Jane Milligan: Sustainability and transformation plans - where next?

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  • Posted:Tuesday 21 February 2017

Speaking at our breakfast event on 21 February 2017, Jane Milligan, STP lead for North East London and Chief Officer of Tower Hamlets CCG, responds to The King's Fund's report, Delivering sustainability and transformation plans.


I think what’s very clear is to some extent each STP is very different and it’s almost impossible to really compare and contrast. So in many respects we are an STP of three covering a population of just under two million which is slightly unique compared to the rest of the country where we have got an 18% population growth over the next fifteen years.  So instead of looking at removing beds or closing or changing any services, it’s very much focused on how we get the best and use what we have in the most efficient and effective way.  And an area of very high need, not dissimilar to other parts of London, or other parts of the country, but a strong working partnership that have been perhaps delivered at a borough level recognising the importance of managing health and equalities in a very joined up way is very much the sort of bedrock of how we do business in east London or north east London.  So that provided a very good strong platform.

But I think it’s fair to say, when we started on the STP journey it took quite a long time perhaps to convince people this was the right route. And somebody said recently about ‘If I went and asked a jobbing GP on the street what the north east London STP would look like, what would they say?’  And I said, “Well I hope they don’t know.”  Because actually what we are trying to do is actually build on the work, whether that is in Barking, Havering & Redbridge and the accountable care work that they have done as part of devolution, City & Hackney have their devolution pilot, and across Waltham Forest, Newham and Tower Hamlets we have had a clinical strategy I suppose jointly with Barts Health on our transforming services together.  So I would hope they would talk about those but of course I might be wrong.

So I think this is a very timely report, I think it very much does for me chime with how we are trying to take this piece of work forward. If you have the delight of reading the north east London STP you would probably read it and think that has everything, it has literally the kitchen sink in it.  And I think what it does do is articulate everything in terms of the needs, but it doesn’t really start to get down to actually what the original question was which is what are wicked issues?  And I think part of the next phase of us working together, rebranding sometimes is just putting a sticking plaster on something, but actually what we are trying to now do is start to think about how we can collectively use the partnership of all the organisations including our patients and citizens to actually do a bit of a social movement and to deliver what we think collectively we can do in terms of really taking forward the work that was already underway.

So we now call ourselves the East London Health & Care Partnership, it’s not quite tripping off my tongue, so there’s a bit of work to be done there and it’s not necessarily talking about north east London because I think east London does have a particular resonance to our local population which is actually what we are all about.

So there are challenges, I am not going to rehearse those. People know we have a number of particular challenges in terms of our population but also from some of our providers, but actually what we recognise is that there is an opportunity for some real specific coherence.  So from a prevention perspective I think there are some opportunities for us to really focus on two or three key things which we can work with our local councils and our local citizens to really have industrial size approaches to.  And that’s...smoking cessation is really critical for us as well as diabetes.  And I think that’s what we want to do to really help get our local authorities and actual people on board, our local councillors.

I think then the other opportunity is that although we have got our three sort of accountable care systems developing, our providers provide a unique opportunity for them to be working to help us answer some of those really difficult questions that we have in terms of our capacity challenges now as well as frankly what are we going to do with this new borough that is coming down the A12 any minute now, and how are we going to do that? And I think what we recognise is more of the same is just not going to hack it.  And actually from a provider perspective, really taking the opportunity to help people lift their heads above the day job and the various special regimes that they are all under to actually start to think about what can we do collectively?

So we have in many respects quite a system which is relatively encased almost, people do move out of north east London, don’t get me wrong, and people do move in, patients flow from Essex and others. But actually we have pretty much every type of care that we need whether that’s the cancer cardiac centre on the Barts site which was a configuration that we did actually achieve, I might come back to that, as well as trauma centre and the Royal London.  But we know that if you essentially stuff up all of the beds on the Royal London site with elective care, you are just not going to be able to get your trauma in.  So it’s a bit about how then we work to really think and plan about using capacity which does have its challenge when you’ve got foundation trusts and other boards that are used to working in a very isolated or institutionally based way, so again another mantra really is a bit about how we actually start to work outside of those institutions.

And then I think key for us then is also looking as you say about the work that we have already done. We have got fantastic examples of good primary and community integrated care, good fantastic mental health care, we have got two really fantastically high performing mental health trusts.  And starting already work that before the STP was even a glimmer, we are already working towards much more alliance type contract based work to provide the pathways of care, knitting together primary care, community care, mental health, working with acute hospitals and working supporting consultants to do what they should be doing which is consulting out into the community, so having those pockets starting to bloom and to move across the whole patch.  So the sharing of good practice to address variations of care is really, really critical.

We have got good examples of good working, but with a bit of teasing and a bit of support using the STP as a facilitator to bring those clinical leaders together to work in that way. And I think then also the other part of course is working with the local authorities about the social reform and how commissioners work together.  So again the question I think I have been asked nearly every day actually ‘So what is STP, what are you actually doing for me?’  So part of this is if we are really serious about really changing the care models that are community based, that are locality based which I think we have about 27 localities across north east London, we need to be allowing people to focus on delivering that and implementing that.  And part of then is actually then the STP shouldering some of the work that needs to be done once.  So another mantra is what do we do once?

We are trying to look at that in an OD framework or system leader’s framework. So instead of people working in those institutions starting to develop system leadership roles and identifying the cultural change that we need to do business.  And I think being also clear about another mantra which I am sure will resonate well with some of my finance colleagues, we know what the money is now, that is probably the first time for a long time, so we now need to collectively work out how best to use it.  And again part of that is not talking about changes in services in a way of closing services or in a way that’s negative but actually building on the feedback we get from patients who frankly don’t want to have to keep trogging up to hospital to have outpatient appointments, they want to have different types of care that actually fits their own lifestyle today.  So it’s about how we use that and also leverage our clinical leadership.  Because we know, if we have got very strong clinical leaders standing at the front saying ‘This is a good change’ working hand in hand with patients, we actually do make a difference.  But we need to do that at a local level as well as the supporting from a north east London.


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