STP in Action: The Dorset Experience

Article by NHS England South

Very few Sustainability and Transformation Partnership (STP) areas are as well advanced as Dorset’s, which is already out to consultation on changes to acute, mental health and community services. Dorset’s thinking on possible new models of care pre-dated the idea of STPs. “We instigated a clinical services review almost two and a half years ago,” says Tim Goodson, Chief Officer of the Dorset Clinical Commissioning Group (CCG) and STP lead in Dorset.

This review led to proposals to change the acute hospital system in Poole and Bournemouth. If accepted, one site – Poole Hospitals – will become largely a planned care centre with an urgent care centre, while the other – the Royal Bournemouth Hospital – will be designated a major emergency hospital.

The smaller Dorset County Hospital – some distance from the other two – could also work with Yeovil Hospital where one may lose consultant-led maternity and children’s inpatient services. Some services would also need to be networked with the main hospital in the county.

The area’s community services are also likely to face changes, with services focused around community hubs. Some of these will be at existing community hospitals but some other hospitals will lose beds and some will close entirely. The plans, which are out for consultation, envisage moving from 13 community hospitals to 12 hubs, of which seven would have beds. Other proposals could see the number of mental health inpatient units reduced from three to two.

Staff and public engagement

The other advantage Dorset has is one CCG covering the STP area and relationships are well developed.

But there the advantages stop. Introducing radical changes is as difficult in Dorset as anywhere else, with the need to sell hard proposals to staff, public and politicians. GP and locality lead Karen Kirkham emphasises the work which has been done to develop the plans in conjunction with them.

”Engage engage, engage and then go back and do it again. We are trying to keep harnessing that senior clinician and management input. There has been massive clinician involvement,” she says.

Five clinical delivery groups were set up, covering different areas of care, which were clinically led but with membership from clinical and public stakeholder groups.

Clinical champions who saw the benefits of change were crucial and there was widespread engagement of clinicians through well-attended meetings. Even a meeting about the use of technology attracted more than 75 people.

“There will be people who don’t know about this but we consistently had well over 100 senior clinicians, not just doctors, engaging monthly over a period of 18 months,” says Dr Kirkham, who is also assistant Clinical Chair of Dorset CCG.

“We are asking people to work potentially in a very different way… we need to invest in our workforce to bring them with us.”

Consultation with the public has included questionnaires, drop in events and ‘pop ups’ as well as wide distribution of the consultation document.

But there was a sense that things had to change. The community hospitals, although much loved, were struggling with recruitment, had beds in the wrong locations – which were not always used and tended to have small wards, which increased staffing costs.

Difficult conversations

The challenge to balance the day job with transformation is acknowledged.

Mr Goodson also sees an emerging problem in potential funds for transformation being swallowed up by deficits across the country, making it harder to drive change forward. The risk is plans come to “a grinding halt”, he says (the changes to acute trusts will require capital funding – likely to be at least £147m). Political support for radical and controversial change is also important.

A decision on the way ahead is expected in the autumn. “Other areas should not be afraid to have difficult conversations,” says Dr Kirkham. “But it is a difficult journey.”

Take a look at Dorset’s full STP plan, Our Dorset.