Tom Coffey: Sustainability and transformation plans in London

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  • Posted:Friday 15 September 2017

Speaking at a breakfast event on 12 September 2017, Dr Tom Coffey, Mayoral Health Adviser, Mayor of London, responds to The King's Fund's report on sustainability and transformation plans in London.


Thank you Chris.  So I’m here very much on behalf of the mayor who would like to thank the Nuffield Trust and the King’s Fund for producing an excellent report which gives us a framework to understand the STPs.  There is probably one very significant omission from the report, you’ve all probably spotted it, there’s no mention of Tooting.  I live in a very small world.  I was born in Tooting, I went to school in Tooting, I work in Tooting, I live in Tooting.  I take my holidays in Tooting, and I am going to die in Tooting.  So myself and Sadiq and obviously lots of Lonely Planet Guide watchers love Tooting.  

But what we’ve got here for the first time is a London wide perspective, and for that we’re very appreciative.  Sadiq’s manifesto had a much higher priority on health than his predecessors.  He was very clear that health was going to be an important part of his terms in office.  He started very clearly on air quality, not because of an aesthetic issue, but because of its damage to Londoners’ health.  He has also had a very strong focus on mental health, recognising that de-stigmatising mental health could be a key role that he will play in the next few years.  He has also said very clearly in his manifesto he wants to champion the NHS, but also wants to challenge it, and the role with this report I’m sure will be doing both.  And very clearly in his manifesto the model of care which he has asked for, which is very much in the STPs is care wherever possible closer to home.  And also he wants to offer strategic leadership in health services, and again this report gives him an opportunity to do so.

The STPs, the mayor and the mayor’s team see it as a fantastic opportunity.  It gives us a chance to work at scale, because we know lots of the problems in London’s health services cannot be solved unless we work at scale, and also unless we work with our partners, and the STPs do that.  However quite soon after their production, Sadiq became aware of both clinical concerns and also significant concerns from his local authority colleagues.  Clinicians were saying that this was the right model, but we’re not quite sure do the figures add up?  People in A&E were saying ‘Do you know this is summertime and the beds are full, this is very unusual’ there is significant pressure on the NHS.  So he decided to say rather than just doing a very bespoke focus on the STPs, we decided to get a London wide perspective.  And this is not a one off report, this is a report which we will use today and for the next few years to understand the issues that the NHS is facing, and a report which the King’s Fund and Nuffield have done admirably.

We asked for an overview, but not for a specific focus on one hospital or another.  Because what we realised was that we wanted an understanding first, before the mayor moves on to making a case by case analysis which the King’s Fund report asks for.  We gave some areas for them to focus on regarding hospital capacity, credibility, how can we implement it, patient and public engagement?  Also the GLA health committee lead by Dr Sahota gave some challenges which we asked the King’s Fund to look at.  The report has come out and there is a lot in it which is very good for the NHS in London.  The idea that there are models of care that are moving care into the community is excellent.  Social prescribing is in every single STP plan, this is seen as a great vehicle to engage our community and our voluntary sector.  Prevention is high up.  The public health agenda has been grabbed by our STP colleagues.  However as Nigel and Chris have identified, there are some concerns, concerns about hospital capacity.  We’re already working at over 90%.  We know that 85% hospital capacity offers a safer service and a service which offers good patient flow.  We also recognise that the plans of moving care in the community are admirable, but they’re not necessarily backed up by detailed implementation plans or costed plans.  The recommendations that the King’s Fund report come out with, the six recommendations, Sadiq I think would like to accept, and they ask him to take a leadership role, a leadership role in the oversight of the NHS, in the oversight of the STPs, not a detailed hands on process, but an oversight of how the plans are implemented.

As such Sadiq has developed six assurances, areas that he would like to see tested when the STP plans come through, because at the moment they’re very much information and we recognise greater detail will follow, and Nigel’s comments identify where the focus ought to fall on.  We want to look at patient and public engagement to make sure they have credible patient and public support, clinical support, not just from the clinical leaders of which many are in the room, but also frontline clinicians.  A third one is looking at health inequality, want to make sure that the STP plans do not worsen health inequality in London.  Fourthly, impact on social care.  We recognise that without a vibrant, effective, social care system, we cannot safely move patients through the hospital.  We need to make sure that our social care colleagues are convinced that the plans will produce the outcomes that they’re suggesting.  Fifthly and our focus today is hospital capacity.  We’ve got to make sure the analysis that Nigel has just shown us is reflected appropriately and credibly in the plans that are developed.  And finally investment, to make sure the investment required to make the changes out of hospital, to make the changes in social care.  

And Sadiq is very keen to work with the NHS.  Simon Stevens has come up with three tests when we’re looking at hospital capacity, and Sadiq isn’t going to come up with a new one, he wants to use Simon’s ones which focus on a reduction in hospital beds, can be accepted, if we have got plans in place in advance in social care and community care, or technology changes which demonstrate a reduction in hospital beds, or where the area has obviously more beds per 100,000 population than what we would expect.  They’re the tests that Sadiq will also share.  Sadiq wants to work with the NHS on the oversight of these STP plans.  We have the London Health Board.  On that board, Sadiq chairs it, we’ve got public health, we’ve got CCGs, we’ve got NHS England, the local authority and the Trusts.  That board we see as an ideal vehicle to offer Sadiq the oversight of the STP process.  Our plans are to work with the NHS, to bring these STP plans forward, to take the excellent parts about prevention, models of care, investment in the community, but to challenge where we believe the plans are insufficiently credible.  Sadiq will do what he said in his manifesto, champion the NHS and challenge the NHS and also offer leadership.  Thank you very much.