10. Staffordshire & Stoke on Trent
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.
The closure of one of the three A&E departments in the county, with the A&E at Stafford Hospital most likely to close to be replaced with a 24 hour urgent care centre.
Closure of community hospitals. 168 beds have been closed at Cheadle, Bradwell, Longton and Haywood community hospitals, with their long term future in doubt.
Possible closure of Leek Moorlands hospital; there is an active campaign to save the hospital from closure.
Reconfiguration of minor injuries units is planned with 75% of the activity transferred to the community and 25% to local A&E.
- Longer waiting times for elective care,
- Closure of wards and theatres
- Staffing cuts
- Ending funding for some treatments and prescriptions
- Delaying or avoiding funding newly approved treatments
For more information, see below.
What are the proposed aims of the STP?
- Elimination of the projected financial gap which by 2020/21 will be more £286 million. The solutions outlined in the STP are expected to deliver £245 million in savings, but will require £120 million to enact;
- Improve prevention services to improve the health of the area;
- Enhance primary and community care;
- Simplify urgent and emergency care system;
- Reduce the cost of services;
- Ensure effective and efficient planned care;
- Overall the STP is focused on reducing admissions to the acute care sector and moving care into the community.
Like other areas the STP aims 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.
The STP plan includes ambitious targets for the reduction in non-elective activity, including a 30% reduction in A&E attendances and a 20% reduction in A&E admissions.
The closure of one of the three A&E departments in the county is planned. The HSJ reports that the part-time A&E at Stafford Hospital is the most likely to close. It would be replaced with a 24 hour urgent care centre.
A reconfiguration of minor injuries units is planned with 75% of the activity transferred to the community and 25% to local A&E. This is designed to save £4.3 million.
A major programme to close community hospitals in Staffordshire is within the STP and by March 2017 was well underway. The STP mentions that community hospitals will lose 167 hospital beds - 85 at Longton and Cheadle and 20 at Haywood Hospital. This is designed to save £4.2 million. However, by April 2017 beds had been closed at Bradwell, Cheadle and Longton. Leek Moorlands Hospital is also now under threat of closure, with the announcement in May of bed closures within weeks.
The STP includes the plan to convert 20% of inpatient orthopaedic cases to day cases at Stoke and Burton hospital, with 1% of all other inpatient stays converted to day cases. The aim is also to reduce the length of hospital stays. Post-surgery, the STP aims to have a 30% reduction in follow-up attendance and a 50% cut in cost of follow-ups.
The STP includes the establishment of a multispecialty community provider (MCP) to deliver integrated community care.
In June 2017 the HSJ reported on discussions between NHS Improvement and NHS England on what certain over-spending CCG 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. The target areas include Staffordshire. 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.