What are STPs?
Sustainability and Transformation Plans (STPs) are shared proposals from NHS organisations and local councils working in 44 geographical areas covering all of England to improve health and care. You can see more about these plans on the NHS England website and also on the BMA website.
This “big picture” approach to care, acknowledging social, financial and cultural context, is fundamental to the palliative care philosophy1 setting an example for wider systems as they develop and implement their STPs.
Familiar territories
Although each STP addresses specific needs of its local health economies (LHE), some themes familiar to palliative care are emerging (eg proactive care planning, shared electronic care records and excellent communication,)
Even so, the overarching motivation to save money affords a different, more challenging perspective. In the last year of life the estimated cost of social care and inpatient admissions is £8,649 and £9,972 respectively2.These figures are quoted in some of the STPs yet the alternative state – the cost of community-based end of life care – is not. It may be that community palliative care investment is offset by acute-sector savings (this is the hope) but the failure to adequately meet demand is merely shifting the burden from one poorly-resourced place to another. This comes with an inevitable realisation that additional funding is unlikely to materialise.
Crossing boundaries: navigating networks
The STPs send out a clear signal for better cross-organisational working. The ubiquitous nature of death and dying means that palliative care services have always operated beyond their designated boundaries. In South East London for example, the @home service takes referrals directly from the ambulance service. Coventry and Warwickshire are exploring rotational working across organisational boundaries, whilst other STPs aim to redesign care pathways and integrate with others such as fraility and cancer.
Every day teams balance health and social care partnerships and mobilise social capital to provide the best care for patients. If nothing else, your local palliative care team will probably have created an extensive network based on decades of local “know-how” that few external consultancy firms can access so readily. Palliative care can (and should) be positioned as a leader of cross-boundary and collegiate working practices.
Creating a balanced whole
Several STPs describe integrated neighbourhood care teams, integrated hubs and integrated care pathways but what this means is rarely made explicit. According to the Encarta English dictionary, integration can denote equality of access, acceptance into a group or working effectively in combination. The definition from psychology – co-ordinating separate elements into a balanced whole, exhibiting behaviour compatible with the environment – is perhaps most appropriate for a reliable and effective future in health and social care.
Achieving this new state of a balanced, responsive and sustainable whole requires change, uncertainty and loss. For instance, the UK ranks highest in the world for end of life care3 so any change risks loss of status. Nevertheless, inequities of access exist and improvements are possible. Are we prepared to adapt a model, constructed largely around cancer, to respond to the needs of people with other conditions, such as dementia and fraility? This is essential if we are to work with colleagues to reduce the number of care home residents dying in hospital and yet the current state may not be equipping us, as world-leaders in end of life care, to adequately support and educate others caring for people with these conditions.
Opportunities
This is, of course, all in the eye of the beholder. The financial pressure on services and the need for better, more co-ordinated care cannot be ignored – whether the local plans proposed will be sufficient to meet demand and improve patient care needs careful scrutiny and open dialogue. Ultimately, we are being offered an opportunity to work more closely with our existing partners or with whom we have long aspired to engage.
What we cannot do is waste time, energy and resource in unproductive competition or unfruitful labour. Hence we should build on recommendations to develop new models of care4,5 and existing work, such as the National Council for Palliative Care’s Pathfinder Project6, NHS RightCare7, new care model Vanguards8 and the Sue Ryder single point of access model9.
Palliative care has a tradition of networking and learning from and with each other. As an e-learning designer and educator I have learnt much from my students and colleagues in rural Australia and Canada about mobile, technology-enhanced healthcare. Nor are we afraid to ask questions and share resources, as exemplified by palliativedrugs.com’s10 impressive documents library and bulletin board. Palliative care has always had the courage to try new things and take a creative approach to solving problems, involving our staff, patients, carers and the communities to which we, more than any other clinical speciality, belong.
Tweetchat
You can join Vicky for a @WeEOLC #WeEOLC tweet chat on this topic on Tuesday 07 February 2017: 8-9pm
It will look at STPs, why they matter and also explore examples and opportunities for palliative care.
References
1.International Association for Hospice and Palliative Care. (2016) 6 Principles of palliative care [Online]. Available at http://hospicecare.com/about-iahpc/publications/manuals-guidelines-books/getting-started/6-principles-of-palliative-care (accessed 31 December 2016)
2.Bardsley, M., Georghiou, T. and Dixon, J. (2010) Social care and hospital use at the end of life. London. Nuffield Trust
3.Economist Intelligence Unit. (2015) The 2015 Quality of Death Index Ranking palliative care across the world [Online]. Available at https://www.eiuperspectives.economist.com/sites/default/files/2015%20EIU%20Quality%20of%20Death%20Index%20Oct%2029%20FINAL.pdf (accessed 31 December 2016)
5.Hospice UK.(2013) Future ambitions for hospice care: our mission and our opportunity: The final report of the Commission into the Future of Hospice Care. London
6. Eyres, G. (2016) Dying Well Community Charter Pathfinder Project: Evaluation Report [Online]. London. The National Council for Palliative Care. Available at http://www.ncpc.org.uk/sites/default/files/J1448%20ncpc_Pathfinder%20Evaluation_05.pdf (accessed 31 December 2016)
7. NHS England. (2016a) NHS RightCare: Reducing unwarranted variation to improve people’s health [Online]. Available at https://www.england.nhs.uk/rightcare/ (accessed 31 December 2016).
8. NHS England. (2016b) New Care Models: Vanguards – developing a blueprint for the future of NHS and care services [Online]. Available at https://www.england.nhs.uk/wp-content/uploads/2015/11/new_care_models.pdf (accessed 31 December 2016)
9. Sue Ryder. (2013) Partnership for Excellence in Palliative Support (PEPS): Evaluation of pilot [Online]. Available at https://www.sueryder.org/~/media/files/what-we-do/care-centres/st%20johns%20hospice/peps%20pilot%20evaluation.pdf (accessed 31 December 2016)
10. Palliativedrugs.com (2016) Document Library [Online]. Available at (accessed 31 December 2016)
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