1. Northumberland, Tyne & Wear
What concerns have been raised about your STP?
Health planners are trying to reduce NHS deficits and think about ways to re-organise care. However getting the large deficit under control could prevent facilities being developed that can cope with the health and care social needs of local people.
Closure of Rothbury Community Hospital in Northumberland
Merger of South Tyneside and Sunderland NHS Trusts. Possible downgrading of acute services at South Tyneside Hospital including the stroke and maternity units. The plans have been described as “unsustainable” by hospital bosses.
Closure of wards and theatres, staffing cuts, the ending of funding for some treatments and delays in funding newly approved treatments have all been suggested as cost-cutting measures, leaked to the HSJ and the Independent.
Lack of investment, growing debts and lack of information
Lack of investment was highlighted by Dr George Rae of the British Medical Association stating in March 2017 that the Northumberland, Tyne and Wear STP would need an extra £76.6m in capital funding in order to successfully deliver the STP plans.
Changes in who organises our care
Northumberland CCG area is developing as an Accountable Care Organisation, under which a single organisation will hold the budget for all care in the area, including primary care.
What are the proposed aims of the STPs?
- Elimination of a projected 2020/21 deficit of £641 million
- Scaling up the new care models, including the Northumbria accountable care organisation (ACO) vanguard.
- Reducing acute admissions.
- Bringing care closer to home.
- Increasing prevention services - reducing smoking and obesity - to produce a healthier population.
Like other areas they plan to transfer services out of hospital and into the community. The concern is that cuts in hospital care will be made, helping to achieve savings, but without proper investment in community health services.
In late August 2017 the results of a 12 week public consultation were released; this consultation began soon after the publication of the STP in November 2016.
One of the main issues from the consultation was that rural residents felt that they would lose services and that there was a lack of connection between the rural population and hospitals. This STP has a very rural population with poor public transport links to hospitals or emergency care centres.
Other issues from the consultation, include:
- A lack of detail in the STP about what it would mean for individual services;
- People wanted the plan to be more specific about how the needs of individual groups would be met, such as young people, carers, people with mental health problems or learning disabilities;
- How the plans would be financed, with many people saying the plan was “unachievable” with current resources and questioning how the STP would actually reduce the funding gap;
- Concerns were raised about having enough staff with the right skills in the right place at the right time to improve the health of local people.
The STP contains a re-configuration of the hospital sector, that will lead to a reduction in acute sites in the region.
The plans include the closure of beds at Rothbury Hospital and the reshaping of the hospital around a Health and Wellbeing Centre. This move was voted through by Northumberland CCG in September 2017, but in October 2017 Northumberland County Council's Health and Wellbeing board voted to refer the move to the Secretary of State for Health.
In July 2017 a three month consultation was launched on the future of hospital services at Sunderland Royal Hospital and South Tyneside District Hospital.
The consultation will focus on:
- Stroke services, specifically hospital (acute) care and hospital-based rehabilitation services
- Maternity services (obstetrics), covering hospital-based birthing facilities (i.e. where you would give birth to your baby and special care baby units)
- Women’s services (gynaecology), covering inpatient surgery where you would need an overnight hospital stay
- Children and young people’s (paediatrics, urgent and emergency) services
Campaigners in South Tyneside believe the South Tyneside Hospital, Harton Lane site is in danger of being downgraded.
Roger Nettleship, chair of Save South Tyneside Hospital, said: “This phase of the consultation means the loss of consultant-led childrens' A&E, consultant led maternity services, the loss of stroke services and the access to all these services out of an area which covers 150,000 people where only 46% have access to a car. This will not be a path to excellence but a path a worse health outcomes to an area which is one of the poorest areas in the North East.”
The North East commissioning support unit will be turned into a community interest company owned by its 11 CCG customers.
New Models of Care
This STP contains one of the most advanced Accountable Care Organisations, Northumberland ACO. The ACO is to be a “partially integrated” model, with Northumbria Healthcare holding a single contract for acute, mental health, community services and adult social care services. The contract was advertised in September 2016, with only one organisation showing an interest in the contract - Northumbria Healthcare. Local leaders have confirmed the new model of care will be run by an “accountable care organisation” board, consisting of Northumberland Tyne and Wear FT, local GPs and other providers.
Cost-cutting across the region
In June 2017 documents leaked to the HSJ revealed discussions between NHS Improvement and NHS England on what certain over-spending areas will be required to do to enable them to spend less money and remain within a budget known as a 'control total' for 2017/18; this is the capped expenditure process (CEP). The 14 CEP target areas include Northumbria. The measures under discussion include the following:
- Limiting the number of operations carried out by non-NHS providers so the funding stays within the NHS. Considerations differ between areas but include both limiting patients’ choice of providers, and reducing work which is outsourced by NHS trusts. In some cases it would require the NHS to find the capacity to carry out more operations.
- Systematically drawing out waiting times for planned care, including explicit consideration of breaching NHS constitution standards. Some plan to target delays at specialties/areas where waits are currently lower than average.
- Stopping NHS funding for some treatments, including extending limits on IVF, adding to lists of “low value” treatments, and seeking to delay or avoid funding some treatments newly approved by the National Institute of Health and Care Excellence.
- Closing wards and theatres and reducing staffing, while seeking to maintain enough emergency care capacity to deal with winter pressures.
- Closing or downgrading services, with some considering changes to flagship departments like emergency and maternity - though these would normally take too long to deliver savings this year.
- Selling estate and other “property related transactions”.
- Stopping prescriptions for some items, as suggested by NHS Clinical Commissioners earlier this year.
The commissioners in the area told the HSJ that they have been told to examine “difficult decisions” and “think the unthinkable”, including modelling changes which are normally avoided as they are too unpleasant, unpopular or controversial.