Over the past few months we’ve been listening to your comments on some of our plans. We’ve captured some of your questions here, and tried to answer them. We’ll be adding new questions and answers as we progress with the consultation.

If you have any more questions, you can email us on: stockportccg.communications@nhs.net and we’ll make sure they’re added to the list on this page.

Thanks for being involved.

Resources for Health & Social Care:

Is Stockport Together just a way of managing government cuts?

No, Stockport Together was an idea which was conceived by the leaders of Stockport’s health and social care organisations to in part avoid making cuts but more importantly to improve outcomes by working together differently.

It is true that all public sector budgets are under pressure. In the next four years we are predicting that Health& Social Care spending in Stockport when taken together will rise slightly but not as fast as advances in medicines, inflation and the pressures that come from the success of us all living longer.

We believe our proposals are the right ones irrelevant of how much funding we have available to us. Our doctors, nurses and other professionals developed and advocate our proposals. We believe it always right to work with people and communities to live healthier lives; identify and address problems with individual’s physical and mental health earlier; care for people using modern medicine and technology in their own homes thus helping them to remain independent longer; and supporting them to spend no more time in hospital than absolutely necessary. This is what we propose.

Nothing in the current proposals advocates cutting any services. All the services that are currently in place will still be there and in some cases we are proposing additional services such as the Falls Service. In some cases we propose bringing services together to reduce fragmentation such as reducing 21 intermediate tier services from 21 to 6, but in that case there is additional funding going in. In other areas we hope we will need less bed based care as people stay healthy and independent longer and we meet needs quickly as they arise. But when you need a service or a bed it will be there for you.

Whatever the resources that are made available through national policy our responsibility is to find the best way to distribute these in order to provide the best health and care outcomes possible for the population. We believe coming together and delivering these joint proposals is the way to deliver that responsibility.

How do we know Stockport won’t have money cut?

How much money the local NHS in Stockport receives is a matter of national policy. We along with our colleagues across the public sector make our case; but our principle task is to make sure the most vulnerable in our society are cared for in the best way, with the money we’ve receive and these proposals set out our approach to that.

You’re making £156million worth of cuts. You have not got the money to implement these changes until you close beds and sell off part of the hospital.

If we continue to run services as we do now and if we are accurate in our planning assumptions we believe that we will be £156m short of what will be required in 2021. That is not that there is less money than now (£450m) rather in reality there will be slightly more, but rather because of inflation and ever increasing demands on services the slightly more is not enough.

Similarly our proposal is not to cut services; so if you need a hospital bed there will be a hospital bed in Stockport. If you need a district nurse there will be a district nurse. If you need to see a GP you will get to see a GP in a timely manner.

Our proposals set out a different way of working designed by professional colleagues. This is an approach that reduces the number of people who develop long-term conditions; that identifies problems and addresses them more quickly; and that supports people to retain their independence longer. We believe this is the way care should always be delivered and we believe that if we make these improvements one of the positive consequences will be that fewer people will need bed based care (in hospitals or care homes).

We also know that we admit around 1/3 more people in an emergency than other comparable health economies around the UK, and we know we work less efficiently than other areas too. These two facts, combined with a higher number of patients in Stockport being given outpatient appointments, all show that we can do something to change our system.

Therefore, over time our proposal is that the proportion of spend on primary, community and social care will increase, and the proportion on hospital care will decrease. We have been very fortunate to be given £19m by Greater Manchester Health & Social Care Partnership to allow us to invest in the new neighbourhood models first.

The mission statement references ‘affordable’. But who is it affordable for?

This simply means that the proposals will contribute towards the health &social care partners living within our means. As indicated earlier we believe this will be around £450m per year.

Two years ago there were discussions about something called an enablement budget. Is this still being worked through?

We have moved on since then, health and social care budgets have now been pooled – this is a major change from how services used to be managed.

If money is being moved will you be transparent and let us see where the money has gone?

Yes, as discussed earlier we do expect the proportion of funding in various parts of the system to be different at the end of this period than at the start. There will greater spending on mental health, primary care, community services and community social care and a lower proportion on hospital care. These shifts are set out in the outline business cases particularly the economic business case.

Please could you explain what is meant by ‘publish’ the increase in capacity and the words ‘statistically’ significant reduction in the overall bed numbers required? How can you make a decision in January?

The decision being made in January is not a decision to decommission beds; rather it is a decision to invest in a new model of care as set out in the outline business cases.

Beds may never be decommissioned, and, if at some future date, it is deemed appropriate to decommission beds, we want to assure people that we will clearly show:

  • that we have put in place additional capacity in terms of staff and services – when we refer to staff we mean real numbers of actual people.
  • that the impact of the changes has actually reduced the numbers of people requiring hospital admissions.

The ‘statistical significant’ phrase is important because we would not wish to take that decision after, say just one month’s improvement – that is not a ‘statistically significant’ change. For instance, we have significant fluctuations based on a range of factors – such as seasons, that have to be taken into account.

Both commissioners and providers would need to be assured that such change is both real and sustained.

I am very worried about cuts to hospital beds. The assumption is that improving community care will reduce pressure on non-elective hospital bed usage. But national evidence goes against this.

The national and international evidence on the impact of integration of services in community on bed requirements is mixed. One stronger correlation is that integration alone does not reduce the need for beds.

Our proposals do assume we will need fewer beds but we have been very clear we will not decommission beds until we have a) invested additional resources in the community and b) have shown that there is less need for them as a result. We have some confidence in our proposals for a number of reasons:

Firstly, Stockport starts in a very different place than many other areas. We have a much higher than average hospital bed use. We also on average keep people in them longer. There are lots of other places in England already using far fewer beds than we do.

Secondly, we are not just integrating services we are investing £16m additional funding into out-of-hospital services. We have been given £19m non-recurrent funds by GM to allow us to test some of our thinking in advance. This has meant we haven’t needed to shut any beds or wards until we can see it working.

Thirdly, we have some excellent early examples of success. Changes to the way we support people at end of life, with some small investment in integrated teams, significantly reduced the number of people requiring hospital care or dying there when they did not wish to do so. The alignment of GP practices to care homes has resulted in a 10% reduction in the number of admissions from care homes. Similarly, our early work on transfer to assess has helped get people home sooner and more safely.

Finally, unlike some early pioneers we have (learning from them) done much work behind the scenes to ensure everyone working in the system believes this is the right thing to do and to share the consequences of us not succeeding.

However, just to reemphasise we will not decommission beds until we have completed the investment in the community and can show that it has had the impact required. We have asked for evidence about what else we should consider through the consultation.

Is there new money going in to this to help us implement some of the new services?

We have been fortunate to get funding to help us implement these changes. Initially we got financial support from NHS England when we were part of the national Vanguard programme. Now that we have devolved power in Greater Manchester, we fall under this system, and have benefitted from their transformation funding.

We have to invest in the short-term to make a long-term impact; do you think this will be seen through?

Yes. We think that is more likely than in many places. At each stage all the key partners have understood and agreed the proposals. The outline business cases are jointly endorsed and form the basis of individual organisational plans. Further we have agreed a benefits/risk share approach that ties us all equally into the success or otherwise of our plans. Finally, we have senior clinicians and other professionals developing and advocating these proposals.

Are there pooled budgets for this activity and who has control of the funds?

We hope eventually the commissioning organisations will have totally pooled budgets. We have already done some work on this though the formal Section 75 agreement and the Better Care Fund, which have both helped to bring the health and care teams together. Currently there is roughly £200m in these pooled budgets. They are overseen by the Health and Care Integrated Commissioning Board which is a committee of the CCG and Council and includes 3 councillors and 3 CCG Board members.

Would it not be more expensive to deliver services at home?

There are two answers to this question. Firstly, we should look at when you need a service; and secondly at how we might prevent you needing services in the first place.

If you need a service we start with the premise that we should treat you in the right place according to your level of need. There can be no compromise on that. If the right place is a hospital with all of the medical and supporting infrastructure 24/7 then that is where you should be. If it is a range of intermediate support with 24/7 care nearby but less intensive medical support you will be there. If it is 7 day a week care in your home you should be there.

We firmly believe that people deserve the chance to go home if they want to and are well enough to do so. For those people who can’t manage at home but still don’t need to be in a hospital, we do have active recovery beds. And we have increased the numbers of staff who can help these people recover. We have different sorts of beds in these wards – i.e. a delirium ward, and there is a triage system to assess the needs of people to make sure they’re appropriately cared for.

At the moment the evidence from the pilot work we have done and from national work, indicates that too many people are getting the highest intensity of service for too long (hospital) and, in the process, many lose their independence more quickly than they should. Therefore, we believe putting more resource in the lower intensity areas and less in the highest intensity areas, is right for individuals and makes sound financial sense.

However, we also believe that rapid identification and response to problems is often much more cost effective. Some earlier work we did with people at the end of life showed us that through some relatively low level increase in home care support, we were able to significantly reduce the amount of very expensive hospital stays people required. This was also what people wanted. Another example might be that through better management and early intervention to relieve anxiety for someone with COPD (breathing difficulty), we reduce the number of 999 calls and short hospital visits they make.

So the right level of support and a focus on early intervention means that we are delivering services in a better way and this will reduce costs at the same-time.

STPs (Sustainability Transformation Plans) and Organisational Form

Are these proposals not just a government driven STP masquerading under a different name?

No. There are a number of differences between these proposals and STP plans.

Firstly, the origin is different. These plans have been under-development since January 2015 and even before. In January 2015 the leaders from the partner organisations came together with senior health & social care leaders from across Stockport and pledged to work differently. STP plans were announced in a top down process in the summer of 2016.

This then means the ownership is very different. Many STP plans were developed very quickly with little input from the public or professionals working in the NHS and social care. This is not the case with our plans. The development has included and been led by clinicians and other professionals and we have involved the public in numerous ways throughout the process culminating in a listening exercise and period of consultation.

Also, STP plans are much broader in scale and scope. They cover large regions such as Greater Manchester and look at a wider range of services including children’s services and the reconfiguration of hospitals. Our proposals are focussed on the adult population at this stage and predominantly on out-of-hospital services and certainly do not address reconfiguration of hospitals.

We have developed our plans bottom-up. Clinicians and professionals have worked with managers to develop the right things to do; we have then costed these and identified the benefits. As a result we do not claim these plans will address all our challenges. In an STP environment, there is a figure given and people are charged by whatever means to reach that. We have not worked in that way.

The BMA have said that Sustainability and Transformation Plans (STPs) should be abandoned. Will you abandon these plans?

Our proposals are not STP plans as explained above, they are focussed on improving rather than on removing services. We believe that it is essential our doctors, nurses, social workers and other professionals develop the way services work along with the population. We are keen through our listening exercises and consultation to hear what evidence we may have missed about how we can do this better.

Are these proposals not a route to privatisation of the NHS and Social Care?

As statutory bodies in a democracy we are obliged to live and operate within the law including the law regarding procurement. However, the proposals as described seek to more closely integrate services and providers rather than further fragment them. The commissioner’s approach to procurement of these services is to focus on service quality and greater integration. Stockport Together is the vehicle to get the different organisations to come together to work better to use the limited resources we have.

Is it a coincidence that the way Stockport Together has been set up is exactly the same as in the Five Year Forward View and as other areas across the country?

No, we are a Vanguard site which means we’ve shared a lot of our learning and this has helped to influence plans in other areas. We put ourselves forward for Vanguard status in 2015, and were awarded it in recognition of the work we were planning at the time. In many cases, national direction and policy is influenced by what happens at a local level, and we have been a part of this.

Stockport Together will become a single accountable care trust. How will the trust be held to account? How are you going to assess the care?

There are a number of routes by which the closer integration of services can be delivered. At the moment we are working as an alliance of providers.

It is true that there are proposals under consideration to create a single Care Trust for provision, but these are yet to be consulted on and lie outside the current consultation.

However, in whatever form the providers of health & care services work together in the future, it is likely there will also be a single integrated commissioner of services. This too is under deliberation and involves much closer working of the CCG and the Council. We have in place a pooled budget and a Health and Care Integrated Commissioning Board that brings together the democratic and clinical accountability necessary for both organisations. This integrated commissioner will be responsible for holding any single or group of providers to account.

The current proposals as set out in the business cases, do not propose a specific form of either an integrated provider of services or an integrated commissioner.


Please could I get some clarification about what you mean by ‘Stockport’ as not all Stockport residents are registered with Stockport GPs, and there are people who live outside of the borough but use the hospital services in Stockport, who will not have a

We are basing our plans for Neighbourhoods around the registered list of GP practices. The vast majority of these people live within Stockport. Where they do not, the local authority services are not allowed to provide support, but reciprocal arrangements are put in place as required. Similarly where individuals are registered with a practice outside Stockport, the majority of services they receive will be delivered via reciprocal arrangements. This is not any different to now. All our neighbouring boroughs are developing similar models of care to us.

NHS Stockport Foundation Trust will continue to offer services as now to a people from across a much wider area. About 25% of its work is for non-Stockport registered people. We expect that some of the changes we are proposing will improve their experience as well including, for example, the ambulatory care unit alongside A&E and changes to outpatient pathways.

As an example, High Peak residents may access hospital services in Stockport, but their local authority would be responsible for delivering their adult social care services, and their local GP practice would deliver their primary care services.

Is High Peak included in the Stockport Together plans?

No. Because these proposals are predominantly out-of-hospital focussed, the plans are for Stockport only. High Peak residents will come under Derbyshire Local Authority and CCG, which are planning something similar. We are in regular conversations with the area, and are sharing plans and learning.

Some patients are not registered with a GP in the area they live. Would you expect people to move to a GP in their area?

These proposals do not require any change to current arrangements regarding registration with a GP practice. It is true however, that the further you live from your GP practice, the greater the complications in providing care can be, and these proposals will not address those complexities. Having said that, so long as you are at a GP practice within the Stockport area the closer integration of services should allow for the ability for reciprocal working by different neighbourhood teams (See above for out of Stockport).

We have heard about “hubs” in each neighbourhood?

The term hub has been used in quite a lot of different ways. Professionals are now working together as a team in each neighbourhood. The teams could comprise a social worker, physiotherapist, district nurse and psychologist all based together working to support your GP. When we talk of hubs, initially this will be a space where the professionals meet.

In time, as we look to have a greater range of services, and services delivered across more of the week in each neighbourhood, we may bring these together to operate in one or more buildings in each neighbourhood. Hubs may be a number of practices working together, but certainly not forcing mergers of GP practices. If practices or individual professionals come together in the same building, this could also then be called a hub.

These hubs will be shaped by neighbourhoods and communities. There is not a plan to put everyone in a single building. During the consultation we would be very interested in your views on this.

What do you mean by neighbourhoods?

We divide Stockport into eight geographical areas which we call the neighbourhoods. These neighbourhoods will have a single integrated health & social care team, working with local people and organisations to promote good health and support those that need it. This team will be led by a GP with support of a social worker and community nurse.

Will co-location of services happen?

Yes, we do expect some of this to happen, but we need to be pragmatic and ensure that this reflects the different geography, transport requirements and needs in each neighbourhood.

Do you think that accessing different GPs or services may exacerbate the health inequalities across the borough? i.e. will the benefits be more skewed to those who have a car for example?

Narrowing health inequalities is one of the goals we have as partners. We believe by looking at resourcing at a neighbourhood level, and giving some freedom to neighbourhoods within a common standards framework, we can support this rather than skew benefits to the more affluent. That is why, in terms of location of services within neighbourhoods, we are not proposing a one size fits all approach.

How are you going to recruit to a new Neighbourhood model, given the recruitment challenges you already face?

You are quite correct recruitment is one of the biggest challenges facing the NHS. The challenges of recruitment exist whether we do nothing, or make the changes we want to make. The new model we are proposing doesn’t require more staff overall, but rather it requires re-focusing existing resources - different staff working in different areas.

GP involvement/access:

GPs are represented by Viaduct Health, but how much will this work depend on GPs opting in, and how much will be about getting them to comply?

We know that imposing changes doesn’t work in the long-term. We have engaged with GPs directly from the outset, finding out what support they need and asking them to tell us the most significant ways we can help. As a result, they provided us with a proposal, which is now being worked through and is reflected in these proposals. Two GP membership organisations with significant GP membership of their governing bodies – the CCG and Viaduct (GP Federation), endorsed the outline business cases, and GPs are integral to the leadership structures at a neighbourhood and system level.

Does this get rid of local GP surgeries?

Absolutely not. We have excellent general practice in Stockport. GPs have helped us to develop these plans and ideas. It will be the GPs who are compiling the care plans for people. They will know what services and support people need, and they will be able to co-ordinate them. The GP practice is the heart of the proposed system. The system around them will be changing, and they will change the way they work with that wider neighbourhood team, but the continuity of care of your GP is fundamental to its success.

But you can never see a GP at the moment.

We know this is a real problem area. To address it, we asked GPs what activity they would need to stop to allow them to see more patients. They came up with three key areas:

1) more physiotherapists to see people with musculoskeletal needs, such as back pain

2) pharmacists – GPs currently spend a lot of time sorting out people’s medications, if more pharmacists were available, people could see them instead of their GP to discuss their medications.

3) mental health – around five out of every 20 GP appointments is taken up by someone who has a mental health need, so having someone who could deal with this would help.

We know that this additional support would all help to alleviate GP workload, and free up some capacity to help ensure that people who need a GP appointment are more easily able to get one. These are all part of our proposals. Equally, it is important that we make general practice in Stockport an attractive place to work, and we are looking at other measures to support management of work flow and enhanced case management of the most complex patients. This should help reduce administrative work and allow GPs to feel part of and leading a strong local team of professionals.

Will receptionists be making decisions about who I need to see? Will I have to tell them what my problem is?

There will be no requirement to tell receptionists what is wrong with you. At the moment most practices have a range of staff you see: GPs, Nurses, and HealthCare Assistants. Many of us chase prescriptions through receptionist staff, and arrange to see Health Care Assistants (HCAs), or nurses without going through the GP. By working together as practices in a neighbourhood, our proposals will increase the number and range of the primary care team, and people may choose, should their knee be a problem for example, to ask for an appointment with a physiotherapist.

Could you explain what will actually happen to GP practices?

Individual GP practices will still be as now. They will be working together more closely on a neighbourhood level to provide a range of additional services. In addition, to say using physiotherapists as part of the practice team, they may work together to carry out home visits more quickly right through the day for those that need them; have non-medical support staff to help people address other concerns; be open at weekends; and provide expert patient programmes for newly diagnosed diabetics. None of these are easy to sustain as a single practice, but by working together at a neighbourhood level, they will be able to offer these and free-up some time.

How realistic is it to implement GPs working out of hours?

We know we only have a finite number of GPs, and resources are already stretched. Stretching the services over 7 days will mean that people may need to have appointments at another practice within their neighbourhood. At weekends we may for example offer vaccinations, screening appointments, blood tests etc. This will mean that practices have more time freed up in the week for continuity of care with patients that need it.

What are you doing for carers?

We have a huge amount of carers in Stockport who offer many hours of care, and we need to ensure they’re supported to keep caring in the way they do. We do have a carer’s strategy, which discusses what we’re doing to offer this group of people the support they desperately need.

Part of the enhanced case management proposals, is to identify all those that are vulnerable, including carers, and ensure that the neighbourhood team takes collective responsibility for supporting them in a systematic way.

Staff recruitment / training:

In Stockport there are a large number of privately owned care homes which have been classed as inadequate. With a great number of vacancies and a high turnover of staff - what is being done to tackle this issue?

This is a national issue as well as one that is relevant to Stockport. We have already undertaken work that has started to see this situation improve. Utilising the wider resources of the NHS will help both at a neighbourhood level and at borough wide level. In time, we want care homes to see themselves, and be seen as, part of the neighbourhood. Prior to these proposals, we aligned care homes to specific GP practices, and in these proposals, we intend to put in place an integrated quality improvement team to go in and work with homes that are most challenged.

We have been looking at other areas, for example Frimley Park hospital, which is working with the local council to start a new scheme to recruit through the hospital. This means staff will receive the same training as on an NHS career pathway. The hospital then provides the workforce to the care home. Currently a lot of care home workers are underpaid with limited career prospects, and here in Stockport we want to consider this as an issue.

There aren’t enough care workers to help get people home. People stay longer in hospital because the support isn’t there.

We agree that workforce is a national challenge, and one we’re working on as a priority in Stockport. There are a couple of places in England which have implemented some initiatives which we’re going to emulate (see above). Some have set up an agency and established a career path to encourage people to consider health and care jobs.

Do you have money to train the workforce?

Yes, that is part of the proposals, and it’s already underway.

We would all like to see the modernisation and joining up of services, but we all know that the NHS is vastly short of workforce. What are the solutions being put forward by Stockport Together to overcome this?

Devolution is part of this answer. We are investing significant amounts in Greater Manchester to expand the workforce across the region. Over the course of the next 12 months, we will hear more about these plans.

We have tried to expand the workforce where we know we can recruit – for example, physiotherapists or pharmacists, as we know that there is much more resource available in these specialities.

What we’re trying to do is make some of these professions much more attractive career opportunities than might be currently seen.

Can you get the staff for all this community care?

We are working together with local universities and colleges to try to ensure we have got people with the right skills and experience for the future. Part of what we want to do is to make Stockport one of the best places to work in the country.

Will there be more mental health staff?

We are increasing the investment in mental health, for example, through the introduction of mental health liaison workers, which are being deployed in to the neighbourhood teams to work alongside colleagues.

It is novel to design a system which uses less GPs, but GPs should be at the core of the NHS.

We are not intending to use less GPs. However, the GPs we already have are overstretched. We want our GPs to have the time to use their skills and expertise to work with those most at need of their medical knowledge. GPs simply do not need to see a lot of people that currently go for an appointment. Many of these people could – and should – be seen by another appropriately trained and skilled health or social care professional.

Success of plans:

How confident are you this ‘plan’ will work?

The way we currently operate is not giving patients the best deal. We have looked at the challenges and opportunities we face, and with our professional colleagues have proposed a different way of working. We know it’s challenging, but we are confident it is a better model than the current one. We believe the quality of care, as well as outcomes and patient experience, will be better as a result of these changes to health and social care, than would otherwise be the case. As a group of partners we are solidly behind the vision and have committed our best people to making it happen.

Do you have a plan B?

Plan B would be to prioritise provision of certain services or treatments over others.

Impact of GM / Healthier Together:

How does this link with Greater Manchester Devolution and Healthier Together?

Devolution Manchester has asked each area of Greater Manchester (GM) to do this kind of work, and we are totally aligned with GM’s plans. This helps with recruitment as GM has much more of a draw than Stockport alone.

As a Healthier Together site for the provision of specialist abdominal services for all of Greater Manchester, we will actually require additional hospital beds. This will be a factor taken into account when and if at a future date we look to decommission any beds.

The Greater Manchester money will help us to implement the proposals without destabilising the existing system.

Where does the transforming care programme fit with this?

The GM transformation programme has a number of themes. One of them is called ‘transforming care’ which is focused on community/neighbourhood care, and we’ve been given the money because we’re so closely aligned to this.

GM has backed us financially with non-recurrent funding (this means it is a one-off payment), which we can use for the double-running of services and for change capacity.

Voluntary services:

You alluded to the voluntary sector, and mentioned how loneliness and isolation are big problems. We know that the state can’t provide the community spirit that people need. How are you engaging the voluntary sector?

You’re right – these two issues are huge factors in peoples’ physical health. We’re beginning to see a huge shift in public mood, and we know that people are moving to be more involved with community and voluntary initiatives.

To capitalise on this, and make the most of peoples’ goodwill, we have introduced a couple of schemes – health champions (volunteers who work with members of the public to maximise their health and keep them well), the prevention alliance (a new service helping to support people around discharge services and needs), and bringing community groups together.

We know there is a challenge on voluntary services – and we need to do more to encourage and support people to do it. There is a dedicated workstream as part of Stockport Together looking at how we can do this.

We know that people need the motivation and opportunity to volunteer, and we need to try and ensure that those that do support, aren’t being taken advantage of and treated as a free member of staff.


Has this been tested in other areas?

Yes, Torbay, Cambridge, Tower Hamlets, Bristol and other areas around the UK and across the world. If we look at areas such as Sweden, Israel and Spain, they have a much more integrated and stronger health service. We’re trying to learn from both national and international evidence.

Didn’t this fail in those areas you mentioned?

Not completely. But where things didn’t work out, we have taken some real learning and have created plans to mitigate against the same things happening in Stockport. However, we are quite unique in having the buy in from all partners - the agreement to share risks and workforce in the way that we do. In areas where this has not worked, these things have not been present.

We believe that providing joined up care, focusing on early detection and prevention, are always the right things to do.

Exclusion of children:

Why are children not included in the plans?

We had to focus somewhere. The number of Stockport residents aged 65 and over is set to rise from 55,700 to 61,000 by 2020. It is, therefore, estimated that the number of people living with a long-term condition will increase by 53% in the next decade. This will challenge the traditional way of managing disease and illness.

You need to look after people when they’re younger

The proposals we are making for neighbourhoods will impact on people of all ages. Once we have put these proposals in place we expect the neighbourhoods to start to drive change in other areas and to look at ways they can as you suggest work with younger people.

People assume that because you’re younger you are automatically ok – they very rarely check if you need any extra support…

The principals of what we’re trying to achieve through Stockport Together ring true for all age groups. We know that if it’s appropriate for you medically, you will probably benefit from being at home rather than in hospital.

What we’re trying to do through this is to identify how we can provide more care in a home setting, whilst recognising that if you’re really poorly you will need hospital care.

IT systems / data:

Is there an IT system across Stockport that allows all of the health and care professionals to talk to each other and share data?

Not yet, but we’re working on it. Up until one year ago, the 40 individual GP practices across Stockport couldn’t share details. Now, all GPs are on one system called EMIS which means that any patient data can be shared whenever it’s needed. Community Health staff are also in this system, and it is available in A&E. On top of this, we have something called the Stockport Health & Social Care record. This pulls together elements of information from hospital, GP, social care and community records. With the appropriate permissions, professionals can access this summary information.

Mental health:

In the issues document you only reference the non-mental health needs of the population of Stockport. We need to include mental health conditions.

Mental health isn’t captured in the document, and that is an oversight. Through feedback at our recent listening events, we have ensured that this issue is given important consideration in the outline business case documents. We have included mental health throughout, with mental wellbeing and psychological services both being worked into the plans.

We know that mental health needs increase with age, but we also know that those with mental health needs in their younger years are unlikely to reach age 65 +.

We are aware that there has been chronic underinvestment in mental health, and are ensuring that mental health workers are being built into the integrated neighbourhood teams.

Pennine care provides mental health services in Stockport, but why are they not included in the neighbourhood hubs?

Community mental health staff will form part of the neighbourhood teams. We are aligning provision of Psychological therapy services to neighbourhoods and propose putting mental health liaison workers into all neighbourhoods. The proposed new psychological medicines team will be similarly aligned to the neighbourhood structure. We are fully committed to mental health being integral to the new model of care that we propose. We believe we are one of the areas furthest ahead in this approach.

Payment or measurement of services:

You say that you want to change the way services are measured. How will you decide the risk factor or the benefits people will get – will this discriminate against older people?

We developed the framework with members of the public to make sure this doesn’t happen: older people should not be discriminated against.

Will services still be measured against the national target? Will Stockport be the only place doing this new measurement? And how will you know if the measures are appropriate / successful?

We established a series of ‘expert reference groups’ which helped to identify a long-list of outcomes. These were then refined to produce the list of outcome measures that will be used. There will then be a further process to collate the baseline data, so that the measures can be set into context, and to agree what good looks like.

We do still need to meet nationally mandated targets, and that will not change through this process.