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.
Grantham A&E may be downgraded to an urgent care centre; at present the A&E is closed at night due to staff shortages.
A reduction of the equivalent of 750 full-time healthcare posts across the county by 2021 is planned.
Proposed closure of Lincoln Walk in Centre.
Extra Cost-savings planned
This STP contains North Lincolnshire CCG, one of the most over-spent areas in England. In documents leaked to the HSJ and reported by the Independent, cost-cutting measures for North Lincolnshire could include:
- 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.
Changes in who organises our care
The STP contains plans to develop a new model of care within Lincolnshire, initially with a multispeciality community provider (MCP) to increase integration within health and social care.
What are the proposed aims of the STP?
- Elimination of the projected 2020/21 deficit of £182 million;
- A smaller acute sector for planned and emergency care;
- Move care from acute hospitals to neighbourhood networks providing care closer to home;
- Develop a network of community hospitals and primary care hubs supporting Neighbourhood Teams;
- Develop resilient specialist mental health inpatient facilities in county.
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 A&E at Grantham hospital has been closed at night since August 2016 due to a lack of staff. In August 2017, it was announced that there would be no full review of the closure of the A&E, following an Independent Reconfiguration Panel (IRP) report saying a full review into the decision by the United Lincolnshire Hospitals Trust is not necessary. The closure was referred by Lincolnshire's Health Scrutiny Committee in November 2016. A decision about whether to reopen at night will be made in November 2017.
Campaigners from the groups Fighting for Louth Hospital and Skegness Hospital Watch are concerned about the future of the hospitals in Lough and Skegness; there is a possibility that one or the other hospital will be closed as to upgrade both would be too expensive.
Major changes are planned for local hospitals:
- New urgent care centres at A&E at Lincoln and Boston;
- Relocation of critical care to Lincoln;
- Relocation of vascular surgery to Lincoln from Boston;
- Consolidating ‘hyper acute’ stroke services to Lincoln with a centralised ‘ Lincolnshire Stroke Unit’ and a single stroke team across Boston and Lincoln;
- Centralising all emergency paediatrics in Lincoln for mothers with complications;
- Developing a paediatric assessment unit at Boston;
- A single neonatal team across Lincoln and Boston with all neonatal services centred on Lincoln;
- A single maternity team across Boston and Lincoln, with a consultant-led obstetrics service in Lincoln with midwifery-led units on both sites. There is also the alternative scenarios of centralising consultant-led obstetrics and maternity units at Lincoln or developing a standalone maternity unit in Boston and relocating obstetrics services to Lincoln;
- The development of a centralised breast cancer care centre in Grantham;
- The learning disabilities inpatient service in Lincoln could also be replaced with a community-based model.
MCPs (multispeciality community providers) will be set-up each overseeing a network of 6-7 neighbourhood teams covering 30-50,000 population alongside developing an integrated strategic commissioning arrangement, for health and social care, with appropriate clinical support and advisory arrangements.
The STP includes plans for GPs to work in larger groups and for a seven day GP service. The plan does acknowledge that currently Lincolnshire has too few GPs and it will need to recruit more if its plans for community/primary care are to be realised.
Council reaction and criticisms
In December 2016, Lincolnshire Council condemned plans to downgrade the A&E at Grantham Hospital. The council’s motion stated that the proposals were “completely unacceptable” and would “have a serious and detrimental effect on the health and wellbeing of residents”. In addition
Councillor Charmaine Morgan, chair of the campaign group SOS Grantham Hospital, said: “It will put more lives at risk if it goes ahead. The STPs are forcing a one size fits all structure that does not work in rural areas.”
In December 2016, Lincolnshire Council condemned plans to develop a single maternity team across Lincoln and Boston Pilgrim hospitals, which would mean maternity services closing at Boston.
In June 2017 the HSJ reported on discussions between NHS Improvement and NHS England on what certain over-spending CCGs 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 target CEP areas include North Lincolnshire. 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.
The CCGs in Lincolnshire (West, East, South, and South West) are considering plans to introduce a minimum waiting time for certain elective surgery in order to save money, according to a report in the HSJ and The Guardian in November 2017. The minimum wait time is likely to be three months for conditions such as cataract surgery and joint replacements.