Sustainability and Transformation Plan (STP)
Meeting
Meeting Notes
Tuesday 6 December, The Vassall Centre, Bristol
STP Draft Report
The draft version of the STP report can be read and commented on here. It is also possible to
register interest in future consultations using the same link.
Presentations
Slides from the presentation by Ben Bennett (Director of Strategic Projects, South
Gloucestershire CCG) and Tony Jones (PPI Lead, Bristol CCG).
Ben Bennett – Question and answer
Q. Can I clarify what the HOSCs means on the slides?
A. Health Overview and Scrutiny Committees. One for each Local Authority area. They can
work jointly on issues, such as the STP which cross LA boundaries. They will hold the STP
process to account and they meet in public.
Q. Why is it Bristol, North Somerset and South Gloucestershire (BNSSG) and not wider?
A. Logical groupings of around 1 million people. We have also worked together on other
projects for a long time. We do have links with organisations like Avon and Wiltshire Mental
Health Partnership NHS Trust (AWP) and Royal United Hospitals (RUH) Bath etc. and we can
work with those organisations.
Q. I’m curious about the timescale and what it is. It seems like a massive jump that is being
planned. What will the plan have by the end?
A.. The STP is founded on the principle that all of the organisations both commissioners and
providers work together to an agreed set of priorities and this will be the basis for the
development of specific proposals. Ultimately there will be a number of plans emerging from the
STP strategy
Q. It is a misnomer to call it a plan as it is not. When does it turn into a plan?
A. Not a plan, it’s a strategy that plans will come from. By January 2017 we expect to be able to
say more about specific themes/plans and about the arrangements for engagement and
consultation. It is acknowledged that the language used in the plans published to date is
inaccessible and there is a lack of specific detail, indeed this has been reflected in the feedback
received for example at recent Health Overview & Scrutiny. Meeting. The expectation is that
this will be addressed before future public engagement and consultation.
Q. Could you talk more about the decision making process with the 15 major stakeholders. How
are decisions made? Where are they based? How are they accountable?
A. Each of the 15 organisations have nominated a person each to be on a programme board
which has overseen and commissioned the work undertaken to date. The Chief Executive of
UHBristol, Robert Wooley is acting as the senior responsible officer for the STP, however the
work has been undertaken on a collaborative basis. The governance arrangements are in the
process of being reviewed as part of the work to progress the further development and
implementation of the plans emerging from the STP.
Q. You talk about a whole person approach. Is there an intention to have a whole system
approach (Public Health, Social Care etc.) and how do they fit together?
A. Yes, document highlights system wide approach. How do we achieve this? Pooled budgets?
Pooled teams? Organisational change and removing boundaries between organisations. This is
ongoing process. There will be opportunities for the voluntary and community sector (VCS)
partners to help define this whole system change.
Q. These plans are often only successful with champions behind them. Would there be any
money allocated to selling/promoting this plan?
A. A resource plan is being developed to support future communication and engagement
activities relating to the STP. This will need to be funded from existing resources
Q. When is the single commissioning board for BNSSG being put together?
A. A shadow joint commissioning board has been set up. This will lead to more specific
collaborative arrangements between the three CCGs from April 2017.
Q. Much of the document reads like Public Health work (emphasis on prevention). Why not work
more closely and not replicate work already done by Public Health?
A. Public Health colleagues from the three local authorities have been directly involved in the
development of the STP to date and have led the work on the Prevention, Early Intervention &
Self Care theme. The collaborative arrangements for the STP will help the NHS and Local
Authorities to work more closely together and avoid duplication.
Q. How will we know what the communications are for the STP in different areas of the
footprint?
A. Communication and engagement for the STP will be coordinated centrally to ensure a
common approach and will make use of existing regular communication channels and
distribution lists used local in each area. The distribution list for Bristol will be linked to this
report.
Workshop sessions: Thinking about what you have heard in the presentations, what
questions or messages would you like the STP Board to hear from a VCS perspective?
(For example, what areas do you want more information about? What concerns do you
have?)
Thoughts and questions from the presentation:
 What is the link/relationship between STP and Local Authorities?
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How to square difference between NHS being free at the point of access and social care
needs assessment.
More detail needed about Health and Care – this element is a major issue.
Prevention – Public Health budgets are shrinking. How does this square with the plan?
All are delivering more with less – how sustainable is this long term?
Services quite fragmented – how to join things up?
Implications of the STP for small organisations?
Collaboration has to happen – is collaboration enough?
Facing privatisation of many parts of services – where does this fit into the STP? What is
the plan locally for this? (example of Virgin in Bath and North East Somerset (BANES))
Dementia Service Providers in Devon – how do they fit with STP area/footprint? This is
likely to be in an increasing issue and service change.
What is the plan? Concern about Sustainability of VCS Services.
More recognition needed in the plan of VCS as partners.
Commitment to VCS in the plan is NOT clear – links within plan to VCS - prevention and
self-care. What is the proportion of spend for VCS.
Implications for supporting volunteers: role of volunteering.
Role for Mayor? Support for VCS = money – filling the funding gap.
How can a detailed plan be created by the 23 December?
What do staff currently working in NHS and Local Authority feel about this and have they
been consulted?
Agree lots of repetition in the system but concerned how these changes are being made.
Where will funding come for meaningful consultation with public?
Tendency for organisations to bid too low to undercut others, creates big impacts in
service due to lack of everything needed.
No information about how this new system would actually reduce the deficit.
How will the approach translate to VCS commissioning? For example, admin, monitoring,
recognising niches of different VCS organisations etc.
This whole process needs professionals who can communicate with each other and
enable signposting (long term care pathways).
Concerns about the ‘cost saving aspect’ of this process. Initial investment is needed to
set up a system which can make savings long term. This is particularly relevant to
prevention services.
Success criteria for the STP – is this actually achievable and/or going to happen?
Social prescribing is good but no strategy for ‘ramping it up’.
Why is the wider community not at the table?
STP is full of general soundbites and ‘glittering generalities’.
System needs cultural approach and whole change, not just ‘back end’ reform.
What are the issues and opportunities for the VCS? What do they need to participate?
This section of the report has been divided into 8 different themes:
Mapping local services and need:
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Use all the research resources we have locally – include this as a part of the plan.
Links to housing/residential care.
Champions for vulnerable communities.
Delivering against equalities – VCS is good at this.
Empowering local residents to identify needs in their community and support them to
develop action plans/solutions e.g. Up Our Street (provide info on local needs identified
by community members through community research).
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VCS organisations often have better relationships with service users and communities
than big organisations and can map local needs effectively. Trust is key for the delivery
of promises in the STP.
Volunteer led services are often vital for support/service in the community and often
serve as the first point of contact.
Benefits of being connected – VCS is part of the community and has strong links with
patient/service users.
VCS engagement in social prescribing – increase capacity and understand need.
Delivery:
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Sign posting coordinators! Need people to help navigate system.
Set out how plan relates to other local strategies and work streams e.g. Public Health
strategy – how do other strategies inform the STP? A two way street.
Training for staff working in the VCS/NHS to understand the planned system change.
VCS strategic intelligence.
Links to vulnerable people.
Experience in collaboration.
VCS organisations are already delivering many of the STP priorities (e.g. co-working,
pooling resources, and working in partnership) – how can this be recognised more? VCS
could offer best practice examples to STP.
VCS is good at offering information in accessible formats.
VCS organisations can encourage ‘Cascade Learning’ and impact by working with
individuals and families/communities.
VCS sharing resources on ‘back office’ functions – shared/pooled resources to save
money and also meet governance standards.
VCS offers evaluation, advisory services, user feedback, community support, a link
between hospital/GP and community, improvement improving links and pathways, Early
Help teams, services for specialist groups, education and training etc.
VCS has close relationship with service user voice – STP needs to engage with that. This
can also include working with very specialist client groups and get them to engage with
services (including taking them to appointments).
VCS can help service users to navigate a complex system and scrutinise process and
ensure communication is inclusive and service design meets need.
VCS is well placed to try innovative methods of providing support and services and
providing more personalised approaches.
VCS works with people who find it difficult to access statutory services without support –
a vital service.
Volunteering – VCS experience in developing and delivering.
Local decision-making, ownership and engagement:
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A need to work closely with small and medium sized organisations – a chance to
contribute to the process.
Consider how we turn this into a more collaborative approach – everyone together –
learn from other regions and localities.
Developing very local understanding – show relationship between high level plan and
very local issues.
Realistic timings – this process seems rushed and without time to ask meaningful
questions.
Concern that this process is just another ‘tick in the box’ and will result in more disillusion
with the process than already exists.
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Big top down structures stop local groups getting access to commissioning. The ‘one size
fits all’ approach disadvantages small organisations. More engagement from working with
small organisations.
Workforce and sector engagement culture – meaningful engagement sessions with VCS
and public.
Proper information sharing with the sector and public – parity of power in the process.
Better communication with the VCS and representative bodies, such as TCF and Voscur
to act as a liaison between STP process and VCS.
Coordinated VCSE info, input and response:
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Forums/meetings with commissioners – use existing provider forums effectively – know
what they are.
Programme boards should be open public meetings – ability to ask questions and regular
feedback/updates.
Representation at Programme Board of VCS is vital to be part of the process and
governance and trust and to be listened to.
Staff/network organisation to be a link between VCS and CCG.
More information about the social care collaborative.
Involvement of the VCS on patient pathway boards – avoid duplication and acknowledge
the VCS role.
VCS marketplace so smaller organisations can be found and accessed by
commissioners. Clear channels of communication for smaller organisations – dedicated
staff for this.
“Right care in the right place” VCS organisations can compete less and complement
more – BUT the STP can help facilitate this with better consultations.
STP/CCG must communicate with VCS to ensure planning of pathways go beyond
statutory and works in the community.
Commissioning, funding, contracts and so on:
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Allocation of funding to consider wider functions and aspirations.
Funding for consultation, engagement and communication.
VCS can do things better and should not be seen as the ‘cheap’ option by
commissioners. Service needs to be delivered properly.
Support for the STP so that small organisations can bid together.
Access to budgetary information – participatory budgeting with the VCS!
Costed plan! Need to see it – social care is in crisis.
Longer funding cycles!
Current system is very risk averse which limits VCS innovation. Commissioning
innovative approaches and learning from mistakes is OK.
Commissioning services efficiently – how to demonstrate efficiency? How to manage
within means without hurting service users?
Social Return on Investment – commissioners ‘buy success’.
Grant funding – what is available?
Clarification of the commissioning process – how is funding allocated/ reallocated?
Risk averse funding model – put more trust in innovation and things like Social Impact
Bonds, Social Return on Investment, and innovation in technology.
Directing funds to facilitate networks between community organisations and service
providers – perhaps a marketplace where organisations can share information and
needs.
More detail on what has been achieved/missed so proper conversations and meaningful
consultation can happen.
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CCG structure chart for commissioning is hidden so it’s often up to personal contacts –
this is something small organisations struggle with. To mitigate this and to help small
VCS organisations apply, publish a structure chart and provide a ‘business case
template’.
Evidence and intelligence:
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Support for VCS in relation to digital technology – secure channels of communication to
share information across organisations!
Closer links to research – sharing evidence base, involvement in evaluating outcomes,
working together with universities.
Internet access with hospitals/GP surgeries (networked/information sharing).
Better information sharing and better technology to facilitate this.
Outcomes/ impact:
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Clarity around the outcomes that we will be measuring in relation to the overall plan –
clear communication.
External impacts such as housing, environment, care homes, education, inequality.
Plan needs to involve movement away from distinction between statutory/non-statutory.
General comments:
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Carers - part of the VCS yet are often forgotten.
Consistency of language – no jargon, needs clarity to understand process.
Role of the Mayor and Metro Mayor – devolution.
Concern over the role of the accountable care organisations in the STP.
Attendance
First
Name
Kathryn
Vickie
Fran
Ben
Kyra
Sue
Mike
Piers
Jody
Keith
Emily
Joan
Michaela
Martin
Mary
Simon
Steve
Patsy
Tony
Greg
Ann
Geoff
Liz
Liz
Claire
Justin
Tim
Viran
Celia
Claire
Steve
Gillian
Paula
Rebecca
Jonathan
Kevin
Ben
Tim
Sam
Allan
Tony
Sam
Sergio
Surname
Antrobus
Athanatou
Bainbridge
Bennett
Bond
Brazendale
Campbell
Cardiff
Clark
Evans
Fifield
Foster
FudgeQuinlen
Green
Griggs
Hankins
Heigham
Hudson
Jones
Juckes
Kerrigan
King
Leaman
Lewington
Maine
Parsons
Part
Patel
Phipps
Rees
Sayers
Seward
Shears
Sheehy
Simmons
Snowball
Stevens
Temple
Thomas
Warnock
Wilson
Wilson
Zedda
Organisation
Bristol City Council
Bristol Community Health
Talking Money
South Gloucestershire CCG
Womankind
Voscur Limited
Cruse Bereavement Care
MacMillan
Bristol City Council
The Care Forum
Up Our Street
CPTPC Ltd
Self Help Community Housing Association
Age UK
Avon and Wiltshire Mental Health Partnership Trust
Southville Community Development Association
Help Counselling
Addiction Recovery Agency
Bristol Clinical Commissioning Group
Bristol Community Health
Independent
Parkinsons UK
Jessie May Trust
Milestones Trust
British Lung Foundation
Alliance Living
The Wellbeing Partnership
Bristol City Council
South Gloucestershire Council
Windmill Hill City Farm
Bristol Older People’s Forum
Alzheimer’s Society
Bristol Area Stroke Foundation
Maples Care
We Care and Repair
Alzheimer’s Society
Big Lottery Fund
The Harbour
MacMillan
Bristol Older People’s Forum
Second Step Housing Association
British Red Cross
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Apologies
First
Name
Colette
Deborah
Matt
Liz
Lynn
Caroline
Gabbi
Holly
Olly
Keith
Jennifer
Matthew
Paul
Philip
Gill
David
Frank
Natalia
Gordon
Helen
Helen
Malcolm
Lisa
Bev
Mike
Jenny
Surname
Organisation
Bourn
Bowen
Britt
Cooke
Cross
Donald
Edwards
Green
Grice
Hall
Harmer
Hill
Hudson
Kirby
Kirk
Melling
Palma
Peremiquel
Podmore
Sipthorp
Underhay
Watson
Wood
Woolmer
Wright
Bright
Second Step Housing Association
Shaw Healthcare
Freeways Trust
The Hive
Alzheimer’s Society
Bristol City Council
Disability Equality Forum
Carers Support Centre
Healthwatch England
Independent
South Gloucestershire Disability Action Group
Television
St Mungo’s Broadway
Avon Local Medical Committee
Bristol City Council
Deaf Plus
Alzheimer’s Society
The Care Forum and Maples Care
British Red Cross
Richmond Fellowship
West of England Sport Trust
Avon and Wiltshire Mental Health Partnership Trust
Keyring
Green Community Travel
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