summary report -...

Summary report

Information Classification: CONTROLLED

Name of meeting Transformation Board

Meeting date 12 March 2020

Agenda item Strategic Plans

Presented by Iain Chorlton, Chair, NHS Kernow

Kate Kennally, Cornwall Council Chief Executive

Jackie Pendleton, Chief Officer, NHS Kernow

Purpose of report

To provide members with an update on the following three areas which highlight many priorities established for 2020/21. The papers include:

i. The Cornwall and Isles of Scilly health and wellbeing strategy

ii. Cornwall Council’s Business Plan and budget overview

iii. The Long Term Plan (LTP) narrative

Recommendations Members are asked to:

i. Review the attached appendices and enquire further, as required

ii. Confirm any future reporting requirements to the Transformation Board so they can be added to the Forward Plan accordingly

Engagement and consultation

Considerable engagement has taken place across all three areas

Date of next update required

The Transformation Board is a quarterly public meeting with the next date being organised for June 2020.

Information Classification: PUBLIC

Report to: Health and Wellbeing Board

Date: 23rd January 2020

Title: Cornwall and Isles of Scilly Health and Wellbeing Strategy Development

Portfolio Area: Children and Wellbeing

Divisions Affected: All

Local Member(s) briefed:

NA

Relevant Scrutiny Committee:

Authors, Roles and Contact Details:

Dr Virginia Pearson, Interim Director of Public Health,

Rebecca Cohen, Advanced Analyst,

Approval and clearance obtained: Y

For Cabinet and delegated executive decisions only

Key decision? (≥£500k in value or significant effect on communities in two or more electoral divisions)

N

Published in advance on Cabinet Work Programme? Y / N

Urgency Procedure(s) used if ‘N’ to Work Programme?

Y / N

Date next steps can be taken

Recommendations:

That the Health and Wellbeing Board:

1. Agree that the Strategy ‘Plan on a Page’, as set out in appendix 5 provides the basis on which to continue the Health and Wellbeing Strategy development.

2. Agree to approve the Population Health document, as a summary of the Joint Strategic Needs Assessment for Cornwall and the Isles of Scilly.

3. Agrees that the Health and Wellbeing Stakeholder Group be used to help inform and develop the approaches for engagement on the area-based delivery plans.


4. Agree to the second stage (development and engagement on the area-based delivery plans) to commence in March 2020 and update to be presented to the Board at its meeting in summer 2020.

5. Appoints three members of the Board to help lead engagement in each of the three locality areas.

6. Agrees to hold a workshop to discuss the specific actions Board members wish to undertake in order to progress the strategy objectives and ambitions.

1 Executive Summary

1.1 Under the Health and Social Care Act 2012, Health and Wellbeing Boards (HWBB) have a statutory duty to develop a Joint Strategic Needs Assessment and Joint Health and Wellbeing Strategy (JHWS) setting out joint priorities. It requires the Local Authority and Clinical Commissioning Group (CCG) to work together to understand the health and wellbeing needs of their local community and agree joint priorities for addressing these needs to improve health and wellbeing outcomes and reduce inequalities through commissioning.

1.2 This report provides the Board with the proposed final vision, outcomes and ambitions of the Health and Wellbeing Strategy 2020-2030 which incorporates feedback from the engagement that ran between 1st August and 25th September 2019. Alongside the proposed final plan on a page is the draft Joint Population Health Needs Summary which provides the underpinning evidence base and narrative for the Strategy. This has also informed the NHS Long Term plan narrative, so there is a common evidence base.

1.3 Subject to agreement of the final vision, outcomes and ambitions the report also seeks to identify the timelines and process for the next stage; the development of the area based delivery plans.

2 Purpose of Report and key information

Joint Health and Wellbeing Strategy Engagement (Stage 1)

2.1 The Board, at its meeting on 25th July 2019, agreed a draft ‘Plan on a Page’ version of the Health and Wellbeing Strategy 202-2030 for further engagement and discussion with stakeholders.

2.2 During August and September an engagement document and questionnaire was circulated to stakeholders as agreed at the July meeting. Alongside, this ongoing engagement, Public Health also attended a series of key strategic and partnership meetings over this period to raise awareness of the Strategy development and opportunities to engage.


2.3 During this period the ambitions of the draft HWB Strategy have informed, and been developed alongside the Cornwall and IoS NHS Long Term Plan, ensuring there is a joint vision across the health and care partnership.

2.4 Work has also been undertaken to develop the Population Health Summary a draft of which is attached at appendix 1. The Population Health Summary is intended to provide the strategic level narrative around the key population health issues for Cornwall and the Isles of Scilly which are reflected in and influence the Health and Wellbeing Strategy outcomes and ambitions.

2.5 The Population Health Needs draft needs to be finalised and various visualisations /infographics need to be designed to support the narrative but also to be used as stand-alone communication tools for the system. It is suggested, that to prevent delay in publishing the document once designed, that delegated authority is given to the Chair and Vice-Chair of the Board to approve the final document following circulation to Members of the Board for comment.

3 Consultation and Engagement

3.1 The development of the JHWBS Plan on a Page has been informed by a range of activities between April 2019 and September 2019, namely:

The development of an initial JHWBS ‘Plan on a Page’ was driven by the prioritisation topics (taken from the JSNA) and a workshop with Members of the Health and Wellbeing Board in April 2019.

The initial ‘Plan on a Page’ output was tested at a workshop event with stakeholders in May 2019. The facilitated event was attended by 42 stakeholders (a summary of these discussions was made available at the July meeting).

Feedback from the Cornwall event informed the next iteration of the ‘Plan on a Page’ and was then tested at a further workshop on the Isles of Scilly (a summary of these discussions was made available at the July meeting).

An online stakeholder questionnaire and engagement document was circulated to key partners on 1st August and remained live until 25th September 2019 (summary feedback report attached as appendix 2)

Numerous strategic partnership boards attended between July and September 2019 to provide updates on the Strategy development and raise awareness of the opportunities to engage and comment on the developing Strategy (list of meetings attended attached as appendix 3).

Stage 1 – Engagement Feedback


3.2 The document set out in appendix 4 was used as the basis for engagement between 1st August and 25th September 2019 as agreed at the Board in July 2019.

3.3 In total there were 126 responses with 82 people / organisations completing the whole online questionnaire. A further 3 responding directly via email. A detailed report containing the feedback from the questionnaire is contained in appendix 2, but in summary:

38% of respondents identified as interested resident, 40% individuals in a professional capacity, 15% were representations from a public sector organisation and 7% from voluntary sector organisations.

Vision (107 respondents) – 78% of respondents agreed with the Vision

Outcomes (92 respondents) – Healthy Communities (95% agreed), Healthy Start (96% agreed), Healthy Bodies (94% agreed) and Healthy Minds (91% agreed)

Ambitions (91 respondents):

o We enjoy an inclusive economy that promotes skills development and access to good work for all (86% agree)

o Everyone has access to a safe home, community assets and built environment that supports wellbeing (85% agree)

o We live sustainably and value the health benefits of our natural environment (82% agree)

o All parents and families have access to the right information and support to thrive (92% agree)

o Our children are lifted out of poverty and protected from adverse childhood experiences (87% agree)

o Every young person is equipped to be successful in the next stage of their life (89% agree)

o Everyone can enjoy a healthy lifestyle (93% agree)

o People living with disabilities or long term conditions, and their carers, enjoy better wellbeing (87% agree)

o We protect health through early detection of disease, screening and immunization programmes (96% agree)

o We can build good emotional and mental wellbeing at all ages (93% agree)

o We all take action to reduce our risk of developing, or support people to live well with dementia (88% agree)


o Loneliness and isolation is reduced through meaningful social contact at all life stages (96% agree)

Principles (90 respondents):

o Collective responsibility and understanding of the benefits of actively managing our health and wellbeing (93% agree)

o Investing in prevention to promote a more sustainable system (94% agree)

o Communities and systems working together to drive a healthier culture (92% agree)

o Promoting inclusion and recognising diversity (92% agree)

3.4 The engagement survey results show broad support for the approach taken by the Boards in terms of the Vision, Outcomes and Ambitions. There were however, valuable comments on the draft (outlined in appendix 3) which have resulted in some suggested amended wording to the Plan on a Page, as follows:


Vision Everyone in Cornwall and the Isles of Scilly can enjoy good wellbeing and can grow, live work and age equally well.

Comment Summary Concerns were raised about the phrase ‘equally well’

Use of the word ‘can’ was questioned– suggested - Opportunity to enjoy good wellbeing ….

Concerns that the word ‘Health’ is missing from the statement – suggested - Can enjoy the best possible health and wellbeing

Tackling health inequalities is not referenced in the vision

Need to link to the Economic growth strategy – ‘can prosper’

Lack of reference to equity Needs to reference the importance of

working in partnership to achieve the vision

Proposed Response By working together to tackle health inequalities, everyone can enjoy good health and wellbeing and grow, live, work and age well.


Outcomes Healthy

Communities

• Communities enable good health and wellbeing where we grow, learn, work and age

Healthy Start

• Children are given the best start in life enabling them to equally reach their full potential

Healthy Bodies

• People feel enabled and motivated to actively manage their lifestyles and reduce risks to health

Healthy Minds

• People pay as much attention to their emotional and mental wellbeing as their physical health

Comment Summary

Concern was expressed about the separation of healthy bodies and healthy minds as it doesn’t encourage holistic consideration of people’s needs.

Suggestions were made that Healthy Communities be amended to state Healthy, Safe Communities to formalise the link to the Safer Cornwall Partnership Plan.

There was a suggestion that the statement ‘People pay as much attention to their emotional health’ should be strengthened to ‘ mental health and wellbeing is valued and considered equally as important as physical health’

Proposed Response

o ‘Healthy, Safe Communities’ o Our mental health and wellbeing is valued and considered

equally as important as physical healthWhilst we recognise the issue raised about the separation of physical and mental health, it was felt that the rising mental health challenges across Cornwall and the Isles of Scilly required a specific focus in order to target collective action.


Ambitions

Comment Summary

Use of ‘can’ seen as a negative – suggested this is edited from healthy lifestyles – Everyone enjoys a healthy lifestyle and ‘people have good emotional wellbeing and resilience’

Sustainability, links to climate change and health benefits in reduction of greenhouse gasses were identified as areas which could be strengthened. Suggestions included:

o We make sustainable decisions that protect our communities and future generations from the impact of climate change

o We live sustainably and ensure we reduce our carbon footprint to protect the planet for future generations

o We take courageous action to reduce our carbon emissions and protect communities from the harm of climate change

o We make bold plans and act to respond to the climate emergency

Proposed Response

We live sustainably and reduce our carbon footprint to protect the environment from climate change.

Everyone has the opportunity to enjoy a healthy lifestyle We build good emotional and mental wellbeing at all ages


Principles

Comment Summary

Concern that Safeguarding the most vulnerable in our communities was not highlighted within the overarching principles. Suggested text:

o Ensure we all safeguard the most vulnerable to enable them to live healthy, safe lives.

Suggestions were made around recognising that the outcomes cannot be achieved in silos and rely on organisations and communities working together and the need to build structures which enable other sectors, other departments and other institutions to collaborate.

Prevention – it was suggested that wording was included to recognise that we need to invest longer term but also that prevention is more cost effective than cure.

Inequalities – highlighted that the most able and resourced help those who are least able to prevent greater divide between those who are able to take responsibility and those who are not.

Proposed Response

Ensure we all safeguard the most vulnerable to enable them to live healthy, safe lives.

Investing in prevention over the longer term to promote a more sustainable system

Promoting inclusion, recognising diversity and reducing inequalities

3.5 Subject to the Boards agreement on the proposed amendments the revised Plan on a Page is set out in appendix 5.

Stage 2 – Developing Local Delivery Plans

3.6 Stage 2, as stated at previous meetings, will be a more involved process. It is proposed, subject to agreement from the Board that the next phase of engagement will focus on the development of area-based delivery plans with partners and communities. These will cover the following areas:

North and East Cornwall Council Mid Cornwall


West Cornwall Isles of Scilly

3.7 These areas form the most consistent boundaries used by the Council and our Partners and so provide a stable basis on which to generate area-based plans. These areas also align with emerging Integrated Care Areas, and provide an opportunity for joint working with NHS on place based population health. Alongside these will be an overarching Cornwall and Isles of Scilly delivery plan which will cover those issues which require a pan Cornwall and Isles of Scilly approach such as whole population approaches or e.g. communications and campaigns.

3.8 It is suggested that the full details of the next stage engagement are developed with the Health and Wellbeing Stakeholder Group, helping to ensure the approach is inclusive and has joint ownership by stakeholders and may also present opportunities to use these events/ engagement activities to support work elsewhere within the system.

3.9 It is also recognised that approaches may need to differ depending on the locality and so it is suggested that the Board nominates three members of the Board to work alongside the development of the engagement events and activity in each of the areas to help drive and lead the process.

3.10 The proposed timeline for the development of the delivery plans is as follows:

Stakeholder Gro

up Dec 2019

Planning Jan -

Feb

Engagement

events Mar-June 2020

Drafts to HWBB July 2020

Public

Consultat

ion Jul -Sept 2020

HWBB

Final Agreeme

nt

Oct 2020

3.11 The Health and Wellbeing Stakeholder group met in early December to consider and discuss potential approaches to deliver the Health and Wellbeing Strategy, based on the 4 main outcomes and delivery plans set out in 3.6. The Stakeholder group supported the focus on the 4 main outcomes to ensure the focus is based on place, harnessing current community network expertise, and reflect local priorities for health and wellbeing. A minimum of four community workshops will be undertaken by locality, including the Isles of Scilly, to co-develop the delivery plans. In addition, Healthwatch Cornwall’s digital platform will be a route for further involvement of the community. It is envisaged this will focus on delivery within the first two years of a proposed 10 year plan.

Healthwatch Cornwall Digital Platform Engagement


4 Benefits for Customers/Residents

4.1 The Health and Wellbeing Strategy is underpinned by a robust assessment of current and future needs; utilising the Cornwall and Isles of Scilly JSNA products and Population Health Needs Summary. The proposals for Delivery Plans at area levels will also support targeted implementation of service delivery and future service planning that meets local health, care and wellbeing needs and reduces inequalities of the local population.

5 Relevant Previous Decisions

5.1 The Cornwall Board received a paper on the development of the JSNA at a meeting on:

31st January 2019https://democracy.cornwall.gov.uk/ieListDocuments.aspx?CId=829&MId=8150&Ver=4

25th July 2019https://democracy.cornwall.gov.uk/ieListDocuments.aspx?CId=829&MId=8957&Ver=4

6 Consultation and Engagement

6.1 Details on the proposed engagement approach for Stage 2 of the Health and Wellbeing Strategy is set out in section 3 of this report.

7 Financial Implications of the proposed course of action/decision

7.1 There are no direct funding implications arising from the production of the Health and Wellbeing Strategy. However, the Health and Wellbeing Strategy is intended to play a significant role in guiding the allocation of resources by all partners.

8 Legal/Governance Implications of the proposed course of action/decision

8.1 The Health and Wellbeing Board has a statutory responsibility to produce the Health and Wellbeing Strategy and the Council and the NHS Kernow Clinical Commissioning Group have an equal and joint duty to prepare it. Legal advice will be required as appropriate during the process.

9 Risk Implications of the proposed course of action/decision

9.1 There is also a reputational risk to the Council and NHS Kernow if they fail to discharge its public health responsibilities (specifically the production of

https://democracy.cornwall.gov.uk/ieListDocuments.aspx?CId=829&MId=8150&Ver=4





the Health and Wellbeing Strategy) as set out in the Health and Social Care Act 2012.

10 Comprehensive Impact Assessment Implication

10.1 The JSNA products and Population Health Summary that informs the Health and Wellbeing Strategy takes account of the health needs of all populations and considers how different populations’ needs vary and are currently met. The overarching purpose of the Health and Wellbeing Strategy is to reduce health inequalities and/or variance to services that impact on health.

10.2 A full CIA will be produced alongside the final strategy document and will be undertaken on each resulting delivery plan.

11 Options available

Agreement to the strategic framework of the Health and Wellbeing Strategy (Plan on a page and Population Health Needs Summary) is required in frame stage 2, the development of the Area based delivery plans. Below are the proposed next steps to progress the development of both the Population Health Needs and Health and Wellbeing Strategy:

Agree the amendments set out in the report to the wording of the Strategy ‘Plan on a Page’, as set out in appendix 5

Agree that the Strategy ‘Plan on a Page’, as set out in appendix 5, is now formally the Strategic Framework for the Health and Wellbeing Strategy and used as the basis for the Stage 2 engagement on the development of the Area based delivery plans.

12 Supporting Information (Appendices)

12.1 Appendix 1 - Draft Population Health Needs Summary 2019

12.2 Appendix 2 – Online Stakeholder Questionnaire Responses

12.3 Appendix 3 - Strategic partnership boards and meetings attended during the engagement process

12.4 Appendix 4 - Cornwall and Isles of Scilly Health and Wellbeing Strategy 2020-2030: Stakeholder Engagement Document, July 2019

12.5 Appendix 5 – Cornwall and Isles of Scilly Health and Wellbeing Strategy 2020-2030: Final Plan on a Page

13 Background Papers

13.1 Statutory guidance on joint strategic needs assessments and joint health and wellbeing strategies, https://www.gov.uk/government/publications/jsnas-and-jhws-statutory-guidance

https://www.gov.uk/government/publications/jsnas-and-jhws-statutory-guidance

https://www.gov.uk/government/publications/jsnas-and-jhws-statutory-guidance


14 Approval and clearance

14.1 [All reports must have Finance and Legal/Governance clearance. The key dates for clearance for your report will be provided by the officer responsible for the meeting agenda].

All reports:

Final report sign offs This report has been cleared by (or mark not required if appropriate)

Date

Governance/Legal (Required for all reports)

Katrina Canning 09.01.20

Finance(Required for all reports)

Sarah Acton-Page 09.01.20

Equality and Diversity(If required)Service Director(Required for all reports)

Steve Brown 13.01.20

Strategic Director(If required)

Appendix 5 – Cornwall and Isles of Scilly Health and Wellbeing Strategy 2020-2030: Final Plan on a Page



Report to: Cornwall and Isles of Scilly Health and Social Care Partnership Transformation Board

Date: 12 March 2020

Title: Cornwall Business Plan, Budget 2020/21 and Medium-Term Financial Plan 2020-24

Authors, Roles and Contact Details:

Kate Kennally, Chief Executive Cornwall Council [email protected]

1 Executive Summary

1.1 Full Council on the 25th of February 2020 agreed the refresh of the Council Business Plan 2018-2022 to reflect their continued commitment to our priorities for Cornwall together with the final budget proposals for the 2020/21 financial year, along with the Medium Term Financial Plan (MTFP) 2020-24, the annual Treasury Management Strategy, the annual Capital Strategy and Capital Programme 2020-24.

1.2 The budget and business plan are based on the findings of the public consultation, and the assessment of the cumulative impact of the budget proposals on people in Cornwall.

1.3 The budget enables the Council to deliver its priorities for Cornwall and invest in the services that residents have told us matter to them most, including:

Support and services for older people and vulnerable adults: The budget for 2020/21 will provide an extra £20m compared to 2019/20 to support the ever increasing demand for care for vulnerable older people and also investing in Learning Disability services.

Support and services for children and young people: There will also be investment of £5.6m (an increase of 8% compared to the 2019/20 budget) into services for children, schools and families, including additional investment for specialist early years practitioners. We will also be putting in £13m of additional capital funding to improve school buildings over and above the current capital programme for 2020-24.

Improving 4,500 miles of rural roads: continuing our commitment to provide an extra £10 million per year from 2018/19 to 2020/21 for road repairs.

Improving recycling and waste services: We are investing in a new waste service to encourage every resident to cut down on their plastic and recycle more.


Providing good quality homes for local people: continuing our investment in good quality homes for local people along with projects that support economic growth including an additional £1.2m increase in budget from 2020/21 onwards for improved bus services.

Working to make Cornwall carbon neutral: This is a green budget to help tackle the climate emergency and protect our children’s future with £20 million capital for environmental assets. This includes, an 8,000 hectare Forest for Cornwall, making energy efficiency improvements to existing Council owned housing and changes to local planning policy to make it easier for residents to install renewable energy and cut their homes’ carbon emissions.

Creating better paid jobs for local people: continuing our commitment to put an extra £10 million over four years into the pockets of the lowest paid, as the first South West council to pay the Living Wage Foundation rate.

1.4 These budget proposals result in a net budget of £602.557m in 2020/21. It includes the following Council Tax assumptions:

a) A total annual increase of 3.99% in 2020/21 which is made up of a 1.99% increase on general Council Tax and 2% increase for the Adult Social Care precept;

1.5 Sound financial management alongside an ongoing drive for efficiency and value for money, means that we can sustain and increase the extra funding this Council is putting into the services people have told us matter most. Whilst bills need to rise to fund services, including the Government’s social care precept, Cornish taxpayers still pay well below the England average, with one of the lowest Council tax levels in the South West. At the same time, we are maintaining council support for the most vulnerable.

2 Council Business Plan

2.1 Full Council adopted its four year Business Plan 2018-22 in February 2018 following extensive resident engagement and consultation, together with its accompanying four year Medium Term Financial Plan which provides the financial resources to deliver the Council’s Business Plan priorities for Cornwall. Over the last two years, significant progress has been made in delivering these priorities.

2.2 Healthy Cornwall: People have told us that local health services are their top priority for Cornwall. We know good health is about more than just services, and includes our lifestyles, aspirations, environment, homes and communities. OFSTED rated Cornwall as “outstanding” for our Children and Families services


meaning we are now in the top 10% of councils in the country and the only authority in the South West to receive an outstanding rating.

2.3 Our reablement project in Adult Social Care has helped 1,687 people since April to successfully complete a period of reablement, following discharge from hospital, which enables them to return to living independently in their own home, rather than being placed in residential care, which in turn has freed up hospital beds. This is an important achievement considering the rise in demand for social care services and uncertainty of funding from Government going forward.

Moreover, we have:

been transforming our day services in Adult Social Care, helping people to engage with their community as well as accessing day centres. We’ve helped 18 people, with 3 more on the way, to start work as supported employees with Employability Cornwall.

continued to exceed our service quality targets in Children’s Services with the percentage of users that are satisfied with the service they received from the Council’s Children and Family Services currently at 81.8% against a target of 76%.

reduced hospital discharges to residential care by 10%, enabling people to achieve more independent outcome. We’ve also reduced delayed transfers of care attributable to social care by 40%, reducing the time people are spending in an acute hospital bed. Use of our reablement service is up by 75% enabling more people to live for longer at home.

connected people to local support within their community, meeting their desired outcomes and reducing the need for social care packages, bringing costs down and targeting services where they are needed most. Our access teams are now diverting 40% of new referrals to more local support

been working to deliver our aim of better health outcomes for everyone and have been progressing a more joined up approach to working with health services. Our new joint care home commissioning contract will commence in April 2020.

approved plans to deliver 3,500 new Extra Care housing units to enable independent living with access to personalised, flexible care.

helped over 560 households stay warm and well this year through support, advice, repairs or heating installations.


continued to reduce the percentage of children who are obese in year 6, down to 29.6% (from 33% in 10/11), and the percentage of adults that smoke, which is down by 7% since 2011.

2.4 Homes for Cornwall: Residents have told us that affordable, decent homes are one of the most important issues for Cornwall. We are in the top 3 councils for providing affordable homes in the country and in the year that we marked 100 years of council housing, we are on track to provide 1,000 new homes direct by the Council with 92 housing completions so far in 2019/20. Adding to this we’ve also brought 90 (120 since the start of the scheme) extra homes back into use through our empty homes loan scheme.

2.5 We aim to take every opportunity to prevent homelessness and have achieved a 79% success rating in homeless prevention outcomes, exceeding our target. Thanks to our co-ordinated partnership approach and action plan, projects like Nos Da Kernow and the Somewhere Safe to Stay Hub, 2019 has seen rough sleeping down by 55% compared to 2018 figures.

2.6 Connecting Cornwall: Connecting our people, places and services, both within Cornwall and to other parts of the world, is a key priority. We have invested in our transport infrastructure and continue to improve the public transport network by implementing one of the only rural integrated public transport systems in the UK. A new contract has been secured to deliver a network of Council subsidised local bus routes with reduced fares for passengers and more cleaner, greener buses. Our local buses are a vital lifeline for our residents, connecting communities and allowing people to get to work, education and leisure services.

2.7 For more active and environmentally friendly forms of travel, Cornwall Council alongside Highways England has committed to invest in and has been developing plans for four new multi-use trails collectively known as the Saints Trails which will connect communities and complement the existing cycle routes and trails across Cornwall. Work is expected to start in early 2020.

2.8 Digital connectivity is just as important as transport connectivity for both the economic and social aspects of Cornwall as a place to live and work. Last year also saw Cornwall Council back the third phase of the highly successful Superfast Broadband programme – Superfast 3. This project leads on from the first two phases which delivered over 3,500 jobs, 3,850 new businesses and £300 million into our local economy and will increase access to Superfast Broadband for at least 2,700 additional premises. This latest stage of the programme reinforces our position as one of the best connected rural regions in the UK.

2.9 Green and Prosperous Cornwall: Our aim is to protect and enhance our unique environment and provide more jobs for people in Cornwall. While


earnings in Cornwall have gone up in recent years, there remains a gap with the rest of the UK. Cornwall Council is committed to championing a proper living wage and is leading by example by building an extra £10 million over four years into base budgets (from 2018/19) to pay our lowest earners the Living Wage Foundation rate of pay. This also extends to our contracted services where the Living Wage has been included in contracts as they have become eligible for changes to be made, for example from 1 April 2020 it will be a formal requirement for service providers to pay care home staff the Living Wage Foundation rate of pay.

2.10 The end of 2019 also saw Cornwall Council approve its plan to tackle the climate emergency and the Forest for Cornwall project being officially launched in December, planting the first 105 trees of an ambitious programme to cover 8,000 hectares of land in Cornwall, taking the first steps towards our aim of becoming carbon neutral.

2.11 Democratic Cornwall: Cornwall is committed to delivering double devolution; transferring powers from London to Cornwall and to local communities and residents. Cornwall is the first rural authority to agree a Devolution Deal with the Government.

2.12 As part of our priority of campaigning and standing up for Cornwall, the Council called for equality in policy and funding decisions by Government with the launch of Britain’s Leading Edge, a collaboration of rural upper-tier local authority areas without large cities and MPs. Britain’s Leading Edge is a mechanism to reframe the story of the contribution that rural regions can make to a sustainable national economy.

2.13 We are a leading authority when it comes to local devolution, and have worked with our local communities and town and parish councils to keep all our libraries open despite budgets being more than. As a result of this, library usage is up and, in some places, opening hours have been extended, delivering a better service and value for money. Libraries are not our only devolution success story, local devolution projects completed in partnership with local communities have included Sports facilities, parks, footpaths and heritage sites.

Refresh of the Council’s Business Plan 2018-22

2.14 The Council set its 2018-22 Business Plan priorities for Cornwall and accompanying financial plans on the basis of extensive resident engagement. The Council’s final decisions were based on the findings of the 2017 Resident Survey about what matters most to residents; consultation and engagement reaching over 60,000 people across Cornwall; and input from each of the Council’s five Overview and Scrutiny Committees. Since then the plan has been updated every year, based on extensive engagement and consultation


with residents, businesses and other stakeholders around the budget and spending priorities alongside feedback we receive through the residents’ survey, which is undertaken on a regular basis with a representative sample of Cornwall residents.

2.15 Overall, this feedback shows that the Council’s priorities still reflect what matters most to the residents of Cornwall. The refreshed 2018-22 Business Plan 1 therefore reaffirms our commitment to the Council’s priorities for Cornwall, with a new foreword from the Leader and updates to key statistics and data.

3 The Council’s Medium Term Financial Plan

3.1 Alongside the four year business plan, the Council agreed the budget for 2020/21 and the four year medium term financial plan (MTFP). As with any organisation, the Council experiences budget pressures as a result of, for example, inflation, national pay awards, increase in demand for its services from changes in demographics or legislation.

3.2 The budget includes total investment of £20m into Adult Social Care for 2020/21. This increase is 11% of the 2019/20 budget and is due to pressures relating to provider market failure, significant increases in price and demographic pressures.

3.3 In 2019/20 Adult Social Care funded a significant amount of prior year payments which has had an impact on the base budget, alongside additional costs arising from increased admissions to registered care arising from hospital settings. A substantial amount of work has taken place to understand the current financial year forecasts and budget assumptions for 2020/21, however there is a risk that the 2020/21 budget assumptions will be insufficient to manage current placements and the service could face budget pressures as a result.

3.4 The savings required to be delivered over the MTFP period total just over £58m for the local authority. To date, savings proposals have been brought forward for just over £42m leaving a budget gap of £15.8m by 2023/24. As part of the balanced budget set for 2020/21, just over £12m of savings are currently proposed.

3.5 Included in the current budget proposals, are c£12m of savings planned to be delivered in 2020/21. This includes £3.5m of savings linked to adult social care transformation. The Adult Social Care Directorate is currently undertaking a review of its budget strategy for the MTFP period. The future ASC Transformation strategy will need to consider and address a number of factors impacting upon service quality and budgets, including market supply, commissioning practices, and pathways and demand management.


3.6 The Council in addition will implement a planned programme of efficiencies, commercialisation, reductions and service transformation to achieve savings that will keep spending within the funding available from government grants, business rates and council tax.

3.7 The impact of each of the savings proposals has been subject to a Comprehensive Impact Assessment

Government funding for social care

3.8 As part of the one year Spending Review 2019, the Government announced the continuation of the power for Councils responsible for providing Adult Social Care to raise additional council tax equivalent to 2% p.a. for a 'Social Care Precept' for 2020/21. The Council applied this additional charge for 2016/17 through to 2019/20, and will raise a further Social Care precept of 2% in 2020/21. Over the five year period this will have generated c£29m of additional funding which has been passed in full and spent on delivering Adults Social Care services.

3.9 In the Spending Round 2019, the Government announced additional funding of £1bn for Adults and Children's Social Care in 2020/21, to support local authorities to meet rising demand and continue to stabilise the social care system. Cornwall Council's share of this additional funding is £11.3m, with no restrictions on how this funding should be allocated between services.

3.10 The Spending Round 2019 also confirmed that a number of one-off social care grants previously announced for 2019/20, will continue in 2020/21. These are as follows for Cornwall Council:

i. Social Care Support Grant (£4.8m) ii. Winter Pressures Grant (£2.8m)

iii. Improved Better Care Fund (£3.9m)

3.11 In line with the messaging from Government that these grants were one-off for 2019/20, Cornwall Council's current MTFP and budget assumptions had not included the receipt of these grants for 2020/21 and beyond. The revised budget assumptions in the 2020/21 - 2023/24 MTFP include these grants, as well as the additional £11.3m for 2020/21, continuing over the life of the MTFP to 2023/24.

4. Background Papers

The full budget report with associated appendices can be accessed on the Cornwall Council website - Item 8.3 of Full Council on the 25th of February 2020.

Summary report

Name of meeting Transformation Board

Meeting date 12 March 2020

Agenda item Long Term Plan for Cornwall and Isles of Scilly Health and Care Partnership

Presented by Jackie Pendleton, chief officer, NHS Kernow

Purpose of report

To provide an update to the Transformation Board on progress towards finalising the Long Term Plan for the CIoS system. It should be noted this version is a draft subject to final approval through NHSE/I and the CIoS organisational governance processes.

Recommendations The Transformation Board is asked to note:

The work that has been completed to date on the long term plan which is summarised in the attached narrative.

That this remains a “work in progress” as we move into the development of our one year operational plan for 2020/21 which will crystalise the delivery plans in more detail

Update from NHSE/I on the national approval and publication timelines;

In addition members are asked to provide any final feedback on the CIoS summary narrative to enable final sign off of the public facing narrative at late March / early April Board meetings.

Engagement and consultation

The Long Term Plan has been developed over the last six months through discussion at a wide range of system meetings including, Clinical Practitioner Cabinet, organisational and system Executive Boards meetings, wide ranging operational meetings, Primary Care Development Group and NHS Kernow’s Clinical Leadership Group.

Date of next meeting Not applicable.

Long Term Plan 2019/20 to 2023/24

cioshealthandcare.nhs.uk

Fit for the future

This five year plan sets out the Cornwall and Isles of Scilly Health and Care Partnership’s response to the local health and wellbeing strategy, as well as providing the partnership’s strategic response to delivery of the NHS Long Term Plan. The annual operating plans that follow will provide more detail on the changes being implemented locally each year.

DRAFT - WORK IN PROGRESS

http://cioshealthandcare.nhs.uk

2 Cornwall and the Isles of Scilly Long Term Plan 2019/20 to 2023/24

Greater focus on prevention and detection so we can tackle the health inequality gap across our system

get to the heart of what motivates a person to get better

2 Cornwall and the Isles of Scilly Long Term Plan 2019/20 to 2023/24 3 Fit for the Future

CONTENTS

Executive summary 4

Introduction 8

Healthy communities 16

Population health management 17

Healthy start 20

Maternity and neonatal services 21

Healthy childhood, adolescence and beyond 22

Healthy bodies 24

More action on prevention 25

Access to planned care - tests, outpatients and treatments 30

Healthy minds 32

Improving children and young people’s mental health 33

Improving adult mental health 34

Improving services for people with learning disabilities and/or autism 36

Fit for the future 38

Personalised care - your choice; taking control 39

Joined up care in the community 40

Access to urgent and emergency care - but only when you need it 43

Keeping a focus on quality 45

Developing our people, going digital, research and innovation, building and our finances 46

Developing our people 47

Why research and innovation is so important 50

Our buildings and estates 51

Our finances 52

Joining up as an integrated care system 55


Executive summaryThis plan has been developed by the Cornwall and Isles of Scilly Health and Care Partnership in response to the local health and wellbeing strategy and the NHS Long Term Plan.

This plan should be considered as our initial high level statement of ambition which will be followed by place-based (neighbourhood) discussions.

Our visionBy working together, with our vibrant communities, we are better able to ensure the people of Cornwall and the Isles of Scilly stay as healthy as possible - starting well, living well and ageing well.

Together we are transforming the ways in which we plan and deliver care with more emphasis on better supporting people to help themselves and each other to stay independent and well.

We will provide joined up, high quality health and care services that we can all be proud to deliver, with more services delivered in people’s homes or in their local communities. This will also make the very best use of the funds available.

Where we are nowWe’ve identified eight challenges, four of which are driving the growth in demand for health and care services, with the other four affecting our ability to respond to the increase in demand.

We have framed this plan using the same structure as the local health and wellbeing strategy which has four outcomes:

1 Healthy communities

2 Healthy start

3 Healthy bodies

4 Healthy minds

As well as our focus on improving health and wellbeing, our new ‘Fit for the Future’ service model will deliver more personalised care, and transform out of hospital care with joined up health and care teams in fourteen primary care networks (PCNs) working across three geographical groupings in Cornwall and the Isles of Scilly known as integrated care areas (ICAs).

Key challenges our system faces

Baby boomer effect: By 2027, 50 percent more people aged 75-84 and 27 percent more people aged 85+.

Increase in preventable illnesses: More people have preventable illnesses and are having more years of ill health, often with multiple illnesses.

A growing population: 62,000 more in the next 20 years.

Health inequalities: 71,000 people at greater risk of long term illnesses.

Workforce shortages: High number of vacancies and a high proportion of our workforce approaching retirement.

Limited resources to meet growing demand: We need to make every pound stretch further.

Geography and settlement pattern: A peninsula and 60 percent of people in settlements of under 3,000 affects how and where services can be provided.

Poor performance of our current system: Improving productivity and reducing variation.


What we need to doKey prioritiesWe have collectively agreed to focus our energies on a small number of priorities to achieve the greatest impact. We will focus on areas where the evidence shows it works:

• • Stopping smoking in pregnancy.

• • Early detection of atrial fibrillation (linked to stroke).

• • Reducing cardiovascular disease (linked to diabetes).

• • Respiratory illness (lung disease).

• • Supporting people at risk of falling.What we plan to do by 2023/24Our health and care services will have a greater focus on prevention and detection so we can tackle the health inequality gap across our local population.

We will work with individuals, families and communities to start well, live well and age well. People will benefit from improved physical health and mental wellbeing, helping children do well at school, reducing working days lost to ill-health and leading to fewer years of ill health for older people.

We will support people to take more responsibility for their own health and wellness and to be independent and in control of their lives and connected to their communities. This will help improve outcomes and reduce demand for public services. We will get to the heart of what motivates a person to get better, and support them to be happy, healthy and independent.

Drive the growth in demand

Respond to the growth in demand

Implement a new model of care for the 21st

century

We want to give children the best start in life and assist older members of our society to age well and stay healthy and connected to their communities for as long as possible in their own homes:

Following the recent opening of the Sowenna Unit which provides local treatment for young people with mental health problems, we will continue improving the care we offer.

Assisted by the recently announced £99.9 million capital funding, and with the input of families, we will be designing a new women’s and children’s centre.

For older people, we are investing in the new Embrace Care programme which will transform community-based care and support, delivering better health and care outcomes for people at risk of hospital admission, or who have been admitted to hospital and helping people to live independently for longer at home.


Place-based care We have a goal of providing place-based care in Cornwall and the Isles of Scilly.

Place-based care will be designed and delivered around localities ‘place’ by joined up teams in local communities with local knowledge. Accessible good quality, resilient primary care services will be at the centre.

Our GP practices are forming primary care networks to deliver more primary and community care closer to home.

We will join up health and care teams on the ground for both adults and children and young people, helping them to co-ordinate care and support in partnership with our vibrant voluntary and community sector.

Recognising that the ability to improve long term health and wellbeing and reduce demand for health and care services often lies with wider partners, we will create opportunities for wider teams to work together to address issues such as housing, debt and social isolation.

We work closely with University Hospitals Plymouth NHS Trust and Northern Devon Healthcare NHS Trust which provide services to communities from Cornwall and the Isles of Scilly. These include emergency and planned care for people living in north and south east Cornwall, as well as some very specialist services in regional centres of excellence. We will be building on these partnerships to ensure that people in these communities are also supported to start well, live well and age well.

We are also working with NHS partners from across Devon through the Peninsula Clinical Services Strategy to ensure that everyone can access safe, high quality care regardless of where they live. The strategy, which is being led by local doctors, nurses and other clinical professionals, is looking at how we can work together to address challenges in recruiting and retaining staff and sharing specialised hospital facilities and equipment.

Digital focusWe will adopt a ‘digital first’ culture, ensuring we are at the forefront of digital innovations meeting the needs of our local communities today and tomorrow.

If you are being asked to take more control of your health, we need to give you easy access to your health records especially if you have a long term condition. Our clinical teams will be sharing information and clinical images to support team working and we will be maximising the use of artificial intelligence for routine and repetitive tasks such as screening and reporting.

Where suitable, you may be signposted to video and application libraries for self-care and preparation for treatment.

Joining up health and careWe know that closer working between health and care makes sense. We have already formed a system wide leadership team to share big decisions about how we collectively use our funds and staff to respond to and improve population health management – both across the peninsula and locally.

The whole of our workforce will operate as part of a shared Cornwall and Isles of Scilly health and care team, working flexibly across and between organisations – delivering skills and capacity where they are most needed. We will also be working with health and care colleagues in Plymouth and North Devon to align workforce strategies.

Our workforce will take every opportunity to encourage and support self-care, prevention, wellbeing and independence and deliver holistic care personalised to what matters to individuals

We have a primary care training hub that supports our primary and community care workforce with their learning, training and development. We intend to develop new roles, blending skills in innovative ways and offering a range of experiences, career pathways and portfolio careers across health and care.


We have launched a new Health and Care Academy for Cornwall and the Isles of Scilly which we hope will help us achieve our recruitment ambitions, creating new opportunities to retain and develop talent locally. We also want to develop a high energy culture where all staff feel empowered to innovate, share expertise and knowledge and deliver personalised care.

Making better use of our fundingFunding for health and care is finite and although we have made good progress in reducing our costs, we are still spending above our budget. With an ageing and growing population with increased demand, we know that more money alone will not bridge the gap. This is why we need to transform the models of care and look towards prevention for long term improvement in health. Evidence shows that a greater focus on prevention and early intervention will reduce demand over time. Achieving this requires everyone to play their part.

We know through our early work on personalising care that it is often the smaller low cost things that make the most difference. Having quick and easy access to local voluntary organisations that can help you address problems such as finance and housing can really help with your overall health and wellbeing, making you much less likely to access health services. This positive approach, combined with working more effectively in teams, will help create a local health and care system for future generations and enable us to live within our means.

We are not just a health and care serviceAs one of the largest employers in the area, as well as providing stable, secure employment we have significant collective spending power across health and care. We want to ensure the local economy benefits from wider strategic decisions across our services.

Building on our track record and engagementWe believe we are ‘change ready’. We have put in place the foundations to work differently, secured some early successes and established the trust and relationships on which such ambitious change is dependent.

We have worked with local communities and our staff to co-produce our plans so we can be confident they respond to local need and preferences. We will be engaging through our new primary care networks and integrated care areas to seek grassroots feedback on service delivery. This will be especially powerful from our more remote areas such as Isles of Scilly and North Cornwall.

Senior leaders are united behind this plan, and there is a growing sense of ambition on behalf of our people to transform our health and care system to deliver improved outcomes within the resources available – and at pace.

ScopeThis plan sets out our longer term intentions for improving health and care over the next decade, but with a particular focus on the progress we intend to make between now and 2023/24.

Further detail will follow in annual operating plans. This plan represents a specific point in time and will evolve as we learn from the changes we make.


Introduction

All partners have agreed to work together to deliver better health

and wellbeing and to collectively take

responsibility for the effectiveness of our

health and care system

Our partnership comprises all of the organisations that are involved in health and care in Cornwall and the Isles of Scilly.

We are also working with our colleagues in Devon through the Peninsula Clinical Services Strategy to ensure that everyone has access to safe, high quality and affordable care regardless of where they live in Cornwall and the Isles of Scilly.

Key principles adopted in developing our plan• • Local ownership: Communities and

voluntary and community sector partners have been involved in the development of the plan.

• • Reducing health inequalities and more action on prevention will be a key focus across all programmes.

• • Proposals that have clinical or professional implications have clinical and professional support.

• • The plan will take forward integration of services.

• • Clinically and professionally led; the plan must drive innovation.

• • We will deliver the commitments in the NHS Long Term Plan, but it will be a phased approach, so we remain focused on responding to local needs and priorities.

• • The plan recognises workforce constraints and is based on realistic workforce planning.

• • The system aims to be financially balanced by 2023/24.

Why the plan is so importantWe must respond to the changing needs of our population and take advantage of the opportunities offered by new technologies. Demand for services is exceeding the capacity of our workforce both nationally and locally and there is an urgent need to rebalance our system to be proactive and focus on improving health and wellbeing and enabling people to successfully manage their own health.

We want to deliver more joined up, better co-ordinated and more efficient care. We will also support people to remain healthy promote self-care, and increase community resilience and independence.


EngagementOur long term plan has been produced by the partnership, developing from the 2016 ‘Shaping our Future’ plan. Building on the co-production, prototyping and trialling of new models of care which has taken place over this time, the plan describes the next stage in our journey.

Our plan has been developed using a wide range of local and national source materials. Locally, we have reviewed the results of recent engagement on the health and wellbeing strategy; the findings of the Healthwatch engagement events; and key themes from our extensive and ongoing engagement programme.

Nationally, we are guided by the implementation framework for the NHS Long Term Plan and commitments in the national plan that will be delivered locally.

We have encouraged practitioners to design and test new ways of working which suit their populations. We have held events to encourage more sharing across partner organisations and with other providers from the voluntary sector. We have looked at how we can redesign community services and pathways of care for major health conditions.

All this work, including the results of public engagement, and a comprehensive review of benchmarking data, have fed into system workshops to design how our system will operate in the future.

We have been keeping our stakeholders updated with articles about the development of the plan in one of the region’s main daily newspapers, The Western Morning News, and the publication of a 16 page community newspaper.

This has identified 12 areas that we need to address through our plan:

1 Workforce challenges

2 Integration and local placed care

3 Prevention and inequalities

4 Access to services in rural areas

5 Communications with stakeholders

6 Financial sustainability

7 Urgent treatment centres

8 Technology and equipment

9 Mental health and wellbeing

10 Voluntary sector engagement

11 Children’s services

12 Isles of Scilly specific challenges

Design and test new ways of working which suit local populations


Working with Devon

We are working with colleagues in Devon through the Peninsula Clinical Services Strategy to shape the future of hospital-based services including specialist services.

We want to ensure that everyone in Cornwall and the Isles of Scilly can access safe, high quality and timely care regardless of where they live in the county. This will be provided locally where possible and appropriate, but will in some cases include delivery through the development of regional centres of excellence to ensure that we can deliver more specialist services as required.

We recognise that, while our organisations are working very hard to meet the increasing need for services, they face significant difficulties in recruiting essential staff and accessing specialised facilities and equipment. The strategy will also help tackle these issues by making it easier for clinical teams to work together across different hospitals and to share diagnostic and expensive specialised equipment.

Clinicians and hospital managers from each trust are joining together to develop new ways to recruit and retain staff, and to spread collaboration, clinical networking and best practice in the services where we are facing the greatest challenges. Together these actions will help us deliver the best standards of care we can.

Whilst this strategy is focusing on Peninsula hospital services, we need to look at the whole health and care system and we are therefore also engaging with mental health, primary care and community services to redesign models of care at a more local level.

One of our GP primary care networks which covers Holsworthy, Bude and surrounding villages, with the Stratton Medical Centre and Neetside Surgery in Bude is part of this network. Another primary care network in east Cornwall includes practices that face towards University Hospitals Plymouth NHS Trust. There are already good connections between GPs and consultants through a number of joint projects, including virtual clinics for diabetes. We will be building on these relationships to deliver more joint working in the future.

An increase in clinical and professional engagementAs well as our public engagement, our staff provide ‘grass roots’ feedback into which parts of our health and care system are working well, and where improvements can be made to improve the delivery and quality of services.

Our work is clinically and professionally driven. Senior practitioners have been identified to lead on developing and implementing proposals for all long term plan commitments that have clinical and professional implications. Work is owned locally, and, following consistent feedback from engagement exercises, a whole system approach to our workforce issues has been adopted to plan for the future, and take steps to improve retention and recruitment.

Improving our reach We want to improve our reach to under-represented communities and ensure we gather as broad a range of opinions as possible. We have been working with Volunteer Cornwall and Healthwatch Cornwall to support us with this work.

Volunteer Cornwall is working with both ‘TravellerSpace’, and Carefree (for young people in care, or leaving care, up to the age of 25). Work is also taking place to develop ways of engaging with single homeless people.


Engaging with the Isles of Scilly

Through engagement we have established the following challenges which are specific to the Isles of Scilly:

• • Travel for mainland appointments and treatment including for people with a mental health crisis which can be delayed due to transport issues.

• • Some women need to have their babies on the mainland which can mean periods of separation at a time of great significance for the whole family.

• • Cost of housing is such that it is hard to recruit the workforce required to sustain services.

Our next phase of engagementIt is vital that people see that what they tell us is given due consideration and, where appropriate, influences our plans. The next phase of our engagement will use the “You said - we did” method to provide clear feedback on the main areas of our plan. Healthwatch Cornwall is also leading the development of a new and exciting interactive online platform, called ASK Cornwall, to capture the views of people living in Cornwall and the Isles of Scilly.

We are continuously looking to identify solutions to improve services for our population on the Isles of Scilly. Engagement has identified a number of priorities we want to deliver:

• • Developing a team of people with wide range of skills to manage 90 percent of need and minimise crises.

• • Integrated and co-located workforce across services.

• • Increased use of technology.

• • Improved anticipatory care to support people to self-manage their conditions and remain connected to their communities.

11 Fit for the Future


Ensuring our plans align locallyThis plan includes the partnership’s response to the local health and wellbeing strategy which has a vision:

By working together to tackle health inequalities, everyone can enjoy good health and wellbeing and grow, live, work and age well

The strategy has four overarching objectives:

Healthy communitiesWe create healthy and sustainable places and communities to live, learn, work and age

Healthy bodiesPeople feel enabled and motivated to actively manage their lifestyles and reduce risks to health

Healthy startChildren are given the best start in life enabling them to equally reach their full potential

Healthy mindsOur mental health and wellbeing is valued and considered equally important as physical health

Underpinning the health and wellbeing strategy are five principles that we have also applied to this plan:

1 Collective responsibility and understanding of the benefits of actively managing our health and wellbeing.

2 Investing in prevention to promote a more sustainable system.

3 Communities and systems working together to drive a healthier culture.

4 Promoting inclusion, recognising diversity and reducing inequalities.

5 Ensuring we all safeguard the most vulnerable to enable them to live healthy, safe lives.


Why change is necessary: eight key challengesThe first four challenges are driving the growth in demand for health and care services and the other four are affecting our ability to respond to the increase in demand.

Key challenges driving change

A new model of care for the 21st century

Responding to the changing needs of our population

Our ability to respond to the increase in demand

A growing population

Baby boomer effect

Increase in preventable illnesses

Health inequalities

Workforce shortages

Limited resources to meet growing demand

Geography and settlement pattern

Poor performance of current system


A shift in our model of careThe increasing demand for services requires a significant shift in our models of care, and how care is viewed and provided.

We need to strengthen our support in the community to help people stay healthy in their homes for as long as possible. We need to provide more information about alternatives to GPs in primary care so people expect different options to choose from.

We will break down barriers at a local level by joining up care and support teams around populations of about 30,000. These teams will be linked with communities in place-based care, providing care and support designed to match the needs of the local area.

Support will be centred primarily on primary care networks in three integrated care areas across our system. More specialist support will cover a wider geographical area.

For both planned and urgent care people will follow a pathway of care aimed at giving them a consistent and seamless experience of care and support, keeping them as healthy as possible as close to home as possible.

When needed, access to specialist services will be swift and easy to navigate.

Our model of care

How care is provided and organised

How we commission and contract

From To

Reactive: Treating ill health

Proactive: Improving population health, focusing on prevention and early intervention, supporting self care

Designed to treat single episodes of ill health

Integrated, personalised care to include support for people with long term conditions

Heavy reliance on hospital care, separation of disciplines

Focused on out of hospital care centred around networks of GP practices and multi-disciplinary teams

Organised separately by individual organisations on a local footprint

Organised by collaboration across the health and care system and by integrated care areas with local arrangements to enable community involvement and ensure care and support is aligned to local needs

Commissioning volumes through contracts with separate providers

Commissioning outcomes, working in partnership with, and encouraging collaboration between, providers

Cultural change

14 Cornwall and the Isles of Scilly Long Term Plan 2019/20 to 2023/24 15 Fit for the Future15 Fit for the Future

Help people stay healthy in their homes for as long as possible


Healthy communities

The Health and Wellbeing Strategy• • Creating healthy and sustainable places and

communities to live, learn, work and age.

• • Enjoy an inclusive economy that promotes skills development and access to good work for all.

• • Everyone has access to a safe home, community assets and built environment that supports wellbeing.

• • We live sustainably and reduce our carbon footprint to protect the environment from climate change.

• • Communities and systems work together to drive a healthier culture.

• • We promote inclusion, recognising diversity, and reduce inequalities.

• • Ensuring we all safeguard the most vulnerable to enable them to live healthy, safe lives.

Our responseWe will contribute to the health communities by:

• • Increasing our focus on the health of the population, improving our understanding of the health and wellbeing of our communities and working with them to design our support appropriately for their needs.

• • Further improving our understanding of which communities and which groups in our population are experiencing health inequalities, what is driving those inequalities, and what action we need to take to reduce inequalities.

• • Contributing to the wider determinants of health, as an employer, as a purchaser, as an estate holder, and how we can work more effectively with existing strategic partnerships focusing on the economy, natural environment/renewable energy, built environment, and community safety in Cornwall and the Isles of Scilly.

• • Working with partners to empower local communities.

Work together to drive a healthier culture



We will be using local and national data and modelling to identify at risk groups of people. This is known as population health management and we will use this information in different ways:

• • It will help GPs and the other health and care professionals in new primary care networks target local services where people have greatest need.

• • It will be used by leaders to identify which communities might need a higher level of funding, compared to others.

• • We will also use it to identify where we should test new ways of delivering services.

Using our modelling, we have created the diagram below which shows the split of our population by the type of care they need.

We have started to use this diagram to think about how we redesign our services to reduce the gap in the number of years that people live healthy in one area compared with another. We know that the gap is not only due to people’s health, but also what type of housing and employment they have. This is why we work very closely with our colleagues in both Cornwall and the Isles of Scilly councils and in Devon to have the strongest chance of success.

Looking at the diagram below, the small proportion of people living well at the base of the triangle shows how fragile the health and wellbeing of our population is and how great the risk of not being able to support the level of demand on services in the future unless we act now.

people living well

managing long term conditions well

at risk

people need more help for care

people need help with complex conditions

people approaching end of life

will have ad-hoc treatment and

support

will be supported to self-manage

will be targeted for prevention

will require co-ordinated

care

will require managed care

4,000

4,000

20,000

145,000

280,000

85,000

will require managed care

Proactive careinc. severely frail

Population health management


The 280,000 people at risk require a significant upgrade in targeted prevention, focusing on a strong start to life and tackling wider determinants of health and wellbeing as well as prevention of specific diseases.

As well as people at risk, we know that focusing on children will be our best opportunity to generally improve our population’s health. However we also recognise that we cannot ignore the needs of our growing ageing population.

This means we will be focusing on two groups:

1 Children and young people• • For immediate benefits of a strong

start to life.

• • To tackle health inequalities for children living in poverty.

• • To tackle inequalities when young people move to adulthood.

2 People aged 65+• • For immediate benefits of reducing

risks to health in a rapidly growing and ageing population.

• • To tackle health inequalities for older people.

• • To improve outcomes for older people when they need help and enabling them to stay independent for longer by embracing a new model of care and support.

For our adult population, the increasing prevalence of long term conditions requires a refocusing on supporting people to better manage conditions themselves. We will also be looking at the design and delivery of out-of-hospital services.

Our ageing population means there is also likely to be an increasing number of people with more than one long term condition. This means we need to plan services that can support combinations of care. We also want to support self-management using technology where this is available.

Read more about our Embrace Care programme later in this document.

Reducing health inequalitiesHealth inequalities are differences in health between people or groups of people that may be considered unfair. They are largely avoidable and have a big impact on people and on our services. We already know that some groups of people are experiencing health inequalities when using our services. These people include those:

• • With learning disabilities or autism or both.

• • With severe and enduring mental health who have poorer physical health than they might expect to have compared to the general population.

• • Aged 65+ who are frail.

• • People who are homeless or part of travelling communities.

Those at greatest risk of health inequalities are:

• • Children living in poverty.

• • People living in areas of multiple deprivation.

What will changeWe will take action to improve outcomes for people most at risk of poor health. We’ll be looking to make every contact count, especially focusing on the five activities below:

Immunisation and screening: Prevention and detection. Focus on places and groups of people where there is low uptake.

Smoking prevention: Increase the number of stop smoking advisers and expand the healthy pregnancy service.

Diabetes prevention and weight management: Recruit to the diabetes prevention programme and provide more targeted sessions on weight management for those most at risk.

Antimicrobial resistance: More education and engagement to reduce use of antibiotics.

Suicide prevention: Improve support for people who self-harm, training for all GP practices working with sports clubs on exercise programmes for people with mental health problems.


Improve outcomes for people most at risk of poor health



Healthy start

The Health and Wellbeing Strategy• • Children are given the best start in life enabling

them to equally reach their full potential.

• • All parents and families have access to the right information and support to thrive.

• • Our children are lifted out of poverty and protected from adverse childhood experiences.

• • Every young person is equipped to be successful in the next stage of their life.

Our responseWe are taking a whole system approach to give children a strong start to life. We are transforming care and support for mothers and children through:

• • Our local maternity services (LMS) programme, which is transforming maternity and neonatal care.

• • Our children and young people’s programme which is transforming care and support for physical and mental health from childhood through to young adulthood, including improving support for young people moving into adulthood.

• • A major estate redevelopment, which will establish a trailblazing women and children’s centre, designed with families and enabled by £99.9 million capital funding already secured.

All parents and families have access to the right information and support



During pregnancy and in early childhood are the best times to ensure children get a strong start in life; supported by their parents/carers, wider family, the community and professionals to provide the best prospects for lifelong health and wellbeing.

Our challenges

10%

5,500births per year

17%grow up in poverty

of childrencurrently

Over 25% of routine manual

workers smoke

Around

who become pregnant are obese.20% of women

14%of pregnant women are still smoking at the time of delivery

By 2023/24

We’ll have achieved:

Extra measures meeting national standards to save babies lives

Continuity of carer for pregnant women

A new maternity hub model of care within the birth centres with ‘spokes’ at locality level

What we have achieved so farWe’ve increased the access to smokefree pregnancy and healthy pregnancy advice.We’re also changing our way of working to make services more personalised for example:

• • Working in co-production with service users.

• • Starting to develop continuity of carer.

• • Implementing the maternity personal health record.

We have started to test a team approach to consultation for parent and infant mental health.

Healthy pregnancy advisors already provide a face to face on site presence at the scanning clinic and are building on other antenatal sessions for example with continuity of carer teams at community sites, maternity and family hubs. This builds trust and supports disclosure.

Importantly the focus at sessions is also on carbon monoxide exposure and not smoking and the inclusion on the maternity pathway of the role of fathers, partners or significant family others which has had a significant impact.

By co-producing plans with the Kernow Maternity Voices Partnership, our local maternity system has learnt what local women think and feel about the services they’ve experienced and this has helped develop how we offer personalised services and choice.

• • More responsive and culturally sensitive approaches to minority groups.

• • Influenced training and role development with midwives, for example, training to offer hypnobirthing and aromatherapy.

As a result of what women tell us we are trialling new ways of delivering antenatal education and support and will be taking this forward this year. The LMS and Maternity Voices Partnership will also be involved in planning for the new women and children’s hospital at Royal Cornwall Hospital.

Maternity and neonatal services

of areas in Cornwall and the Isles of Scilly are

among the most deprived in England.


Digital accessThe electronic maternity health record was launched in July 2019. Now all women can access their maternity notes and information online and through their smart phones.

We will develop maternity information advice, media access, and potentially an interactive mums’ app.

Healthy childhood, adolescence and beyond We need to give our children and young people a strong start to provide the best prospects for their long term health and care and improve our overall health and wellbeing, reducing the gap in healthy life expectancy.

Everybody working togetherResearch on poor childhood experiences demonstrates a clear link between the quality of a child’s experience of childhood and traumatic experiences, and the resulting health risk behaviour in adulthood, such as smoking, substance misuse, and obesity which directly links to both mental and physical illness.

Services for children and young people are different to other adult services. We have a specially trained workforce who has experience of working with children, their parents and carers.

Our plan is to have our staff working together across the whole system of education, health and care to ensure we get things in place to prevent avoidable long term health needs.

By 2023/24• • We will be well on the way to establishing a new

women and children’s hospital as a centre of excellence. This will act as a hub to support and promote excellent child health across Cornwall and the Isles of Scilly.

• • We will use more technology - enabling parents and families more choice and ownership of their care.

• • Children with additional health, neurodevelopmental delay or learning and physical disability will receive the right support at the right time so that they have every opportunity to thrive and live as independently as possible in adulthood.


What else we plan to do• • Implement our postnatal action plan: a

women's health and pelvic floor specialist physiotherapist is already working with maternity services. This is the first step towards developing the postnatal physiotherapy pathway with postnatal clinics.

• • Maintain our UNICEF Baby Friendly accreditation and aim to increase this to venues in the wider community such as family centres. This will provide more local access and help us to achieve the infant feeding gold standard UNICEF accreditation.

• • Review the need (including those of vulnerable groups and those with existing education, health and care plans) of individuals and map against current services provision, to identify of any ‘quick wins’ for the 18-25 age group for 2021/22.

• • Develop future models and approaches to perinatal and infant mental health in line with a clear pathway from maternity through the first 24-months and beyond.

Mental health services for children and young peopleWe want to ensure that we support the mental health wellbeing of all our children and young people. See the mental health section of our plan for details of how we are working with partners to achieve this.


Our challengesWe have a growing younger population and local studies (source: joint strategic needs assessment) have found that we have higher rates of:

• • Children not reaching a good level of development by the end of school reception year.

• • Social, emotional and mental health needs.

• • Attendances at emergency departments as a result of self-harm.

A lower proportion of children and young people in a population can sometimes make them invisible to a system which is struggling with high volumes of age-related disease and frailty.

Key priorities

The development and build of the new women and children’s centre at the Royal Cornwall Hospital

Improving our approach to outpatient care, including digital options and integration

Developing the paediatric and child health workforce to ensure delivery of good quality pathways for those with long term conditions

What we have achieved so farA successful bid and confirmation of £99.9 million of capital funding for the development of the women and children’s centre at the Royal Cornwall Hospital.

Following an inspection of children’s social care services in October 2019, Ofsted awarded ‘outstanding’ in three areas and good in the fourth.

Childhood obesityWe know that we have many children who are overweight. Our colleagues in public health are looking to treat and prevent childhood obesity. They have already introduced a healthy weight pathway and we will add to this during 2021/22 to increase the capacity to support obese children and the severe health complications.

Expert health support and advice for primary and secondary aged children

What else we plan to do • • Good quality prevention.

• • A core foundation for child development in the first 1,001 days of life and the pre-school years, specifically targeting vulnerable families.

• • Expert health support and advice for primary and secondary aged children to build resilience, improve lifestyles, provide early intervention or identify those in need for more specialist support.

• • Specialist assessment and short or medium term evidence-based interventions to promote recovery for those who develop health and mental health problems.

• • Whole family approaches to improve family circumstances, promote change and safeguard children where family poverty, parental lifestyle or capacity is impacting negatively on child development and long term health and wellbeing outcomes.

• • Teams working across education, health and care for those with longer term or complex health, disability or mental health needs, including crisis management.

• • Better outcomes for children and young people with cancer.


Healthy bodies

The Health and Wellbeing Strategy• • People feel enabled and motivated to actively

manage their lifestyles and reduce risks to health.

• • Everyone has the opportunity to enjoy a healthy lifestyle.

• • Protect health through early detection of disease.

• • People living with disabilities or long term conditions, and their carers enjoy better wellbeing.

• • We all share collective responsibility for, and understanding of, the benefits of actively managing our health and wellbeing.

• • We will invest in prevention over the longer term to promote a more sustainable.

Our responseWe are transforming care and support through:

• • Our more action on prevention programme. This will have an immediate effect on some people’s health as they stop risky behaviours. Others will see improvements in their health over the short to medium term, whilst investing in prevention, early detection and early intervention over the longer term for our whole population will significantly reduce the prevalence of preventable diseases.

• • Our planned care programme. This is transforming pathways of care for people at risk of or in the earlier stages of major diseases to deliver better care and better outcomes for their long term health and manage long term conditions successfully through to end of life.

Protect health through early detection of disease



More action on prevention

Behaviours Diseases Deaths and disability

Smoking

Physical inactivity

Unhealthy diet

Excess alcohol

Lack of social connections

Cancer

Heart disease and stroke

Bone and joint conditions

Mental health conditions

Lung disease

lead

s to

whi

ch c

ause

s 75% of premature

deaths and disability

As part of reducing our health inequalities, we will be focusing prevention where we can have the quickest impact and then rebalancing resources over time.

By 2023/24• • We want more people to feel enabled and

motivated to actively manage their lifestyles and reduce risks to health.

• • Early detection of disease is the norm and earlier intervention to prevent or delay its progression is available.

• • People’s health is being protected through immunisation and prevention of infection.

Our challenges• • The places where we live do not always

promote active lifestyles or a good diet, leading to an increase in preventable disease.

• • Focusing on behaviour change can widen health inequalities if people accessing support are not those who need it most.

• • We need to work together with local communities, particularly in areas of high deprivation or rural isolation.

Key priorities

Provide leadership for prevention and tackling health inequalities

Enable behaviour change

Early detection of disease and earlier intervention

Prevention, diagnosis and management of infection

People feel enabled and motivated to actively manage their lifestyles


What we have achieved so far• • Well developed support for people to stop

smoking and reduce alcohol dependency and introduced support to help people manage their weight.

• • Increased the number of people screened for cancer, especially people with learning disabilities, and the number of people at increased risk of diabetes supported to prevent diabetes.

• • Started to increase detection of cardiovascular risk factors.

• • Improved our handling of antimicrobial resistance.

Making every contact countEvidence shows that helping people change their behaviours and providing access to early detection of disease and protection from infections can help prevent disease and reduce early deaths

We are working with all our health and care service providers to make every contact count – that means they may ask you about your current smoking and drinking habits and offer advice.

The more we do, with your input, the biggest impact we can have:

• • Stopping smoking can lead to immediate improvements in health and prevent early deaths from cardiovascular disease or cancer.

• • Stopping smoking in pregnancy can reduce pre-term births and improve outcomes for infants.

• • Immunisations and screening programmes are a cost effective way of preventing illness and detecting disease early when it is treatable reducing demand on services and the cost of care per capita in the longer-term.

Stopping smoking 63,000 people in Cornwall and the Isles of Scilly continue to smoke even though we know it causes about 1,000 premature deaths each year. As part of our healthy children programme we are focusing on women who smoke during pregnancy.

We are above the national average for the proportion of people in hospital who are smokers and the proportion of people with a serious mental illness who smoke.

What we have achieved so farAlthough much of smoking cessation support is offered via primary care, services are not consistent. We want access to smoking cessation advice to be provided in every GP practice.

As part of designing better care for people with respiratory disease, we will target and support people with a respiratory condition to give up smoking.

All our hospital sites have smokefree policies. As an example the Royal Cornwall Hospital is a smokefree site with:

• • Stop smoking advisers offering support five days a week, including use of nicotine replacement therapy.

• • Every smoker seen via a pre-operative assessment automatically referred to the stop smoking advisers.

• • All people in hospital can be referred electronically.

We offer face-to-face support to pregnant women and their partners or family members immediately following their 12-week dating scan at the Royal Cornwall Hospital.


What else we plan to do• • Increase access to stop smoking advice.

• • Provide more staff training across all areas at the Royal Cornwall Hospital so they can advise on stopping smoking.

• • Improve the smoking cessation provision for new parents, particularly those whose babies require neonatal care or parents whose children are admitted to the paediatric wards.


Alcohol and drugsAlcohol has been identified as a causal factor in more than 60 medical conditions including cancer, heart disease, stroke and depression. There is a strong association between drinking and suicide.

Evidence shows that mental and behavioural disorders, cancer and cardiovascular disease are the leading diagnoses associated with alcohol related hospital admissions. Locally we know that almost one quarter of adults drink above recommended healthy levels and nearly 30,000 more than double the recommended levels.

An estimated 84,000 people in Cornwall and the Isles of Scilly are classed as binge drinkers.

New estimates from Public Health England indicate that Cornwall and the Isles of Scilly has around 6,600 dependent drinkers, equating to 1.5 percent of the population.

A review of case studies of frequent hospital attenders reflect that these people are often very vulnerable and have problems with alcohol and other drugs, alongside other physical and mental health needs. Many have a chaotic lifestyle and demonstrate problems with engagement, often resisting treatment and change and requiring more support.

The number of young people in treatment for alcohol as a primary drug is eight percent, which is consistent with the national treatment population.

What we have achieved so farWe have an alcohol liaison team based in the Royal Cornwall Hospital which consists of nurses and assistant practitioners with a specialist interest in alcohol. They work with people to:

• • Reduce acute alcohol related hospital attendances, admissions, outpatient appointments and readmissions.

• • Reduce acute length of stay for appropriate patients and ensure adequate community-based resources.

• • Provide advice and support for appropriate patients in ED settings and across wards where indicated.

People in hospital with high alcohol consumption scores or associated conditions receive bespoke intervention and support. Using data obtained at admission, the team can be made aware of people with high alcohol consumption. This ensures they are supported and followed up during their admission.

This can then link people into community alcohol pathways, including access to direct admission to residential detox facilities for appropriate patients.

We have benefited from receiving funding for a voluntary sector colleague to work with us to help reduce alcohol related admissions for those people with five or more admissions in the previous year.

Detection and management of cardiovascular risk factorsWhat we plan to do• • We aim to improve the detection and

management in primary care of cardiovascular risk factors (atrial fibrillation, high blood pressure, and high levels of cholesterol).

What else we plan to do• • We will introduce routine screening

for alcohol consumption for all people admitted to hospital. People scoring above a threshold will be reviewed by the team for brief intervention if indicated.

• • The voluntary sector service will be expanded to provide support to young people over weekends and overnight.

• • We will work to reduce pressure on hospitals and increase discharge rates through developing services across appropriate community hospital sites and by increasing the availability of home detox and care.


Weight managementWhat we have achieved so far

A weight management service is offered by Healthy Cornwall for people aged 18+, who have a BMI above 25, with group sessions available in rotation across major towns.

People can self-refer onto the programme or be referred via a health professional. The service can also be accessed by people with Type 2 diabetes.

Healthy Cornwall also offers a range of physical activity opportunities including health walks and swimming for health sessions.

Cancer screeningWe have invested in a specialist service to support people with a learning disability to access cancer screening programmes. Our uptake is now one of the highest nationally.

We have prioritised improvements in cervical screening uptake, including supporting individual GP practices to develop local solutions such as drop-in appointments. This has helped attract women who didn’t take up the offer of a booked appointment.

Evidence shows the newer testing kits for bowel screening are proving more acceptable to people and we are hoping this will have at least a 10 percent increase in uptake.

Compared with other areas, we are already doing well with early diagnosis of breast cancers at 87 percent.

Screening for disease and immunisationsThe good news is that our general uptake of screening and immunisation programmes is meeting national targets and is in line with the rates across the south west.

However, this masks variation in local uptake which contributes to the inequalities across our geography. We have been reviewing local uptake at GP practice level, with the results confirming considerable variation.

What else we plan to do

• • Improve what we can provide digitally to increase the reach and impact of the service.

• • Provide more targeted sessions for those most at risk, for example working with Plymouth Argyle to develop Argyle Fit for working age men to engage them in healthy lifestyle messages through sport.

• • Improve links with GP surgeries.

What else we plan to do• • Exploring using text messaging to notify

people that screening and immunisation is due.

Diabetes prevention What we have achieved so far

We have recruited over 1,600 people into our diabetes prevention programme.

Several GP areas are funding diabetes initiatives; including walking groups for people with diabetes, self-management and lifestyle intervention sessions and low carb apps.

What else we plan to do• • Support uptake for those GP areas with the

lowest rates.

• • Explore digital solutions to notify and remind people that they are due to take part in cancer screening programmes.

What else we plan to do• • Work with GPs and the health checks

programme to emphasise the importance of HbA1C and explore a variety of ways to increase referral.


Prevention, diagnosis and management of infection We will prioritise measles, mumps and rubella (MMR) coverage, pneumonia and seasonal flu vaccination for at risk groups.

Pneumonia vaccine is also applicable to babies, and children/adults with a long term condition who may need just a single one-off pneumococcal vaccination or vaccination every five years, depending on their underlying health problem.

The overuse of antibiotics in recent years means they’re becoming less effective and has led to the emergence of superbugs. This is referred to as antimicrobial resistance.

What we have achieved so far

A system-wide collaboration on flu has improved oversight of communication, vaccination and outbreak control.

The human papilloma virus (HPV) vaccination programme is being extended this year to boys aged 12 and 13.

We have set up a local antimicrobial resistance group. The group will focus on education and engagement with the public, healthcare workers and veterinarians.

What else we plan to do• • We will explore digital solutions to notify

and remind people that they are due to take part in an immunisation programme.

• • Support GPs to develop understanding of their local infection and vaccination profile.

• • Review provision of the service to support primary care and care homes.

• • We plan to do more advertising locally to encourage uptake.

Prioritise measles, mumps and rubella (MMR) coverage, pneumonia and flu vaccination for at risk groups



Planned care refers to any health care service that has been scheduled in advance. This includes outpatient consultations and treatments, as well as diagnostic tests.

By 2023/24Our vision for planned care is that you will be offered safe, high quality planned care, in the right place, at a time which is right for you. Central to this is our ethos that we value people’s time. We are also working to reduce greenhouse gas emissions as part of our commitment to tackling climate change and are looking to reduce the travel time for patients to access services.

We are working with colleagues in Devon through the Peninsula Clinical Services Strategy to develop ways of sharing specialist hospital facilities and equipment, and recruiting and retaining staff. This will help us to manage waiting times so they are kept as short as possible and deliver the best standards of care we can across the whole peninsula.

We will have centres of excellence for orthopaedics, ophthalmology, renal and cancer services. We expect some consultants to switch to provide expertise across a given geographical area rather than a site-based service, working with a multi-disciplinary team and upskilling knowledge so that more care and support is available as part of first line treatment.

Key priorities

Implement new models of community-based care to reduce waiting times

Improve outcomes for people with cancer

New, prevention focused pathways of care for musculoskeletal problems, cardiovascular disease, respiratory disease, diabetes, and falls and fragility fractures

Transforming outpatient care delivery utilsiing digital technology, relocating services and workforce redesign, and promoting self-care including follow ups that can be initiated by the person themselves

Implement the Peninsula cancer alliance plan for improving cancer outcomes

Ensure sufficient capacity is available for both planned and urgent surgery

Access to planned care Tests, outpatients and treatments

What else we plan to do• • Care and support will be more personal and

tailored to meet individual needs, to enable better self-management of condition/s.

• • Shorter waiting times for tests, outpatient appointments and treatment.

• • Wherever possible care will be delivered in community settings. This will mean you will have to travel less, usually only when a physical examination is necessary, and multiple appointments will be combined in one stop shops.

• • Greater use of artificial intelligence, tele-diagnosis, and assistive technologies to support diagnosis.

• • Other, more appropriate options to bed-based care.

• • More dedicated specialist locations for day case and diagnostic services, including for cancer.


Improving outcomes for people with cancer

We are a member of the Peninsula Cancer Alliance and our plans for cancer services have been developed with colleagues.

Priority actions will include work to deliver:

• • Earlier diagnosis of cancer.

• • An increased range of treatment services and access times.

• • A plan to consistently meet national waiting times standards.

What we have done already

We already offer personalised care for cancer, understanding the individual needs of people receiving treatment, ensuring they get support and signposting to various services and better communication at the end of each stage of treatment with the person’s GP.

One national development is for rapid diagnosis tests for people who have unexplained but concerning symptoms. We have been improving the guidance to GPs on what examinations or tests should be progressed in primary care to determine if a two week wait pathway can be appropriately selected.

Alliance projects in prostate, lung, colorectal and upper GI pathways are focused on supporting people from referral though diagnosis to decision to treatment, as this is where the majority of delays occur. The alliance will also support the introduction of one stop clinics for lung cancer and for prostate cancer.

There is a commitment by all providers to deliver a quicker, less invasive biopsy test under local anaesthetic. Prehabilitation enables people with cancer to prepare for treatment by promoting healthy behaviours and prescribing exercise, nutrition and psychological interventions where appropriate to a person’s needs.

Everyone diagnosed with cancer will receive personalised care from the point of diagnosis. This will include a recovery package comprising holistic needs assessment, care planning, treatment summaries and wellbeing support.

When people reach the point in their pathway of care where the initial phase of diagnosis and treatment is complete, they will be considered for either supported self-management or continuing professional-led management. We are now able to give people access to earlier supportive and palliative care within cancer care. This aims to:

• • Improve experience and quality of life.

• • Reduce overall healthcare costs (primarily through reduction in unplanned admissions to hospital).

• • Reduce the need for aggressive interventions in the last days or weeks of life.

We also have MySunrise App which was developed with the oncology team at Royal Cornwall Hospital, and supported by the Sunrise Appeal. It provides a complete up-to-date information guide and reference tool for people with cancer and their families. Locally we have seen approval of circa £31 million funding for the replacement of two of Royal Cornwall Hospital NHS Trust’s (RCHT) magnetic resonance imaging (MRI) scanners and the re-provision of the trust’s cancer ward (Lowen) into a new fit for purpose building.


Healthy minds

Our mental health and wellbeing is valued and considered equally important as physical health:

• • We are building good emotional health and wellbeing at all ages.

• • We are all taking action to reduce our risk of developing, or to support people to live well with, dementia.

• • Loneliness and isolation are reduced through meaningful social contact at all life stages.

We are transforming care and support:• • Our children and adolescent mental health

programme is improving outcomes for young people.

• • Our adult mental health programme is improving outcomes for adults and older adults.

Our new mental health strategy• • With help and feedback from the public,

service users and other interested parties, we have produced the new Cornwall and Isles of Scilly mental health strategy: Futures in Mind.

• • This emphasises prevention and the maintenance of healthy living, as well as the delivery of evidence-based and specialist care.

• • We are going to focus on those within the age range 0-25, putting in early support to prevent crisis, as well as helping older members of our communities who feel vulnerable and lonely.

• • We know that some people with long term conditions may require a longer period of treatment. We’ll help them own their personal recovery and enjoy a quality of life while receiving ongoing treatment.

• • If you’re a carer and are involved in supporting the choices of your family members, friends and loved ones, we’ll also help to look after any mental health needs you may have.

Building good emotional health and wellbeing at all ages



Improving children and young people’s mental healthChildren and young people’s mental health is overseen by the children and adolescent mental health programme. This is often referred to as CAMHS.

By 2023/24We will have invested in improving the CAMHS service, especially for perinatal mental health support and in schools, as well as the service available for those aged between 18 to 25.

Key priorities

Establish mental health support teams for community and schools based early help

Develop comprehensive support for children and young people aged 0-25; including access to psychological therapies

Improve crisis care

Improve pathways of care for children with neurodevelopmental need, eating disorders and vulnerable young people in and on the edge of care or the criminal justice system

What we have achieved so far In line with our ambition of moving services closer to the people who need them, we have opened Sowenna, our 12 bedded inpatient unit in Bodmin, to ensure children and young people who may have been cared for previously out of area are able to access services in Cornwall.

Headstart Kernow has improved mental health awareness within schools and communities, supporting staff to recognise and respond to emotional and mental health needs.

We now have 11 sites across Cornwall and the Isles of Scilly where youth information advice and counselling services are available. As well as Headstart’s awareness training, we have invested in a training scheme for specialists so that they can deliver CAMHS interventions in secondary schools and their communities.

We have also invested in the voluntary care sector capacity to provide options for children where there are high levels of demand, including investment in wellbeing practitioners.

To meet the rising demand, we are expanding our capacity to treat children and young people’s eating disorders. Cornwall Council has invested in a new model of trauma support for those aged 5-10 in or on the edge of care and we have increased our community and hospital crisis response to 8am to 8pm seven days a week.

What else we plan to do • • Money identified to provide a 24/7 crisis

response to help ensure that children and young people can be assessed and supported in a community setting.

• • Work with social care colleagues to look at other ways of managing a crisis response for children and young people with multiple and complex needs. We want to link the crisis response to the single point of contact service people may access via a 111 call.


We want everyone in Cornwall and the Isles of Scilly to enjoy the best possible emotional, mental health and wellbeing.

By 2023/24Our personalised, integrated team for community care will focus on the whole person, tackling mental health issues and the causes of them with the same energy and priority as people’s physical health needs.

When people need urgent care or are in crisis, we want to provide this 24/7 through NHS 111 and, as much as possible, by offering alternatives to traditional health with crisis resolution and home treatment teams. We will have further developed specialist provision in Cornwall and the Isles of Scilly, minimising the likelihood of anyone having to stay outside our area for treatment.

Our mental health services providers are working with other areas to improve the way in which people move from services such as adult secure services, and adult eating disorders to our local services.

Improving adult mental health

Key priorities

Increased access to evidence-based interventions

Urgent and crisis care

No one is sent out of Cornwall and the Isles of Scilly for treatment

We want to give you more information about prevention, and reduce health inequalities

Offer alternatives to traditional health with crisis resolution and home treatment teams

What else we plan to doWhen you need care, our aim is that it will be closer to home and more people will experience recovery with a reduced length of stay. You can expect to receive personalised care delivered by a joined-up team looking at your needs as a whole person.


Urgent and crisis careWhat we have achieved so far A successful crisis café pilot, run by Redruth-based charity Valued Lives, offers responsive out of hours care for people in distress at night and over the weekends.

We have an out of hours telephone line giving access to emotional and practical support via phone, text, email or web chat.

Mental health specialists are based in both our main hospital’s emergency departments. This ensures that anyone arriving experiencing a mental health crisis will receive appropriate support within four hours.

We want to avoid admissions wherever possible, as well as reducing the length of stay for people who are admitted to hospital and then supporting people to safely return home. This includes providing pre-crisis support, a dedicated therapeutic vehicle and peer support.

We will expand the use of personal health budgets to enable people to access the services they need to improve their health, including accessing complementary therapies, creative opportunities, intensive psychotherapy and hydrotherapy.

Towards Zero - more action on prevention of suicideWe have a higher rate of suicides than most other parts of England. This contributes to our health inequalities in life expectancy, particularly amongst men.

We want to maximise the contribution of long term, population-wide prevention in reducing suicide. We hold events for ‘Towards Zero’ – see www.cornwall.gov.uk - so please get involved.

We all have a role to help destigmatise mental ill heath in the general population and to raise awareness of suicide prevention in communities. It will only be by the combination of all activities that we are likely to see a reduction in our rates.

Key priorities

We are prioritising the physical health of people with a serious mental illness and history of suicide prevention. Another group being supported is rough sleepers

All agencies are targeting support for those with complex needs, including people who are homeless and those with drug and alcohol problems. This includes providing community outreach support to improve physical health, mental health and a range of long term conditions including cognitive impairment.

We are developing short-term supportive accommodation, helping people to manage domestic tasks, manage finances and budgeting, access employment, education and training, and attend health appointments to increase social inclusion

We also want to help them to improve their emotional wellbeing, and how they manage their physical and mental health.

http://www.cornwall.gov.uk


We want to improve our understanding of the needs of people with learning disabilities and autism and work together to improve their health and wellbeing.

We know that people with learning disabilities are less likely to comply with health checks and medication regimes. We already have a team working with primary care to encourage the uptake of annual health checks for individuals with learning disabilities. Regular medication reviews also take place to reduce and cease the prescription of multiple psychotropic medications.

What else we plan to do• • Run a training programme so that autism and

learning disability awareness is raised across all the workforce.

• • Reduce the levels of inpatient care for individuals with autism or learning disabilities through alternative services.

• • Develop the provider market for individuals with complex needs, including complex respite care.

• • Continue to develop the parent and carer and self-advocate group so that they have their voice heard.

• • Increase investment in intensive, crisis and forensic community support to enable more people to receive personalised care in the community, closer to home.

• • Introduce a new step down, step up service, alongside 24-hour crisis support, to prevent unnecessary hospital admission.

• • Restrict the use of seclusion, long term segregation and restraint for all people in inpatient settings, particularly for children and young people.

• • Review all hospital placements, focusing on early discharge and the prevention of unnecessary admission.

Improving services for people with learning disabilities and/or autism

SEND - for children and young peopleOur plans for children with neuro-developmental need (including autism) and learning disabilities sit within our whole system special educational needs and disability (SEND) strategy which aims to:

• • Have high aspirations for all children and young people.

• • Ensure that the achievement gap between those with SEND and their peers is narrowed.

• • Include the majority of children and young people in their local early years’ settings, schools and colleges.

What we have achieved so farWe have developed a wellbeing and autism wheel with advice, guidance and links to support services that parents can access online.

Raise awareness of autism and learning disabilities across all workforces

What else we plan to doWe want to reduce the wait times for diagnosis for children and young people and ensure that the whole education, health and care system works together to provide them with the right support at the right time.


Include children in their local early years’ settings



Fit for the future

The NHS Long Term Plan is focusing on making sure that the NHS is fit for purpose in the 21st century as much of the way we currently do things dates back to the 20th century when the NHS was first created. It sets out five major practical changes to the NHS service which must be delivered over the life of the plan. These are:

• • Boost out-of-hospital care, and finally dissolve the historic divide between primary and community health services.

• • Redesign and reduce pressure on emergency hospital services.

• • Give people more control over their own health, and more personalised care when they need it.

• • Mainstream digitally enabled primary and outpatient care.

• • Increasingly focus on population health and local partnerships with local authority-funded services, through our new integrated care systems.

Local plansWhile the national plan focuses on the NHS, locally we are working together across health and care and with other partners to deliver our plans. Some of this work is highlighted in earlier sections of the report.

The next sections describe our approach to providing:

• • Personalised care – your choice, taking control.

• • Joined up care in the community – especially our new Embrace Care programme.

• • Access to urgent and emergency care when you need it.

• • We are also working on ways to digitally transform our service model and establish ourselves as a mature integrated care system.

Joined up care in the community



Personalised care your choice; taking controlWith instant access to many services now available through the internet, we all expect to have choice and control in our lives.

Personalised care gives us the same choice and control over our mental and physical health that we have come to expect in every other aspect of our life.

Evidence shows that we will have better experiences and improved health and wellbeing if we can actively shape our own care and support.

Personalised care supports us to make decisions about managing our health so we can live the life we want to live based on what matters to us, working alongside clinical information from the professionals who support us.

One way of providing people with more choice and control is through social prescribing. Social prescribing connects people with a wide range of community-based activities and support. Based on “what matters to me” conversations between a social prescribing link worker and the person they are working with, a personalised care and support plan is developed which might include attendance at a local walking club for example.

By 2023/24We want personalised care with social prescribing to be your first expectation, helping you to manage your own health and wellbeing, even if you have a long term condition.

What we have achieved so far • • Encouraging more individuals and carers to

maintain their independence through the use of personalised plans and for people to use their own strengths and networks to achieve individualised solutions.

• • Putting more people at the centre of the decision making process and helping them purchase support through a personal budget or direct payment.

• • Giving supported access to good information and advice on universal services, early intervention, prevention, re-ablement, community-based services and specialist resources.

Provide compassionate support to people at the end of their lives

What else we plan to do • • Look at our whole population by primary

care network area and identify those who would benefit the most from being the first people to have access to a combined health and care personalised budget.

• • Ensure every primary care network has a social prescribing link worker embedded within their multi-disciplinary team.

• • Provide compassionate support to people at the end of their lives. This can be provided through a network of support from family, friends, neighbours, volunteers and trained staff.


Joined up care in the community

By 2023/24You will have better access to local health and care support in your local community. This will reduce the need to attend the emergency departments in Truro, Barnstaple and Plymouth.

We will be offering more short term interventions at home. Older people will only receive care in an acute hospital bed when clinically necessary and for as short a time as clinically appropriate

The care market will have been developed to support the timely discharge of people from hospital.

We will help you to maintain your independence at home for longer so you or your family are less likely to be admitted to long term care.

Proactive care and support in the community for physical and mental health will be provided by integrated teams of health and care practitioners working with primary care networks and extended multi-specialty care teams that also include voluntary sector partners.

Our primary care networks will support seamless care across primary care and community health and care services.

Primary care networks will lead population health management in their area, increasing action on prevention and reducing health inequalities for their population.

Networking will have stabilised general practice and enabled a closer working relationship with community and secondary care clinicians offering opportunities to integrate some elements of secondary care into place-based care and support.

Key priorities

Further development of primary care networks

Implementation of the seven primary care network specifications

Developing multi-specialty working and integrated teams (Embrace Care)

Improving the responsiveness of community health crisis response services (Embrace Care).

Key actions • • Recruitment of clinical pharmacists and

implementation of structured medication reviews.

• • Actions to deliver earlier diagnosis of cancer.

• • Enhanced health in care homes.

• • Further development of social prescribing.

• • Continue to roll out the Prevent, Detect and Perfect programme across primary care networks for earlier detection and management of cardiovascular disease.

• • Implement the Embrace Care programme.


Embrace Care programme - improving our care and support for older people

We are committed to improving the health and wellbeing of our population. To support this one of the first areas to have a detailed review has been older people’s services.

In Autumn 2019 we launched Embrace Care, a new programme designed to improve how we care for and support older people.

Health and care leaders have pledged to give this programme top priority and ensure it gets the support it needs from each organisation.

What we have achieved so farThe programme began with a detailed examination of the opportunities for improving outcomes for older people. This involved conversations with over 320 people and looking at lots of individual people’s cases where emergency services have been used and they have been admitted to one of our acute hospitals. We have analysed over one million lines of data.

We found that:

• • One percent of 65+ admissions reviewed were documented as a less than ideal outcome for that individual.

• • 57 percent of the cases reviewed were felt to be ideal, whether that was an admission, a discharge decision or community provision. Therefore 43 percent were not.

• • Only 56 percent of people in residential or nursing placements were felt to be in the best place for their circumstances.

• • Being discharged from the acute hospital into another short term setting (care home or community hospital), is the ideal outcome for only half of the people.

• • 22 percent of our acute beds and 67 percent of our community beds are occupied by people who would be better supported elsewhere.

What we are doing now• • Work is now taking place to redesign services in

response to these findings. We will be involving colleagues from across the system and the people who use services to shape this work and design the detail. This will help ensure they are confident it will support people and their families to remain as independent as possible.

We’ve already started on the following design areas:

1 Making sure the right people attend the emergency department and are admitted.

2 Reducing the time people have to spend in an acute hospital.

3 Supporting people at home in the community.

4 Ensuring we have enough home care support to allow people to be at home.

We know that our services will only be as good as the staff that provide the support. We realise that the changes are big and our staff are going to need time and support to learn new skills and new ways of working.

What else we plan to do • • Where people do attend our emergency

departments, we will avoid them being admitted if they can be cared for at home with support.

• • We will learn from patient experiences to design alternative services to help keep people out of hospital, wherever we can.

• • If you do get admitted, we’ll be encouraging more effective ward rounds in all of our hospitals to minimise delay and getting you discharged with support from the community, if required.


The changing role of community hospitals

We expect that, over time, this new way of working will change the way we use our community facilities.

What we have achieved so farWe have already started work with local communities and practitioners to develop joined up community care in three areas where beds in community hospitals have been temporarily closed for over two years: Saltash, Fowey and St Ives.

We’re making sure that we use lots of different ways to have these conversations. These include local workshops, public drop-in sessions, attendance at pre-existing meetings and groups such as the practice participation groups, League of Friends, community network panels, town and parish council and meetings with our workforce.

What if you live on the Isles of Scilly?The Isles of Scilly is supported by the west Cornwall integrated care area.

The Isles of Scilly health and social care integration programme is developing a new model of joined up health and care for the islands with the ultimate aim of bringing together emergency medicine, general practice, dentistry and adult social care services within a single health and care campus

How you can get involvedWe hope that people will get involved with our assessments of what influences health and care locally and drives up demand for services.

We want to better understand local needs and priorities and involve people and health and care team members to help design the future model of community services and the role our community hospitals could play.



Access to urgent and emergency care but only when you need itThe focus of our plan is about improving our health, increasing action on prevention and delivering a new model of out of hospital care. These changes will reduce our reliance on urgent and emergency care, reducing hospital attendances and admissions.

For those occasions when we do have a need for care which is urgent, we are working to provide more access to urgent care in our local communities.

By 2023/24You can expect:

• • Increased access to same day urgent care and support.

• • Extra services in community-based urgent care settings.

• • Services which enable same day ambulatory emergency care.

• • A rapid community response for people in crisis.

Key priorities

1 GP surgery-based minor injury services

2 Minor injury units

3 Urgent treatment centres

Each of these has staff and facilities to deal with a predefined set of urgent conditions. Their capacity is based on the current usage and will be extended to cover estimated future demand.

We have been piloting a new approach to support people who make greatest use of our emergency and acute services.

By understanding and working through underlying social issues we have been able to change the behaviour of the most frequent users of the 999 ambulance service, out of hours GP service and emergency departments.

This has helped people address the problems that were driving their behaviour and helped reduce pressure on our health and care system. This pilot will be extended to March 2021

Of course when it’s the right thing to do, the ambulance service will continue to take people to the nearest urgent treatment centre or hospital.

Create an improved network of urgent treatment centres (UTC) and minor injury services (MI)

Support people who are high intensity users of urgent and emergency care services with direct case management

Implement a falls rapid response service to get elderly frail people who fall without injury back on their feet, with access to ongoing support without the need to transfer to an acute hospital

What is available in the communityThere is already a wide range of services which are providing care in local communities. These include NHS 111, GP practices, GP out of hours services, pharmacies, emergency dental services and paramedics.

There are three additional types of facility planned to deal with urgent care in the community:


Who has influenced these changes? We have held extensive conversations with members of the public and frontline practitioners through a number of place-based engagement events. We have used this feedback to shape the plan for urgent and emergency care.

For people suffering a stroke• • We are looking to increase the number of

dedicated stroke beds at Royal Cornwall Hospital and improve the support for people who have had a stroke once they leave hospital.

• • We are working with our colleagues in Devon to improve stroke care support for people living in the north and east of the county.

• • Some strokes can be treated by an emergency procedure called a thrombectomy. We’ll be looking to increase the proportion of people who receive a thrombectomy after a stroke.

• • We will be developing pathology and imaging networks for stroke care to improve the accuracy and turnaround times on tests and scans.

• • GP practices will be able to book appointments.

See our website cioshealthandcare.nhs.uk for a map that outlines the urgent care provision.

What else we plan to do • • We will be running a public campaign to

increase uptake of pneumonia vaccination for people at risk over the age of 65.

• • As much as possible we will have a single point of access for joined up urgent care and discharge from hospital for people, their carers and health professionals.

• • A review of the urgent treatment centre provision across Cornwall and the Isles of Scilly is planned in 2020/21 to ensure services are suitably located.

https://cioshealthandcare.nhs.uk/


Keeping a focus on quality

We know that we must continue to concentrate on the quality of services across our system. Quality covers three key areas:

1 Safety

2 Effectiveness

3 Positive experience of care

SafetyThe national Patient Safety Strategy was published in summer 2019. In response, as a system we will:

• • Work across health and care to understand how best to implement new expectations for safety incidents response, including new safety investigation standards.

• • Implement the new safety incident management system for reporting.

• • Establish hospital-based medical examiner scrutiny of all deaths in acute hospitals by April 2020, and all deaths by April 2021.

Following a change in the law last year, 2020 will see Liberty Protection Safeguards (LPS) replacing the Deprivation of Liberty Safeguards (DoLS) for people over the age of 16. As a system we will work across health and care to carefully consider how we, as ‘responsible bodies’, will achieve the changes to the law to maintain vulnerable people’s safety.

EffectivenessOften referred to as clinical effectiveness, this is about improving the total experience of health and care and is an essential part of improving and assuring quality. The aim of clinical effectiveness is to use evidence-based approaches to improve the outcomes for patients from clinical practice and service delivery.

Positive experience of care and supportAs well as being safe and effective, having a good experience of care, treatment and support is an essential part of an excellent health and care service.

We will use the experience improvement framework to promote senior-level discussion of the factors such as leadership and culture that underpin an ability to improve the experience of people using our services.

We will use your feedback from using services to drive quality improvement and learning.

How you can get involvedWe will continue to improve the involvement of people in all our safety initiatives. Quality improvement partner panels give a close working relationship between health professionals and the local community. You can read more about how these panels work and how you can join at www.swahsn.com/quipps

Improve the total experience of health and care

http://www.swahsn.com/quipps


Developing our people, going digital, research and innovation, building And our financesKey to our success in delivering this plan for the population of Cornwall and the Isles of Scilly will be making demonstrable progress in our ambitious underpinning strategies for workforce, digital and our estate wrapped around a sustainable financial position for the system by 2023/24.

Digital technology with research and innovation will underpin system transformation plans over the next five years and it is expected that the existing model of care will look markedly different in the future.

Where necessary, we want to have high quality, modern, accessible and welcoming buildings to enable the joined up delivery of modern health and care services. We have the opportunity through the recently announced HIP 2 funding to redevelop core parts of our health estates infrastructure whilst dealing with our significant backlog maintenance challenges.

Local plans• • We will continue to increase our workforce,

training and recruiting more professionals and providing more routes into work such as apprenticeships. We will also make our health and care system a better place to work, so more staff remain with us and feel able to make better use of their skills and experience for patients.

• • Ensure the system can ultimately deliver the required level of savings and improved productivity over the next four years whilst ensuring these savings and transformation programmes do not materially impact on the levels of quality and safety for care across our providers.

We want high quality, modern and welcoming buildings



Developing our people

All our health and care organisations are working together to attract and recruit, develop and transform, and retain and support our teams of people so that we grow our skills and strengths.

We are committed to:

• • Transforming our approach to workforce development.

• • Transforming services through workforce redesign.

By 2023/24All communities in Cornwall and the Isles of Scilly will receive high quality, safe and effective care from our valued teams of people. We are developing new roles aimed at producing a more diverse, versatile, and resilient and fulfilled workforce.

Our health and care academy and primary care training hub will be leading the way nationally on how we plan and deliver a more varied workforce through our shared developments and progression.

People will be choosing to come to work and train with us through our tailored apprenticeships.

We will focus on ensuring that our teams are confident to use the latest technologies, releasing more time to care.

Key priorities

Addressing urgent gaps in our teams; developing new types of jobs with varied roles

Focusing our collaborative health and care academy on enabling local people to access careers in health and care

Using the primary care training hub to deliver primary care workforce training requirements

Organisational, system and leadership development

Developing system wide workforce plans that incorporate new roles and different ways of working

Health, wellbeing and resilience of our workforce and promoting flexible working opportunities

Improving retention of our workforce

Making Cornwall and the Isles of Scilly a great place to work in health

and care


Changes to attract new peopleWe have gaps in almost all our staff roles, especially nurses, hospital doctors, GPs and care workers.

We are developing new jobs with varied responsibilities, where expertise can be shared across the health and care sector, supporting recruitment and widening post holders experience and skills.

We are developing joint training programmes for pharmacy assistants and technicians to develop our own local supply of pharmacy support workers.

One central resource for all staffAll health and care providers are working on a shared workforce bank and have ambitions to undertake shared joint recruitment campaigns. There is also an opportunity to share roles across our system to develop a shared workforce.

Apprenticeships, work experience and accreditationWe continued to increase the number of apprenticeships during 2019 with investment especially in the care sector.

Recognising that we need to attract local talent, we are looking to encourage young people into health and care through work experience, internships and apprenticeships, covering the whole range of roles across health and care so we can grow our own workforce based on future skills requirements.

We have internships within care homes for the over 17s in advanced development and for roll out early in 2020.

We are working with the private sector to explore the development of a registration scheme for care workers to include an accredited transferable care certificate.

Cornwall and Isles of Scilly health and care academyWe have established the Cornwall and the Isles of Scilly Health and Care Academy to take an overview and approach to securing and developing our future workforce.

We know that GPs and their teams are under growing pressure, especially with recruitment. Through the Cornwall and Isles of Scilly primary care training hub, our local GP provider, Kernow Health CIC, is offering training to provide wider skills and encourage the existing and new workforce to work differently.

Our GP primary care networks (groups of practices) are being encouraged to have five new roles. These are:

1 Clinical pharmacists

2 First contact physiotherapists

3 Paramedics

4 Social prescribers

5 GP assistants

In order to maximise the available workforce across general practice, e-consultation and triage is available to a growing proportion of people.


Equality and diversity We know that equality is not about treating everyone the same; that’s why our aim is to ensure that access to opportunities are available to all by taking account of people’s differing needs and capabilities.

Diversity for us is about recognising and valuing differences through inclusion, regardless of age, disability, gender, racial origin, religion, belief, sexual orientation, commitments outside of work, part-time or shift work, language, union activity, HIV status.

We are committed to reducing the health inequalities that affect our local communities and ensuring that everyone has access to the health care they need, while treating people with respect, dignity and fairness.

We are committed to providing care services and employment to our community with an increasing variety of backgrounds, and ensuring a workforce that is representative of the communities we serve.

Since the Workforce Race Equality Standard (WRES) was introduced in 2015, we have been working across all our organisations to comply with this important standard.

Evidence shows that by getting this programme of work right our workforce will deliver high quality care, giving increased satisfaction and better safety.

Harnessing voluntary and community sector supportWe recognise the importance of the voluntary and community sector in delivering our exciting plans. By working alongside health and care colleagues they significantly increase capacity and provide additional skills and knowledge.

We need to do more work to understand the network of smaller, community-based organisations in each community. We can then use this information to explore how we can support them to continue their vital work.

Developing new rolesThe introduction of new and emerging roles is vital. We can no longer replace staff on a like for like basis and so developing and embedding new and hybrid roles is a key element of transforming our workforce.

We will have a combined team of NHS, social care and volunteer staff who deliver tasks on the basis of available skills rather than traditional roles.

The key building block at a place (local level) are primary care networks and GP practices. Here we will have multi-professional teams including GPs, nurse practitioners, case managers, paramedics, health care assistants, care workers, volunteers, social prescribing workers, mental health practitioners and community pharmacists.

Improving the health and wellbeing of our workforce We recognise the importance of staff health and wellbeing and are investing in a wide range of initiatives to support and enhance staff wellbeing.These are aimed at supporting our staff to feel happy at work and ensuring they can access facilities, tools and training to improve their mental and physical wellbeing.

Examples include:

• • Providing confidential counselling.

• • Mental health first aid.

• • Stress and resilience and mindfulness workshops.

• • Access to workshops promoting financial wellbeing, healthy weight, physical activity.

• • Promoting health campaigns throughout the year (eg Fizz free February and hydration challenge).

Within Cornwall Council there has been a concerted effort to reduce sickness absence in adult social care teams.

The council (as well as the NHS) will be supporting free flu jabs for all staff.


Why research and innovation is so important

Why it is importantResearch and innovation is a high priority for our system as it:

• • Gives us new knowledge about how to treat and care for people with different health conditions.

• • Ensures that we do not become professionally isolated as a result of our geography.

• • Gives access to new diagnostics and treatments enabling more proactive care and less invasive interventions becoming available as day procedures.

• • Transforms access to services ie physical distance will only be part of the picture with virtual reality and artificial intelligence revolutionising delivery.

• • Provides innovations such as lab in a bag which are already allowing for more testing in community settings.

Recent evidence has found that innovative, research active organisations deliver better outcomes for people and that there is a significant correlation between clinical trials activity and improved Care Quality Commission ratings.

Research organisations are also more able to attract high quality staff and achieve higher rates of staff retention.

Being involved with research exposes staff early to new ways of working and ensures they are trained in providing care in enhanced ways.

Expected impact:

• • More people will take part in research, improving outcomes for people using services.

• • Enhanced skills across our workforce.

Technological innovationWith support from the South West Academic Health Science Network, we recently held a Cornwall and Isles of Scilly expo event where clinicians and industry were invited to showcase the use of latest technology in health and care.

This was attended by over 150 staff working in health and care across Cornwall and the Isles of Scilly where it provided a focus on new technologies and practice, both those in use currently and ideas for the future including robotic surgery, use of AI, virtual, apps etc helping to shape future priorities for our clinical strategy

We intend to seize this opportunity to meet the increasing needs of our population by transforming provision of care through digital innovation, through innovation in medicines and diagnostics combined with the development of new skills and roles.

Transform provision of care through digital innovation


Our buildings and estates

Our ambitionWe want to have high quality, modern, accessible and welcoming buildings to enable the joined up delivery of modern health and care services. This will increase efficiency, improve quality of care and help meet the expectations of people using our services.

By 2023/24By developing our current buildings, we hope to be well on our way to:

• • Improving people’s experience of care and support.

• • Enabling greater integrated working between individual care providers.

• • Progressing critical developments across the Royal Cornwall Hospitals NHS Trust sites.

• • Maximising effective utilisation (clinical and non-clinical) of our NHS estate (and where possible the public sector portfolio).

Key challenges• • Our current building estate is a patchwork of

historic and bespoke buildings built in a range of different eras across multiple sites and rural communities.

• • Funding needed for backlog maintenance of existing buildings.

Key priorities

Ensuring the development of our buildings support the new model of locally designed place-based care

Accessing funding for urgent investment in tackling backlog maintenance to sustain existing facilities and services

Enhancing sites for planned care activity including diagnostic provision and improving outpatient facilities

What we have achieved so far • • Opened a 12 bed CAMHS tier four unit

(Sowenna) bringing specialist mental health care into Cornwall and the Isles of Scilly.

• • Opened a new state of the art £6 million medical centre in Penzance (St Clare) bringing together three GP practices under one roof.

Obtained funding for:

• • A new oncology unit and improved MRI re-provision on the Royal Cornwall Hospital site (£31.3 million).

• • Improvements in other Royal Cornwall Hospital sites at West Cornwall and St Michael’s hospitals (£9.1 million).

• • A £99.9 million state of the art women’s and children’s centre at Royal Cornwall Hospital.

Responding to the climate emergencyThe NHS contributes around five percent of all UK greenhouse gas emissions. We need to urgently respond by reducing greenhouse gas emissions by using resources more efficiently in all aspects of the local NHS.

This will require action in the areas of energy, travel, waste, procurement, pharmaceuticals, buildings and land use. We aim to maximise the health co-benefits of interventions to reduce greenhouse gases, particularly in terms of active travel, healthier diets and air quality.


Our finances

National and local resource pictureIn January 2019, following publication of the NHS Long Term Plan, NHS England and Improvement set out the funding available to support the development of the national health system for the next decade which included publishing a five-year financial settlement.

NHS England’s five-year revenue funding settlement, averages 3.4 percent a year in real terms and reaching £20.5 billion extra a year by 2023/24.

CCG allocations over planning horizonNHS Kernow is receiving a growth in resources of between 4.0 percent and 4.3 percent per annum over the next 4 years. Although this is slightly ahead of the England average growth rate, it fails to reduce the existing gap between local funding and the measured need in the county.

NHS Kernow is assessed as being underfunded by £14 million in 2019/20 (1.7 percent), and this grows to a shortfall of £29.6 million (2.98 percent) by 2023/24.

This distance from target position adds to the challenge the system has in moving to a sustainable financial position by 2023/24 which will need to be addressed through our service prioritisation redesign and transformation plans for the system across each year.

The system financial strategyThe NHS system has an agreed strategic approach to achieving financial sustainability refreshed in the context of the long term plan. The system recognises and supports the requirement to fully meet the requirement to achieve a sustainable and balanced financial position by 2023/24.

An overriding consideration however is that this must be delivered within the context of a system maintaining safe services especially as Royal Cornwall Hospitals NHS Trust remains in quality special measures at this time.

Moving to a mainly financially focused plan which would be necessary to achieve the financial improvement trajectories currently set by NHS England and improvement could materially affect both the performance and quality improvement journey the system has set.

On a broader basis within the system, national funding issues facing Cornwall Council and adult social care services together with the age profile of the population in Cornwall creates further financial challenges for the health and care system over the life of the long term plan.

Achieving a sustainable financial position The system financial framework Working within our financial framework, we have agreed to work as one system to achieve a clinically and financially sustainable health and care system that will improve the health and wellbeing of the population and address quality and safety issues.

As the system develops towards being recognised as an integrated care system, there is agreement to deliver a single system operating plan across health to enable improved management of our collective resources.

We soon hope to extend this with Cornwall Council and the Council of the Isles of Scilly for care services.


System wide efficiencies and transformation opportunities

Senior leadership within the system supported by organisational boards are focused on maintaining the improvement journey demonstrated over the last two years.

Approach to delivering savings The focus will move towards overarching system wide transformational change. In year delivery remains critical, to support and achieve financial targets including the need to turn one off savings into recurrent savings to reduce financial risk.

Our programme of transformationOur plans will require investment in our new model of care, focusing on prevention, out of hospital care and digital technology. Our future financial sustainability will only be achieved by working collaboratively, with a focus on overall cost reduction across Cornwall and the Isles of Scilly.

We are reorganising the way of working together rather than in organisational silos, developing aligned planning processes and investment decisions.

This has been set in an NHS financial framework agreement which has now been in place for over two years. Our finance leaders review in-year financial performance and risk management to maximise the overall system financial position.

We have strengthened links with social care and improved our joint planning processes with our local authorities. We will continue to work with local authorities to focus on prevention, and invest in primary and community services, and where appropriate avoid costly hospital admissions as well as focus on timely discharge from hospital.

We will be working with social care to target investment where we will get best collective value and outcomes for our population.

We will continue to utilise internal and external benchmark data to understand our opportunities for improvement and target top quartile efficiency and productivity transforming services to improve people’s experience and outcomes, and at the same time reducing overall system costs and avoiding future cost pressures from unmitigated growth in demand for services.

The five high level system wide efficiency programmesThe efficiency programme is prioritised around five key themes which will be further developed through the annual operating plan process. These are:

Within these areas we are thinking differently and focusing on reducing waste, increasing efficiencies and reducing premium costs.

Pay-related savings focus on staff cost reduction through service redesign, productivity and efficiency, and reducing our reliance on agency staff. The programmes contain plans for significant transformation, productivity and efficiency schemes to achieve the level of savings that will be required from the pay budget.

1 Out of hospital care for the over-65 population (Embrace Care)

2 Addressing unwarranted variation

3 Transformational savings (system wide programmes across pathways of care)

4 Transactional productivity savings and cost efficiencies

5 Productivity opportunity through enabling work streams eg workforce, digital and estates


Non-pay schemes continue to be developed using the following themes: Our current plans

Whilst the system financial position is forecast to improve significantly by 2023/24, further work is required to finalise operational and financial plans to ensure the system can ultimately commit to and deliver the required level of savings to achieve a balanced financial position by 2023/24 which is both a national requirement and local ambition.

This work will be taken forward through the operational planning process for 2020/21 and includes determining the level of savings required to meet, in particular, the 2020/21 financial trajectory and which would not materially impact on the levels of safety for care across the provider sector, a position that would be unacceptable to the system.

Reduce waste, increase efficiencies and reduce premium costs


Demand: How can we use less? How can we standardise products?

Contracts: How can we get better deals, track the contracts we have and get the best price?

Inventory management: How we manage our stock. Should we buy in bulk or ‘just in time’?

Planning and analytics: How can we use information to help us reduce cost?


Joining up as an integrated care systemThe long term plan reiterates the requirement for health and care partners to join up and become an integrated care system during 2020/21. We are one of 44 similar groupings across the country.

Health and care across Cornwall and the Isles of Scilly has a relatively uncomplicated landscape with one clinical commissioning group, one acute trust based in the county, one mental health/community services trust and two councils, supported by a vibrant third sector. We have 59 GP practices organised into primary care networks within three integrated care areas. There is also a compact between NHS Kernow, the Local Medical Committee and Kernow Health CIC, providing a route to a single voice for the practices.

We have close working links with providers outside of the Cornwall and Isles of Scilly footprint, including University Hospitals Plymouth NHS Trust (Derriford hospital) and Northern Devon Healthcare NHS Trust (Barnstaple hospital) who provide emergency and planned services to people living in north and east Cornwall and specialist services to everyone in Cornwall and the Isles of Scilly. We work closely with the South Western Ambulance Service.

We will be building on these strong relationships to ensure that everyone has access to the highest quality health and care, and are supported to start well, live well and age well.

Over the life of this plan, we expect people to increasingly experience joined up care, delivered in an integrated and seamless way by a workforce who are part of a shared Cornwall and Isles of Scilly health and care team, working flexibly across and between organisations. Much of this transformation can be delivered by a different way of working enabling the network of providers to work more closely together.

Whilst each organisation will retain their statutory responsibilities, in line with the current legislative requirements, increasingly solutions that are in the best interests of local people are being developed at system level and being taken back through individual organisations rather than looking at things through organisational lenses.

We have appointed an independent chair who is supporting us in working collectively, and maturing our system governance arrangements so that we plan and deliver together, and hold each other to account for delivery.

Through the system working undertaken to date, significant progress has already been made, with a strong emphasis on prioritising those actions that move us towards the delivery of high quality, timely, integrated care by frontline staff.

A cohesive system operational plan was developed for 2019/20, shaped by strategic commissioning priorities, and underpinned by a single set of system strategic objectives adopted by all key partners. This provided a firm foundation on which we have built this longer term plan.

Everyone has access to the highest quality health and care

Our local systemBy working together, with our vibrant communities, we are better able to ensure the people of Cornwall and the Isles of Scilly stay as healthy as possible - starting well, living well and ageing well.

Together we are transforming the ways in which we plan and deliver care with more emphasis on better supporting people to help themselves and each other to stay independent and well.

We will provide joined up, high quality health and care services that we can all be proud to deliver, with more services delivered in people’s homes or in their local communities. This will also make the very best use of the funds available.

February 2020

If you would like this information in another format or language please contact: FREEPOST RTES-UZXK-SHBG Cornwall and Isles of Scilly Health and Care Partnership, Sedgemoor Centre, Priory Road, St Austell PL25 5ASTelephone: 01726 627800 Email: [email protected] cioshealthandcare.nhs.uk

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https://cioshealthandcare.nhs.uk/