14. Nottinghamhire

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.

Proposed changes

Bed cuts: 200 acute bed losses over two years at Nottingham University Hospital and 20 beds lost at Sherwood Forest Hospital.

A 12% reduction of “core staff”, with a concurrent 24% increase in staff working within community services and primary care. This is intended to save £12 million over the next five years.  An article in the HSJ  notes that these staff changes could see hundreds of band five nursing, social worker and therapist posts cut.

Local campaigners fear that the STP will lead to drastic cuts in both healthcare and social care services.

Changes in who organises our care

Greater Nottingham is to become an Accountable Care System (ACS). In August 2017, Nottingham City CCG asked for bidders for a £205 million contract for community services, which will form part of the ACS. Contracts have also been awarded to Capita and Centene UK as part of the ACS development.

What are the proposed aims of the STP?

  • Eliminate a projected 2020/21 financial gap of £628 million;
  • Promote wellbeing, prevention, independence and self-care;
  • Strengthen primary, community, social care and carer services;
  • Simplify and improve urgent and emergency care;
  • Deliver technology enabled care;
  • Ensure consistent, evidence based pathways in planned care.

Like other areas this 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.

Further information

The STP does not contain detailed information as to how the deficit will be eliminated and standards maintained, nor how the STP's stated aims will be achieved.

Primary/community care

A key component to the redesign of the acute sector in the STP is moving care into the primary/community care sector.

There will be a major push to shift work into primary care on a much wider scale than has been attempted in the area before. The aim is a rise of 10% in primary care and self-care activity.

An extra £14.5 million over five years will be spent on primary prevention. This funding will be ring-fenced.

In December 2016, document leaked to the HSJ outlined 13 services that could be decommissioned from the Nottingham University Hospitals (NUH) Trust and transferred to the community, plus 17 services that could undergo a redesign after review.  In February 2017, it was announced that the following five services will transfer from the NUH to the community from July :

  • pain management and back pain service;
  • integrated dietetics service across community and acute settings;
  • chronic fatigue syndrome service;
  • home visiting service for patients with motor-neurone disease; and
  • Geriatric day care/medicine day care/complex rehab.

Nineteen other services will remain at the NUH.

Accountable care system

Part of the STP is the development of an accountable care system (ACS) in Greater Nottingham with implementation by early 2018/19. In August 2017, the STP awarded a contract, worth £2.7m, to Capita to help support the development of the ACS. As part of the contract Capita has sub-contracted Centene UK, a data analysis and IT software company, to deliver support to the STP. Centene will give leaders advice on the development of new service models, information management and technology.

Centene UK is a subsidiary of Centene Corporation, a major US healthcare insurer that provides plans for the Medicaid and Medicare schemes.

Then in the same month, Nottingham City CCG tendered a contract for community services worth £205m. As part of the contract, the successful bidder must form part of an ACS in Greater Nottingham.

The contract is due to start in July 2018 and will last seven years with the option to extend for a further two.

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The Workforce 

In contrast to many STP areas, an appendix was published alongside the primary document, in which the STP board outlined plans to change the workforce skill mix over the next five years.

The appendix says the core skills group would have a net reduction of more than 640 posts, with the largest falls in urgent and planned care, which would drop by more than 400 posts. There would also be a drop of 116 mental health and learning disability posts, but an increase of 38 in primary care.

According to an article in HSJ, within the example outlined in the STP there would also be a net reduction of foundation skills staff, typically bands 1-4 staff, which would drop by more than 200. There would be growth in what the STP calls “enhanced” and “advanced” staff, which it defines as bands 6-7 staff and junior doctors and consultants, GPs and advanced nurse practitioners. Bands 6-7 posts would grow by 2% and the other roles by 7%, an increase of almost 300 posts. According to the article, however "across all staff groups, the example suggests there would be a net reduction of 562 staff or 2.7%."

Hospitals

The plan included the merger of two acute trusts: Sherwood Forest Hospitals Foundation Trust (SFH) and Nottingham University Hospitals NHS Trust (NUH). However, a delay was announced in October 2016, soon followed by the cancellation of the merger in November 2016. This was attributed to the NUH’s poor A&E performance and financial challenges. However the British Medical Association (BMA) claimed that the deal was mired in practical and financial issues, such as how to transfer liabilities from the dissolved trust into another which was heavily in deficit. The merger was the first attempt to unite a foundation and non-foundation trust. The BMA noted in early November that SFH’s crippling PFI debt for the building of King’s Mill hospital could be too much to overcome.