Frequently asked questions
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.
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.
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.
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.
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:
We will focus on diagnosing cancer earlier so people get the most effective treatments and outcomes, including psychological support.
We will help people reduce their risk of diabetes, improve blood pressure control and provide more consistent cardiovascular services across the whole area.
The whole health and care system will move to a more person-centred and holistic model of mental and physical wellbeing.
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.
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.
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.
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.
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.
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.
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.
Statutory responsibilities will not change – this agreement signals a commitment by parties to work more collaboratively under the existing legal and regulatory frameworks.
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;
- Public Health services (additional to the functions which Local Parties already have responsibility for);
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.
 This refers to those specialised services that can be commissioned appropriately and effectively at Surrey Heartlands level
 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.
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.
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.
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
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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)