15. Leicester, Leicestershire and Rutland
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 all acute beds at Leicester General Hospital (LGH) and reconfiguration of services within University Hospital Leicester which will lead to a net reduction of 243 acute beds.
All clinical services will be moved onto two sites: the Leicester Royal Infirmary and the Glenfield.
Closure of maternity units at St Mary's Hospital, Melton Mowbray and Leicester General Hospital. These maternity services will be consolidated onto one site at the Royal Infirmary with the possibility of a midwife led unit at the General Hospital.
Surgery for children born with heart defects could end at Glenfield Hospital.
Two community hospitals will see their inpatient beds cut. Leaving six sites with such facilities.
The closure of all in-patient facilities at Fielding Palmer Community Hospital in Lutterworth and Rutland Memorial Community Hospital in Oakham. Consultant geriatrician Dr Alex Miodrag, branded the decision as 'pure insanity' due to the rising and ageing population in the area.
50% reduction of beds as Hinckley and Bosworth Community Hospital and an overall net reduction of 38 beds across the remaining community hospitals.
The number of acute hospital beds will be cut from the current 1,940 to 1,697 by 2020. Together with the closure of community beds this will be an overall bed reduction of 12.9%.
It is estimated 1,500 local hospital jobs will be cut by 2020, although the number of full-time health workers in the community will go from 2,271 to 2,505.
Changes in who organises our care
The STP is to develop into an accountable care system, however the councils involved have expressed concerns over this move. The three local authorities involved have criticised the lack of detailed plans to tackle a £399 million financial gap in the document outlining the ACS development.
What are the proposed aims of the STP
- Elimination of the projected 2020/21 deficit of £399.3 million;
- Consolidation of the hospital sector, including maternity care and community hospitals;
- Integrate care in the community with primary care at the centre and a focus on prevention to reduce demand on acute services;
- In general, the STP aims to drastically reduce the use of the hospital sector and move care into the community sector and primary 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.
The STP does not contain detailed information of how its aims will be achieved, in particular how the changes will be funded.
The STP is particularly vague on the area of funding: "To realise our transformation plans the system will require £350m capital, including capital raised from alternative sources such as PF2 and funding some investments from disposal proceeds."
The STP has a major emphasis on consolidation of the acute sector.
The reconfiguration outlined in the STP will move all acute clinical services onto two sites, the Leicester Royal Infirmary and the Glenfield. This will mean the closure of all in-patient beds at Rutland Memorial Hospital and Leicester General Hospital, with the net result a loss of 243 beds.
Maternity services will be consolidated onto one site at the Royal Infirmary with the possibility of a midwife lead unit at the General Hospital. The maternity unit at St Mary's Hospital, Melton Mowbray, will close.
There will be reconfiguration of community hospitals to reduce the number of sites with inpatient beds from eight to six sites and services in Lutterworth, Oakham and Hinckley will be redesigned.
This will mean the closure of Fielding Palmer Community Hospital in Lutterworth and Rutland Memorial Community Hospital in Oakham. Some outpatient services may continue to be provided at these sites.
Beds at Hinckley and Bosworth Community Hospital will be cut almost in half. Overall, this will achieve a net reduction of 38 beds across remaining community hospitals.
Dr Sally Ruane, at the Health Policy Research Unity at De Montfort Univeristy, Leicester, has published an analysis of the STP outlining key concerns. The full report can be found - here. In summary the report notes:
- Poor public involvement and absence of key information;
- Lack of detailed calculations and financial assumptions underpinning the figures in the STP;
- Weak evidence base for the overall model of moving services out of hospitals and into community settings as a means of enabling hospital bed closures;
- The importance of retaining enough acute hospital beds for safe patient care;
- Weak evidence base for the assumption that the model of moving services out of hospitals and into community settings will create a cheaper (per unit) health system;
- Centralisation of services and removal of services from Rutland - the STP proposes a significant centralisation of services which would leave a forty mile gap with no beds between Leicester and Peterborough;
- Difficulties in recruitment of workforce;
- Weak risk analysis and the experimental nature of the new models of care.
In September 2017 the STP board presented the report 'Moving towards Accountable Care in LLR', which was criticised by all three councils involved and by GPs in the STP area.
The councils criticised the lack of detail on how the deficit was going to be tackled plus the lack of detail on governance and accountability. The councils were critical of the lack of discussion with the council health and well-being boards.
The criticism from the GPs was that it was unclear how the GPs would be involved.