
“This Plan can have huge effects on our health services but does not even appear on local NHS Websites.
“There seems to be no desire to allow local people even to see it, let alone give their views on a Plan that could lead to the transfer of services out of St Mary’s.”
He goes on to points out,
“The Plan makes way for the transfer of services from St Mary’s to Southampton and Portsmouth hospitals, but there is no mention of the cost and difficulty of travel for Islanders to get to these hospitals.”
Read other points raised by the IW Labour Party.
This time “it will be different”
In any organisation, the words “transformational change” can create feelings of dread among staff, but the report seeks to reassure those involved that this time, “it will be different”.
It says,
We recognise that where we have tried to make transformational change before, a number of barriers have impeded our success. This time will be different – the STP represents the first time that our organisations have come together to work collaboratively to address the challenges facing the health and social care system
Challenging demographics
There’s no denying that NHS services on the Isle have been faced with significant demographic challenges for decades.
Twenty five per cent of the population is over 65, and the number of over 85s will double by 2030. As well as the resident population, there are 2.5m visitors to take into consideration.
As has been heard many times before, the report highlights that in order to maintain a range of cost effective services in a hospital the size of St Mary’s, the population would generally need to be over twice that of the Island.
Heading towards a recruitment crisis
A lack of patient numbers in certain specialisms results in fewer doctors choosing to maintain and build their skills on the Island which can lead to “to concerns about quality”.
Recruitment problems on the Island have been highlighted for many years, with gaps, the report states, in specialties such as emergency medicine, paediatrics and urology. However, there are also problems recruiting and retaining those in general practice (remember the £20,000 incentive to attract Junior GPs to the Island), nursing, therapies, consultants and care work.
The STP reveal that the Island has 19 consultants who are likely to retire in the next five to ten years and 34 GPs in the 50-60 age band, also likely to retire in the next ten years.
Sustainable services on the Isle of Wight
The work programme to bring about sustainable services for the Island will take place by the alliance over a three-month period, which, the paper states, will be informed by the “pressing issues that require a resolution”.
Individual Trusts will remain sovereign organisations and retain responsibility for finance, performance and quality but will work together to agree common approaches to improvement, operational management, IT, quality and strategy, and a joined up clinical strategy that delivers seven day services; specialist services to the right critical mass; and sustainable services on the Isle of Wight.
Mental health services
The STP claims, “For more specialised services, across both physical and mental health, our providers will work collaboratively to ensure that all people across HIOW have access to high quality consistent acute care and mental health services”, however, a user of the Isle of Wight’s mental health services told OnTheWight they have been informed that Chantry House were currently working to a ‘business continuity plan’ and only dealing with ‘absolute emergencies’.
IW Labour: Major implications for the Island
Other points raised by the Isle of Wight Labour Party include:
- It seeks to implement the Government’s GP Forward View programme. While there are some benefits from this, the funding may put resources into the larger surgeries and there is no guarantee in the Plan that smaller rural surgeries will stay open.
- It is driven by a £719m funding gap and Jeremy Hunt’s obsession with a 7 day NHS without the resources to provide it. The Plan admits that to implement a 7 day NHS will lead to services being concentrated elsewhere and not on the Island. St Marys will never fit into the standard national model because its catchment area is inevitably smaller and Andrew Turner has failed to get his Government to understand this and accept that Island’s health has to be differently resourced. His promise of a post-Brexit boost for the NHS seems to be fading away.
- The Plan expects people to get health information on their phones and through the internet. While the use of new technology to support staff is to be welcome, this approach for patients can be costly and lengthy to develop and is hardly relevant to many of the elderly and low income people on the Island. It is likely to lead to a focus on particular symptoms rather than the overall diagnosis that GPs and Hospital Consultants are expert at providing.
- The Plan explains that proper social care is essential to allow people to move from hospitals into the community but is forced to accept the cuts to the Isle of Wight Council’s social care budget which undermine local attempts to integrate health and social care. The Government has told the Plans to exclude social care.
- Although the Plan appears to have been completed at the end of June and implementation starts this year, there appear to be no provisions for public consultation.
Review by Turnaround Director
Back in May this year, OnTheWight reported that Isle of Wight NHS Trust and Isle of Wight Clinical Commissioning Group (CCG) were having to take emergency measures due to a financial crisis.
A specialist was called in to help them out of the serious situation and the major part of that person’s role was to build a Financial Recovery Plan. This external person, labelled a Turnaround Director, set about a ‘system wide’ review, covering the financial and operational side both the Trust and CCG.
Compatible with the Solent Deal
The papers refer to conversations that are ongoing to shape the future services:
The tiers of planning are flexible, and are intended to be compatible with other initiatives such as the Solent devolution deal and other similar types of collaboration.
These conversations are ongoing and will continue to shape the future form of services across HIOW.
Further assessments
Before any final decisions are addressed, work is required to scope the plans further, including, in particular, the Isle of Wight integration and whether there is a requirement for formal consultation.
A detailed implementation plan is due to be developed by December 2016.
IW NHS response
We asked the Isle of Wight NHS whether they’d like to add anything. A spokesperson replied,
“As I understand it, it’s not final. Further version(s) have to be submitted.
“Earlier this month NHS England issued guidance about engaging local people in developing STPs to all STP areas (there are 44 – see embedded below).
“You’ll be aware of the My Life a Full Life programme and the engagement process we have been through around ‘Caring for the Island’ – more details available online.
“The ‘Time to Act’ leaflet delivered to all households and with an accompanying video explains why locally this work is necessary. This applies as much regionally and nationally as it does to the local scene.
“Our local engagement process for the My Life a Full Life programme has been fed into the wider regional plan for Hampshire & Isle of Wight.”
They went on to add,
“The Hampshire and Isle of Wight Sustainability and Transformation Plan is still in development and we are therefore not ready to discuss it at the moment. After the plan is submitted to NHS England, it will be published locally. We do not have a date for that at this stage.
“We will then begin a phase of sharing our draft proposals with local people and groups and gathering their views. Part of this process will be to identify whether any of the proposals should generate a public consultation.”
The report
More detail can be found in the paper below.
Engaging local people: A guide for local areas developing Sustainability and Transformation Plans
Article edit
Formal response from IW NHS added 12.50pm.
