Frequently asked questions 2018-06-14T13:16:28+00:00

Frequently asked questions

What is the relationship between NHS Digital’s ‘Your NHS Data Matters’ scheme and the Surrey Care Record? 2018-07-05T09:44:09+00:00

NHS Digital launched the ‘Your NHS Data Matters’ campaign on 25 May 2018.  This is also sometimes referred to as the national data opt-out.  This national initiative enables individuals to register their choice in relation to the use of thier data for purposes other than direct care, such as research and planning. This replaces previous preferences individuals may have registered with their GP in the past and anyone who has registered an opt-out in the past will have been contacted directly by NHS Digital to explain the changes.

The Surrey Care Record is a local scheme accross the areas covered by four NHS Clinical Commissioning Groups – East Surrey, Guildford & Waverley, North West Surrey and Surrey Downs. The Surrey Care Record will only be used to support the direct care of patients and is not used to support other purposes such as research and planning.  The ‘Your NHS Data Matters’ campaign is therefore unrelated and not relevant to the Surrey Care Record.

Even so, you can still choose to opt out of the Surrey Care Record. This will however mean that professionals involved in your care will not be able to access shared information about you through the Surrey Care Record. Details on how to opt out of the Surrey Care Record.

What is Surrey Care Record? 2018-06-13T11:06:23+00:00

When fully operational the Surrey Care Record will be an extract of records from health and social care providers that can be seen and used by authorised staff in the health and care system who are involved directly in your care. Phase One of the project, commencing 29 August 2018, will see some GP records being made available to professionals within the A&E departments of the four local hospital trusts – St Peter’s, Royal Surrey, Epsom and East Surrey. Local GPs will have access to the Surrey Care Record too. The remaining phases of the project are still under development.

What information is available in the Surrey Care Record from hospitals? 2018-06-13T11:53:27+00:00

These are some of the key data items from acute hospitals which may be available in the Surrey Care Record in due course:

  • Allergies
  • Medication
  • Key medical notes/record
  • Episodes
  • Diagnosis
What information is included in the Surrey Care Record? 2018-06-13T11:35:20+00:00

Initially the Surrey Care Record will hold:

  • Basic information such as your name, address, postcode, NHS Number, age and GP practice details;
  • Limited information from your health records held by your GP Practice and Hospitals such as test results, medications and allergies

In time, additional health and social care providers will begin to share data into the Surrey Care Record.  Each organisation will be responsible for deciding what information about their service users should be shared into the Surrey Care Record.  This will ensure the most important information is shared.

The Surrey Care Record project follows many years of engagement by the NHS discussing the concept of shared records with the public nationwide.

Can I see my Surrey Care Record? Can I correct any errors? 2018-06-13T11:36:24+00:00

You can talk informally to any health or social care professional providing you with care during an appointment and ask to see the information they hold about you.

Some GP Practices will also allow you to access your GP records online.  You can check with your Practice to see if you are able to access a summary of your GP record on their website. If so, they can give instructions on how to access your record. The availability of this type of access is a matter for individual Practices.

In either case, you can go through any concerns you may have about the accuracy of the information with the relevant professional who will be able to update the records they hold about you.  They will then be able to share accurate and up to date information with other professionals via the Surrey Care Record.

There are also proposals to extend direct access to patients but these plans have yet to be finalised. In the meantime only health and social care professionals will have access.

Can I object to the sharing of my information? 2018-06-13T11:50:20+00:00

Care professionals will be trained to ask for your permission at the point of care before viewing your Surrey Care Record, giving you the opportunity to decide if you agree or not.

If you do agree, you don’t have to do anything and those caring for you will access your Surrey Care Record to support your direct care.

What if opt out but then want to opt back in? 2018-06-13T11:52:34+00:00

This is not a problem.

What do I do if I would like to make a complaint about improper use of my Surrey Care Record 2018-06-13T11:56:38+00:00

Please contact the health or social care provider alleged to be responsible for improper use directly to register a complaint. In Phase One providers will be:

  • GP practices from:
    • North West Surrey CCG
    • Guildford and Waverley CCG
    • Surrey Downs CCG
    • East Surrey CCG
  • Hospitals:
    • Ashford and St Peter’s Hospitals NHS Foundation Trust
    • Epsom and St Helier University Hospitals NHS Trust
    • Royal Surrey County Hospital NHS Foundation Trust
    • Surrey and Sussex Healthcare NHS Trust

Eventually it is planned to include a wider selection of health and social care providers:

  • Surrey County Council
  • CSH Surrey
  • South East Coast Ambulance NHS Foundation Trust
  • Surrey and Borders Partnership NHS Foundation Trust
  • First Community Health and Care.
  • Urgent Care and Walk-In Centres
  • Locality Hubs
Will the data be sold to insurance companies or drug companies? 2018-06-13T11:48:14+00:00

No. The Surrey Care Record will only be used by authorised health and social care professionals to provide you with care. Your records and information will never be sold or given to insurance companies, drug companies or be used for research.

Is this related to other national patient data sharing programmes? 2018-06-13T11:45:59+00:00

No. Other national programmes you may have heard of are completely separate. The Surrey Care Record is only integrating data in Surrey Heartlands and the area covered by NHS East Surrey Clinical Commissioning Group. We are only using the data to support your direct care.

Doesn’t GDPR mean that everyone now needs to opt-in and provide their consent? 2018-06-13T11:38:21+00:00

The Surrey Care Record supports the provision of direct care and enables health and social care providers to fulfil their legal duty to share information about patients where this will support their care.  Where information is shared in this way, consent is not required under the GDPR and the regulator, the Information Commissioner’s Office (ICO), has specifically advised that consent should not be relied upon in these circumstances.  Please see the Privacy Notice for full details of how the Surrey Care Record complies with the GDPR. 

Will this affect the care I normally receive at my GP practice? 2018-06-13T11:54:50+00:00

The Surrey Care Record has been designed to ensure that providing information does not affect existing GP services at all.

Sending data to the Surrey Care Record is an automated process that happens overnight, when no treatment is being provided, and therefore does not change the care you would normally receive.

Having data on the Surrey Care Record may improve the care you receive by providing the professionals who are caring for you with access to additional accurate information about you quickly and easily.

Can I opt-out of this altogether? 2018-07-17T08:42:13+00:00

Yes. If you want to opt-out of the Surrey Care Record you can contact any participating organisation who will ensure that the sharing of your Surrey Care Record is disabled.  This will however mean that other professionals involved in your care will not be able to access shared information about you through the Surrey Care Record.

If you have already opted out of the national Summary Care Record, you will automatically be opted out of the Surrey Care Record. It is important to understand that if you do this staff caring for you may not be able to access details from your GP and other care providers about care you have already received, your current medications, your allergies or any bad reactions to medicines you have had in order to treat you safely in an emergency. Your records will stay as they are now with information being shared by letter, email, fax or phone.

Please contact enquiries.surreycarerecord@nhs.net for specific advice on options available to you.  If you are sure you wish to opt out of the Surrey Care Record you can fill in a Surrey Care Record opt-out form and give it to your GP practice.

Is my data used in any other way? 2018-06-21T10:01:35+00:00

The Surrey Care Record will only be used by authorised health and social care professionals to provide you with care. 

Who can see my records? 2018-06-13T11:37:19+00:00

Only health and social care professionals engaged in your direct care will be permitted to access your record. The Surrey Care Record will eventually give health and social care staff the ability to share relevant information about you with other health and social care providers.  This will support you as you travel through the health and social care system and engage with different health and social care providers.

How is my information protected? 2018-06-13T11:44:36+00:00

Your information will be stored securely inside the NHS network and will be encrypted.  The Surrey Care Record will only be accessible to health a social care professionals who will only access your information where they or their team are directly involved in your care and have a lawful basis to access your record (e.g. your consent). 

Can I stop certain people looking at my Surrey Card Record? 2018-06-13T11:39:20+00:00

Care professionals will be trained to ask you before viewing your Surrey Care Record so you will have the opportunity to decide if you agree or not.

If you do agree, we have built safeguards into the system to ensure that each type of care professional can only access the parts of your record they need to see in order to provide you with safe and effective care.

If at any point you decide that you no longer wish to have the information within your Surrey Care Record shared between professionals, you can inform any of the participating organisations who will be able to disable your Surrey Care Record.  Once your Surrey Care Record is disabled this will prevent any professional from accessing the information about you which had previously been shared.

If you would like to restrict the sharing of certain parts of your record, you should speak to the relevant organisation or team who hold the information you would like to restrict.  They will be able to amend the sharing preferences for you to prevent other professionals or organisations from being able to access the information they have provided into your Surrey Care Record.

Will I be asked for permission to share my records? 2018-06-13T11:40:44+00:00

Under the Health and Social Care (Safety and Quality) Act 2015, providers of health and social care services have a duty to share your information where this is in support of your direct care.  The Surrey Care Record helps those providing you with direct care to meet this legal duty, as well as ensuring your information is shared with those who have a need to know in order to provide you with the best possible care. 

In most circumstances, professionals will ask for your permission to access your Surrey Care Record before they do so.  This will provide you with an opportunity to object if you are not happy for them to view the information.

The only exception is if you are unable to provide consent (for example if you are unconscious or otherwise unable to communicate). In these circumstances, the healthcare professional may decide to look at the record because doing so is considered to be in your best interest.

How does Surrey Care Record affect children and young people? 2018-06-13T11:42:44+00:00

Children and young people will also benefit from the Surrey Care Record.  Nevertheless, those who hold parental responsibility for children and young people can choose to opt them out of the scheme. The UK’s Data Protection Act 2018 (which came into effect May 2018) has clarified that the age of majority for decisions relating to the use of data is 13.  This has been seen as a change from the widely held view that decisions like this cannot be made until the age of 16.  Young people can therefore make their own choices about the Surrey Care Record and the sharing of their health information from the age of 13.

What is an STP? 2018-06-12T12:07:10+00:00

STP stands for sustainability and transformation partnership. Surrey Heartlands is one of 44 areas covering all of England, where local NHS organisations and councils have drawn up proposals to improve health and care in the regions they serve.

STP can also stand for ‘sustainability and transformation plan’, plans drawn up in each of these areas setting out practical ways to improve NHS services and population health.

They aim to help meet a ‘triple challenge’ set out in the NHS Five Year Forward View – better health, transformed quality of care delivery, and sustainable finances.

What are the benefits of sharing patient information? 2018-06-13T11:41:48+00:00

Shared records like the Surrey Care Record provide a range of benefits to both patients and medical staff including:

  • Reducing the amount of times you will need to repeat your medical history or social care information every time you deal with a new member of staff, service or organisation
  • Clinical staff will be able to work with patients in their care to make the best decisions about their diagnosis, treatment and care plan
  • Care professionals will be able to find shared information when they need it, such as test results, helping to avoid unnecessary appointments and further tests
  • Where several organisations work together to support your care, sharing information via the Surrey Care Record helps the various teams to co-ordinate your care, resulting in more time spent on better co-ordinated and safer care and less paperwork.
What is devolution? 2017-09-12T12:54:11+00:00

In its purest sense, devolution is the transfer of powers and funds from central government to local areas to enable greater local accountability and decision-making. With regards to health, devolution can be achieved through a range of mechanisms from parties having shared decision-making processes through to delegated or devolved control over specific functions.

The Surrey Heartlands agreement signals a commitment by NHS England and NHS Improvement to support the design and implementation of devolution in Surrey Heartlands. 2017/18 will be a “shadow year” in which the devolution model for 2018/19 and beyond will be further scoped and defined.

Who drew up the proposals? 2017-09-12T12:37:37+00:00

STPs are a way for the NHS to develop its own, locally appropriate proposals to improve health and care for patients. But they are working in partnership with democratically elected local councils, drawing on the expertise of frontline NHS staff and on conversations about priorities with the communities they serve.

A collaborative approach has allowed local leaders to plan around the health and social care needs of whole areas, not just those of individual organisations.

The partnerships are led by well-respected figures from different parts of the NHS and local government, including chief executives of NHS trusts, accountable officers of clinical commissioning groups (CCGs), local government senior leaders and clinicians.

What is the status of STP proposals? 2017-09-12T12:38:04+00:00

Proposals have been published for every part of England. Surrey Heartlands is one of a small number of the partnerships are now evolving into integrated or ‘accountable’ care systems (ACSs). In these areas, providers and commissioners come together, with a combined budget and fully shared resources, to serve a defined population.

STPs are a work in progress – they have evolved since organisations began working together in 2016, and will continue to do so as every area holds conversations with local staff, patients and the public. These conversations are still taking place and local proposals will continue to reflect them.

What is the Surrey Heartlands Partnership trying to achieve? 2018-02-28T13:41:16+00:00

Our vision is to improve health outcomes and add value by working together and in doing so close the health and wellbeing, care and quality and financial gaps. By this we mean:

  • Providing the best quality care for patients as close to their homes as possible
  • Healthcare professionals working with patients and carers to ensure quick access to diagnostic tests and expert advice so that the right decision about treatment and care is made
  • Ensuring, as modern healthcare develops, our local hospitals keep pace by using innovation to provide high quality services to meet the changing needs of our patients
  • Avoiding people being unnecessarily admitted to hospital or having to use A&E services because we can’t offer a better alternative
  • Caring for people in their own homes where possible
  • Spending funding wisely to ensure the provision of consistently high quality care that supports improved health outcomes.

Currently, there are eight clinical programmes of work:

Cancer care

We will focus on diagnosing cancer earlier so people get the most effective treatments and outcomes, including psychological support.

Cardiovascular care

We will help people reduce their risk of diabetes, improve blood pressure control and provide more consistent cardiovascular services across the whole area.

Mental health

The whole health and care system will move to a more person-centred and holistic model of mental and physical wellbeing.

Musculoskeletal services

We will develop a more consistent pathway through services for people with joint and bone problems with more care closer to home so people don’t have to rely on hospital appointments.

Urgent and emergency care

We will provide more consistent urgent and emergency care across Surrey Heartlands, including raising awareness about when to use emergency services and the benefits of self-care.

Women and children’s services

Women, children and young people will have access to more prevention services such as help to stop smoking, substance misuse, sexual health and immunisations. Hospital and community services will look to improve maternity services based on best practice and recent national evidence from the Better Births review.

Out of hospital & Primary care

Care will be managed to a consistent set of standards and coordinates care across a consistent set of Surrey Heartlands treatment pathways. Boundaries between care settings begin to “blur” with providers spanning multiple settings. The new model will have generalist professionals at the heart of the system, but will see networks of doctors and hospitals coordinating care.

Prevention

Surrey Heartlands places preventing ill health and disability at the heart of the health system.    We will drive a fundamental shift towards prevention and early intervention during the whole life.  The delivery of this vision will increase the number of years all Surrey residents live in good health and accelerate improvements in those currently experiencing the worst health.

Is the Surrey Heartlands Partnership all about saving money? 2018-02-28T13:39:22+00:00

The Surrey Heartlands plan is about delivering on the stated NHS aim to close three fundamental gaps:

  • The health and wellbeing gap: if the nation fails to get serious about prevention then recent progress in healthy life expectancies will stall, health inequalities will widen, and our ability to fund beneficial new treatments will be crowded-out by the need to spend billions of pounds on wholly avoidable illness.
  • The care and quality gap: unless we reshape care delivery, harness technology, and drive down variations in quality and safety of care, then patients’ changing needs will go unmet, people will be harmed who should have been cured, and unacceptable variations in outcomes will persist.
  • The funding and efficiency gap: if we fail to match reasonable funding levels with wide-ranging and sometimes controversial system efficiencies, the result will be some combination of worse services, fewer staff, deficits, and restrictions on new treatments.

We believe none of these three gaps is inevitable. A better future is possible – and with the right changes, right partnerships, and right investments we know how to get there.

The financial challenges faced by the NHS are well documented and careful decisions about how to be more efficient in the way we deliver healthcare need to be made. Although the NHS in Surrey Heartlands is expected to receive an increase in funding in the next five years, we know that expenditure is growing at a faster rate than the money that will be available to us.

If we do nothing differently, rising costs, inflation and increasing demand for NHS services will lead to a financial gap of more than £100m by the end of 2020/21. We aim to close this gap through working more efficiently, redesigning the way in which services are delivered, maximising the benefits that working across a large area can bring (working at scale) and using national sustainability and transformation funding.

What do the proposals mean for patients? 2017-09-12T12:39:06+00:00

The proposals include practical changes to improve patients’ lives. These include things  that patients often tells the NHS they care about; like making it easier to see a GP, speeding up cancer diagnosis and offering help faster to people with mental ill-health.

The NHS is one of this country’s proudest achievements and it has always adapted to improve care for patients. The growing number of older people in England is in part a testament to its success. But with demand for NHS services rising, new technologies emerging and demand for social care increasing, the NHS needs once more to adapt to a changing world.

What about NHS frontline staff? 2017-09-12T12:39:23+00:00

The proposals are based on local knowledge about the priorities and challenges in different parts of the country. Frontline staff are crucial to understanding these. Many STP senior leaders come from a clinical background and leadership teams often include clinical representatives.

STPs have allowed areas to think about long-term solutions to local workforce challenges, as well as supporting staff to develop their skills and provide the best care possible for patients. Surrey Heartlands includes Workforce in its priorities list.

What will happen next? 2017-09-12T12:35:40+00:00

In 2016 Surrey Heartlands began to discuss its proposals with local staff and communities. Since all STP proposals were published in 2017, Surrey Heartlands has begun to intensify this engagement – the involvement of clinicians is a crucial part of this. We have developed our own Clinical Academy to offer best practice clinical advice and support in association with the Kent, Surrey, Sussex Academic Health Science Network (add in link). We are also drawing on the voluntary and community sector, Surrey Heartlands citizens and others.

No changes to the services people currently receive will be made without local engagement and, where required, formal public consultation. There are longstanding assurance processes in place to make sure this happens.

In April 2017, STPs became the single application and approval point for local organisations to access NHS transformation funding. However Surrey Heartlands is set to become a devolved health and social care economy with funds devolved directly to it from government.For more information on Devolution please visit the Devolution Frequently Asked Questions page.

What will happen to STPs in future years? 2017-09-12T12:39:42+00:00

Sustainability and transformation partnerships were not designed to answer every question facing health and care services. But they are bringing together the right groups of people to think about what fundamental local changes are needed.

Partnerships will be forums for shared decision making, supplementing the role of individual boards and organisations. The immediate focus for Surrey Heartlands is on refining and implementing the local sustainability and transformation plan so that patients can see practical benefits locally.

Surrey Heartlands is also among a small group of partnerships in the first wave of potential ‘accountable care systems’ in which those who provide services and those who pay for them come together with a combined budget and fully shared resources to serve a defined population.

Where will commissioning powers now sit? 2017-09-12T15:40:07+00:00

Statutory responsibilities will not change – this agreement signals a commitment by parties to work more collaboratively under the existing legal and regulatory frameworks.

What does this mean for direct commissioning? 2017-09-12T15:40:56+00:00

NHS England will continue to discharge its direct commissioning functions. Statutory responsibilities will not change – this agreement signals a commitment by parties to work more collaboratively under the existing legal and regulatory frameworks.

Matthew Tait, Joint Accountable Officer of the Surrey Heartlands CCGs, will take up the role of NHS England Director of Commissioning for Surrey Heartlands and provide oversight of direct commissioning.

2017/18 will be a “shadow year” in which the devolution model for 2018/19 and beyond will be further scoped and defined. The scope being explored includes (but is not restricted to):

  • Primary care, including GP services, dental, pharmacy and optometry;
  • Specialised services;[1]
  • Public Health services (additional to the functions which Local Parties already have responsibility for);[2]

Any future request for delegation or devolution of any direct commissioning functions would be subject to further discussion, development and agreement with NHS England, in accordance with NHS England’s maturity assessment process. Ultimate decision-making would rest with the NHS England Board.

[1] This refers to those specialised services that can be commissioned appropriately and effectively at Surrey Heartlands level

[2] This covers those public health services for which the local authorities are responsible, subject to the statutory ring-fence by NHS England on behalf of DH.

Why are we doing this? 2017-09-12T12:58:02+00:00

At the core of our STP is a set of proposals to eliminate variation by delivering consistent clinical and professional standards. Devolution is an essential component to unlocking far broader changes, accelerating integration and more effective collaboration in Surrey Heartlands.

Across Surrey Heartlands we have a strong history of working in partnership, both in collaborative commissioning arrangements and service delivery. Since their inception, the Clinical Commissioning Groups (CCGs) in this area have worked across Surrey and with Surrey County Council to commission all children and young people’s and learning disabilities services, as well as some elements of mental health. The development of the Surrey Better Care Fund plans and ongoing drive towards integration have helped to ensure relationships between partners are strong, with a shared vision for the future of health and care services.

Will all or some of direct commissioning be devolved? 2017-09-12T15:41:50+00:00

No direct commissioning functions will be devolved in 2017/18. 2017/18 will be a “shadow year” in which the devolution model for 2018/19 and beyond will be further scoped and defined. Any future request for delegation or devolution of any direct commissioning functions would be subject to further discussion, development and agreement with NHS England, in accordance with NHS England’s maturity assessment process. Ultimate decision-making would rest with the NHS England Board.

Is this devolution agreement the same as that in Manchester? 2017-09-12T12:56:24+00:00

The Surrey Heartlands agreement is different to the Greater Manchester agreement, reflecting the different size and complexity of the health economy. The Surrey Heartlands agreement signals the beginning of a longer journey with an intention to:

  • Accelerate the integration of health and social care through much closer working between partners
  • Increase public engagement and the involvement of the people of Surrey Heartlands and system leaders around the transformation of health and social care
  • Increase local decision-making and flexibilities to achieve the best possible outcomes for the local population
How will that happen? 2017-09-12T15:42:28+00:00

A clear roadmap and supporting delivery plan will be developed and agreed with all parties in 17/18. The roadmap to devolution will include stepped increases in responsibilities and powers, underpinned by a clear set of financial and performance milestones and trigger points, robust risk and benefit share arrangements and aligned development of Surrey Heartlands governance arrangements. It will specifically enable regular reviews of progress against the key milestones drawn from the agreed aims and achievements.

How does this relate to the Surrey Heartlands? 2018-02-23T10:07:39+00:00

The devolution footprint is aligned with our Partnership footprint. Our Partnership was developed to describe a wide range of health benefits and improved outcomes that will be realised for the population through the transformation of health and care services. At the core of the strategy is a set of proposals to eliminate variation by delivering consistent clinical and professional standards. Devolution is an essential component to unlocking far broader changes, accelerating integration and more effective collaboration.

What will be the benefits for patients and the NHS? 2017-09-12T15:31:10+00:00

The overarching ambition is for Surrey Heartlands to be a prosperous and healthy place with a high quality health and care system for the population that is sustainable for the long term. The agreement signals the beginning of a longer journey with the intention to:

  • Accelerate the integration of health and social care through much closer working between partners;
  • Increase public engagement and the involvement of the people of Surrey Heartlands and system leaders around the transformation of health and social care; and
  • Increase local decision-making and flexibilities to achieve the best possible outcomes for the local population.

We anticipate the following benefits will be delivered through devolution:

  • Improved health and social care outcomes;
  • Greater integration of services and functions that will help to improve quality and reduce health inequalities;
  • Increased freedoms and flexibility to achieve maximum public value;
  • Increased public engagement in decision-making;
  • Greater ability to develop standardised best practice in health and social care through commissioning and provision, in order to secure improved outcomes, efficiencies and effectiveness; and
  • Greater ability to develop a sustainable financial balance.
Couldn’t this be achieved without devolution? 2017-09-12T15:31:44+00:00

Devolution will be a key enabler of transformation and closer integration of health and social care services in Surrey Heartlands. It will help to facilitate the delivery of the ambitions set out in our Sustainability and Transformation Plan.

Will this agreement help create greater integration between health and social care? 2017-09-12T15:32:23+00:00

Yes. Devolution will help to unlock far broader changes, accelerating integration and more effective collaboration in Surrey Heartlands. At the heart of our STP is the commitment to a place-based approach to joining up health and social care, including the development of new models of care aligned to the vision set out in the NHS’s Five Year Forward View. Through devolution, Surrey Heartlands’ ambition is to:

  • Improve health and social care outcomes;
  • Drive integration of services and functions that improve quality and reduce health inequalities;
  • Standardise best practice in health and social care through commissioning and provision, in order to secure improved outcomes, efficiencies and effectiveness.
What will happen between now and April 2018 in terms of implementing devolution? 2017-09-12T15:33:15+00:00

The agreement describes the aspiration for Surrey Heartlands to achieve transformation of health and social care at pace and scale. Local Parties, NHS England and NHS Improvement will continue to work together during the shadow year in 2017/18 to agree the preferred mechanisms, timescales and resources to achieve the aims and objectives described in the agreement.

A clear roadmap and supporting delivery plan will be developed and agreed with all Parties with the objective of achieving fuller devolution from April 2018. The roadmap to Devolution will include stepped increases in responsibilities and powers, underpinned by a clear set of financial and performance milestones and trigger points, robust risk and benefit share arrangements and aligned development of Surrey Heartlands governance arrangements. It will specifically enable regular reviews of progress against the key milestones drawn from the agreed aims and achievements, including relevant key milestones which occurred before the signing of this agreement. Further details on the roadmap are set out within the agreement.

How will it work in practice? Are there any practical examples of what devolution might mean in practice? 2017-09-12T15:34:04+00:00

New governance arrangements will be established this year to enable more collaborative working between partners. A Joint Committee (made up of representatives from the three CCGs and the County Council and with the interests of NHS England represented) will be established, with delegated authority from Surrey County Council and the three CCGs to make decisions within the authority provided; and an Executive Leadership Group will be established within the County Council, chaired by the County Council’s Chief Executive.

Clinical/professional leadership will be at the heart of these governance arrangements and a principle of subsidiarity will be rigorously applied, with commissioning and decision-making taking place at the lowest appropriate level.

During 2017/18 (the “Shadow Year”) Surrey Heartlands (through the Devolution Vehicle) will be able to access a ‘fair share’ of relevant transformation funds, held by NHS England and have freedoms to allocate the funds to achieve the best outcomes for the population, taking into account national priorities and fulfilling any agreed conditions attached to the funds.

Partners will work together in the shadow year to agree an approach to potential “fuller” devolution in Surrey Heartlands in the future. This will need to be explored and discussed with relevant bodies including the Department of Health.

What will be the leadership arrangements in light of this devolution agreement? Who will be ‘in charge’ of local health services now? 2017-09-12T15:35:10+00:00

The Surrey Heartlands Transformation Board will continue to be the executive partnership board with accountability for the delivery of the Surrey Heartlands Sustainability and Transformation Plan and be the primary forum for collaborative systems leadership across health and social care commissioners and providers.

The devolution governance model introduced in 2017/18 will work alongside the Transformation Board and will include a Joint Committee (made up of representatives from the three CCGs and the County Council and with the interests of NHS England represented), with delegated authority from sovereign organisations to make decisions within the authority provided; and an Executive Leadership Group within the County Council to be chaired by the County Council’s Chief Executive, David McNulty.

Matthew Tait the new Joint Accountable Officer for the Surrey Heartlands CCGs will also take up the role of NHS England Director of Commissioning for Surrey Heartlands. NHS England will also be recruiting a joint NHS England/NHS Improvement Director of Delivery, Assurance and Oversight.

Why are local providers not part of the agreement? 2017-09-12T15:35:59+00:00

This agreement is between Surrey Heartlands (Surrey County Council and the three CCGs), NHS England and NHS Improvement. It focuses on the elements of devolution relating to these organisations and their relationship with the provider community in Surrey Heartlands.

Whilst local providers have been engaged in the development of the devolution proposals through a number of workshops and discussions held locally, the focus of the agreement has been on commissioning and system oversight responsibilities. A second Memorandum of Understanding is being developed locally across the eleven partners (commissioners and providers) that form the Surrey Heartlands Sustainability and Transformation Partnership – this will set out how partners will work together to lead the health and social care system.

Is Surrey Heartlands an ‘Accountable Care System’ frontrunner? 2017-09-12T15:37:08+00:00

NHS England and NHS Improvement will include Surrey Heartlands in its Accountable Care System* development programme and the support they intend to provide to systems which are a member of this network.

In this agreement Surrey Heartlands has committed to collaborate with other shadow Accountable Care Systems to identify how delivery of these service improvement priorities can be accelerated, to solve problems jointly and to build population health management capabilities – including through new care models – in a way that other NHS systems can learn from.

*Accountable Care System (ACS) is an ‘evolved’ version of an STP that is working as a locally integrated health system. They are systems in which NHS organisations (both commissioners and providers), often in partnership with local authorities, choose to take on clear collective responsibility for resources and population health. They provide joined up, better coordinated care. In return they get far more control and freedom over the total operations of the health system in their area; and work closely with local government and other partners to keep people healthier for longer, and out of hospital.

Are other areas looking at devolution? 2017-09-12T15:38:49+00:00

The Government announced the first devolution deal with Greater Manchester in November 2014. It subsequently invited areas interested in a devolution deal to make a bid by September 2015. Greater Manchester’s ambition for health in its proposals prompted the inclusion of health and social care in many devolution bids.

Of the 38 devolution bids submitted to HMT and DCLG in September 2015, there are now approximately 19 that include health within scope to varying degrees. The number of those which contain health within scope is an evolving picture, with deals being revised, and proposals being refined throughout the process.

Following Greater Manchester (which is currently in implementation stage), eight other areas now also have ‘devolution deals’ agreed with Central Government (with health in scope to varying degrees):

  • Cornwall (Local integration of health and social care)
  • West Midlands Combined Authority (Mental Health Commission)
  • Liverpool (Health and Employment)
  • Sheffield (Health and Employment)
  • Greater Lincolnshire (integration of health and social care)
  • East Anglia (integration of health and social care)
  • West of England (health and employment – National work and health programme)
  • London (Collaboration agreement to explore devolution and integration options for London at borough, sub-region, and pan-London levels)