16. The Black Country
What does the STP mean for your area?
Merging of Sandwell and City district hospitals by October 2018 into the Midland Metropolitan Hospital.
Only the Midland Metropolitan Hospital will have an A&E, reducing the number of A&Es in the area.
The new Midland Metropolitan Hospital maternity service will replace the Serenity Unit and labour wards at City Hospital.
The back pain and arthritis service at Walsall Manor hospital will be cut, as it is deemed to be unsustainable.
Closure of Walsall urgent care centre although it was only opened in 2016.
Changes in who organises our care
The STP includes the development of two multispeciality community providers (MCPs) in Dudley and Sandwell and West Birmingham, however the aim is to explore the use of this model across the whole population by April 2019, including in Walsall and Wolverhampton. In June 2017, a 15-year MCP contract worth £5 billion was advertised by Dudley CCG and Dudley Metropolitan Council.
What are the proposed aims of the STP?
- The elimination of a projected £700 million funding gap by 2020/21.
- To implement local-based models of care for each community that deliver improved access to local services for the whole population, greater continuity of care for those with ongoing conditions and more coordinated care for those with the most complex needs.
- Transition to outcomes based commissioning, which may take the form of a single, or multiple, accountable care organisations.
- Development of the new Midland Metropolitan Hospital (bringing together acute services from Sandwell and City hospitals).
- Extend collaboration between service providers to ensure continuity of care.
- Improve maternal and infant health.
Like other areas they plan to transfer services out of hospital and into the community. The concern is that financial pressure will mean that cuts in hospital care will be made, helping to achieve savings, but without proper investment in community health services.
The STP contains ambitious targets, including a reduction in infant mortality, improvement in cancer survival and A&E waiting times, however the details of how these are going to be achieved are unclear from the STP.
A major component of the STP is finding savings through re-organisation of back-office functions across both commissioning and provider organisations, including payroll, support staff employment models, procurement, human resources, telephony and legal services, call centres, licensing of telephones, IT applications and hotel services.
The STP document also notes that sustainability and transformation funding could be used to buy out expensive private finance initiatives and local improvement finance trusts.
CCGs across the Black Country will combine to become one provider for mental health care. The STP also outlines proposals to save £16.7m by reducing the number of patients with mental health problems going to A&E.
The STP expects to save £7 million by reducing the number of admissions to care homes across the Black Country.
In June 2017, a £5 billion, 15-year Multispeciality Community Provider (MCP) contract was advertised by Dudley CCG and Dudley Metropolitan Council. The contract covered community-based health and care services including GP services for the registered patient population covered by the CCG and resident population of the Council.
The incumbent providers - the local GPs and the local trusts - that had developed the MCP, were announced as the lead bidders in August 2017. The CCG will take forward the bid for the contract from a consortium formed of GPs with four NHS trusts - Birmingham Community Healthcare Trust; The Dudley Group Foundation Trust; Dudley and Walsall Mental Health Partnership Trust; and The Black Country Partnership FT. It is unclear whether there were any other bidders for the contract.
A consultation is ongoing on the viability of a hyper-acute stroke service at Walsall Healthcare NHS Trust: this service may be consolidated in Wolverhampton's New Cross Hospital.
Walsall CCG plans to close Walsall urgent care centre, which would save the £951,000 per annum running costs. The centre was only opened in 2016 at a cost of £1 million. Critics have said that its closure will put pressure on the other urgent care centre at Manor Hospital.
The STP includes an investment of £25 million in primary care services.
Walsall CCG has proposed a shake-up of its GP surgeries. The CCG has plans to close two GP surgeries, merge six surgeries, and end weekend and out-of-hours appointments for five surgeries. Instead, Walsall CCG is proposing to provide evening and weekend services at some hub GP practices in the borough.