Tag Archives: STP

Place-based Care

What do we mean by place? There is much talk across health and social care about the future being “place-based” and it is not always easy to grasp what this is all about.

Here is an introduction to get you going:

Place-based

A simple proposition lies at the heart of place-based care: that we blur institutional boundaries across a location to provide integrated care for individuals, families and communities. Energy, money and power shifts from institutions to citizens and communities. Devolution becomes an enabler for a reform programme that starts to deliver on the long-held promise of joining up health and social care for a population in a place, with the ultimate aim to improve the public’s health and reduce health inequalities.”(1)

There is added value in:

    • collaborating at different levels in the system
    • building up from places and neighbourhoods
    • providing leadership across the system
    • focusing on functions that are best performed at scale” (2)

The King’s Fund offer the following definitions:

  • System – area covered by Sustainability and Transformation Partnership (STP) or Integrated Care System (ICS) (size varies but they cover one to three million people)
  • Place – area covered by local authority (tend to cover populations of around 250,000 to 500,000 people)
  • Neighbourhood – smaller geography that might correspond to district council boundaries or covered by a primary care network (PCN) (tend to cover populations of around 30,000 to 50,000 people) (2)

What will this look like in practice?

Groups of organisations including NHS trusts and local authorities will work together as an STP to decide on priorities for their place, and this may evolve to form an ICS and work together more formally. This will mean people with local knowledge developing the right services for their population across a whole area. It is designed to acknowledge the fact these services are not experienced in isolation by the people using them – although they are run by separate organisations, the thing they all have in common is the people from that place. It may also mean trusts agreeing that staff can work across different sites, or for some highly specialised services to be offered by one trust rather than several.

 

National organisations such as HEE as well as NHS England and Improvement and Public Health England, have teams aligned to each STP or region. These teams will work as a link between the locally driven priorities, and nationally provided initiatives such as those to develop (in HEE’s case) the right workforce to meet the needs of each place as well as the country as a whole.

As a very simple (and entirely fictitious) example, Anytown identifies that they have an aging population and rates of dementia are predicted to increase. They need staff with the right skills to meet their population’s needs, to run the right services such as specialist dementia clinics. This local intelligence can be fed into national plans by HEE to create postgraduate courses for nurses to become specialist dementia practitioners with a number of places offered to nurses from the area. The same local intelligence also identifies that many of the city’s GP workforce is rapidly approaching retirement, and they could be facing a shortage soon. An initiative could see additional placements for trainee GPs offered, to help encourage new staff to consider moving to the local area.

So, it should mean greater collaboration between organisations within a particular area and ideally, seamless care for the person receiving it.

What might this mean for you in your library and knowledge service as you support place-based care? ​

Are there local partners who you need to work with to support and improve your offer across your STP or region?​

References:

  1. The journey to place-based health, Public Health Matters
  2. Health and Wellbeing boards and integrated care systems, The King’s Fund

Emily Hopkins and Katie Nicholas
Knowledge Management Service
Health Education England

The Sustainability and Evidence Mobilisation (STEM)Club

Background:

The STEMClub is an informal group of NHS and public health colleagues working cooperatively to support the mobilisation of evidence at the system-wide level in the north east of England.

We are trying to achieve this aim in two ways:

    • By making links to system-level work streams within the North East and Cumbria Partnership, and potentially beyond.
    • By providing both virtual and real, in person, opportunities to connect as a group and understand who is working on what, making effective use of our collective knowledge and insights.

The founding members of STEMClub have been enthused by the level of interest and commitment among colleagues from commissioning, public health and library and knowledge services (LKS) to a collaborative, system-wide approach.

Work to date:

The working model so far has been to identify work streams within the Sustainability and Transformation Partnership (STP) with an evidence need and match these to NHS library and knowledge services (LKS) staff who have volunteered to support with evidence searches. LKS staff are currently supporting work in the following areas:

    • Development of a frailty framework
    • Maternal choice in perinatal care
    • Mental health

There have also been two community-of-practice events attended by colleagues from across the NHS. The main themes emerging from these events are:

    • This is a bottom up “movement” which needs to be led by its members.
    • It needs input from policy-makers, decision-makers to help members to understand the priorities and shape the offer.
    • The Club offer needs to be defined and articulated
    • The question of “how to sustain momentum and keep moving forward?” is a recurring theme.

What will success look like?

There is evidence to show that commissioners are currently ad hoc users of research evidence and that interventions tried so far to improve uptake and use of research have had little or no impact. The ambition of STEMClub is to change the NHS decision-making culture:

At every decision-making table, there will be someone with the skills, experience and knowledge to ensure that decisions are informed by relevant evidence.

What are the next steps?

    • Club members need to broaden the network and work more closely with colleagues from the AHSN and other academic partners.
    • Most of the resource and expertise required to achieve the aims of STEMClub will be in kind. In order to reach out to more work-streams, we need to scale up the activity and make it sustainable. This may require funding.
    • There will be a need for coordination of activity and some infrastructure to support the sharing of evidence and searches. This is being explored currently.
    • NHS LKS staff are going through additional skills development to support this work and ongoing development will be required. Opportunities for mentoring support will also be explored.

 

Shona Haining Head of Research & Evidence North of England Commissioning Support s.haining@nhs.net

Tom Hall Director of Public Health, South Tyneside tom.hall@southtyneside.gov.uk

Mark Lambert Consultant in Specialised Services Public Health (North East and Cumbria) mark.lambert2@nhs.net

Joanne Naughton Library and Knowledge Services Development Manager, HEE joanne.naughton@hee.nhs.uk

David Stewart Director of Health Library and Knowledge Services, North, HEE david.stewart@hee.nhs.uk

Paul Wilson Senior Research Fellow, Manchester University paul.wilson@manchester.ac.uk

The STEM Club in the North East of England

Working in partnership to support the work of the Sustainability and Transformation Partnership

The publication of the NHS Five Year Forward View and the subsequent arrival of Sustainability and Transformation Partnerships (STPs) signalled an attempt to change relationships between NHS providers and commissioners, moving away from a competitive marketplace towards closer partnership working.

In the North East of England, a group of staff from NHS Library and Knowledge Services, Commissioning and Public Health are looking to do the same. The Sustainability and Transformation Evidence Mobilisation Club (or STEM Club) is an informal group of colleagues working to support the mobilisation of evidence within the healthcare system.

We are trying to achieve this aim in two ways:

* By making links to work streams within the North East and Cumbria Partnership (and potentially beyond)

* By providing both virtual and real (in person) opportunities to connect as a group and understand who is working on what, making effective use of our collective knowledge and insights

A small group of STEM members has been meeting for over a year now and we have started to make links between work stream leads and library and knowledge staff. So far, a number of LKS staff have been involved in working on number of topics including:

* Frailty

* Maternal choice in perinatal care

* Physical exercise in preventive healthcare

We held our first full meeting of the STEM Club in March 2018. We used the name Club as the group has no formal governance arrangements as such. The event was attended by staff from LKS, Public Health, Commissioning and HE. A number of members of the group are from Yorkshire and Humber and we are happy to welcome colleagues from outside the North East. We were genuinely surprised at the level of enthusiasm in the room. There was a huge amount of interest in the work that has been done so far and a shared commitment to continuing with this approach. A few key challenges and affirmations came from the day:

* STEM is a “bottom-up” movement. This is genuine partnership working between colleagues with a shared interest in evidence mobilisation.

* We need to be responsive to the pace of work at a system level and be able to “share as we go”.

* We also need to be open to accessing and using a range of different types of evidence and knowledge (including tacit knowledge).

We are thinking about how we can share more widely regionally and nationally and we would be very interested to hear from others who have been working with their STPs locally.

The librarians who have been involved in the work are happy to share their experiences with you: Kirstin Himsworth County Durham and Darlington NHS Foundation Trust Claire Masterman County Durham and Darlington NHS Foundation Trust Dor Wilson Gateshead Health NHS Foundation Trust

You may also want to contact your Regional LKS Lead to find out more about working with STPs:

David Stewart  (North)

Ruth Carlyle (Midlands and the East)

Helen Bingham (South)

Louise Goswami (London & KSS)

Joanne Naughton
NHS Library and Knowledge Services Development Manager – North East