18. Coventry & Warwickshire
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 Acute Stroke Unit at George Eliot Hospital will close, with a new unit built at University Hospital Coventry & Warwickshire.
Possible Reduction in the number of maternity and paediatric service sites as services are consolidated.
Pregnant women will be encouraged to have home births with the support of newly established and expanded community hubs.
Apart from a small number of changes, the lack of detail contained within the STP document means that its impact is very unclear.
Lack of information and collaboration
The STP has received a great deal of criticism for its lack of detail and for not involving local GPs. News stories have hinted at cuts to A&E and maternity, but not enough details have been revealed to know if this is going to happen or not. One media article noted that the man in charge of the STP can't "offer any guarantees [that services won't be closed amid fears for the future of services."
Changes in who organises our care
The STP plans on becoming an Accountable Care System (ACS) in which health and social care become more integrated.
What are the proposed aims of the STP?
- Eliminate a forecast 2020/21 deficit of £267 million;
- Reduce demand for services, through prevention and proactive care of the population;
- Remodel urgent and emergency care and review and change planned care to reduce costs;
- Reduce unit cost of provision, by delivering care at lower cost setting/s or by becoming more efficient in current setting/s;
- Improve efficiency within and across organisations;
- Make specific organisational changes in clinical pathways and services to facilitate a move towards an Accountable Care System;
- Overall the aim of the STP is to reduce the use of the acute sector and move care into the community sector.
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 Coventry and Warwickshire Sustainability and Transformation Plan (STP) has now been renamed the Better Health, Better Care, Better Value programme, by the STP board.
In August 2017, a report to the Warwickshire Health and Wellbeing Board noted that progress is underway on the plan; an action plan for maternity is expected in autumn 2017.
According to the STP, stroke patients will be admitted to to the UHCW unit for initial care before being moved to rehabilitation beds at GEH and Warwick and then back home with the support of the Early Supported Discharge (ESD) team.
The STP has been roundly criticised for a lack of detail on how the deficit will be cut and services maintained. Cuts are expected although yet to be announced.
The Coventry & Warwickshire STP was the last to be published in December 2016. News stories appearing before the publication reported on the likelihood that the STP included closures of A&E and maternity units. However, upon publication, it was found that the STP contained very little in the way of detailed plans about closures.
Labour Councillor Damian Gannon, chairman of the health scrutiny committee at Coventry City Council, questioned why hospital chiefs had failed to provide details of exactly what the plans mean. He said:
“The report is completely incomprehensible to patients and the public. It raises questions about why NHS managers would want to produce a report that is so opaque.”
Professor Andy Hardy, the STP board lead, hit back at the speculation of A&E and Maternity closures in an article for the Coventry Observer, commenting:
"I can confirm that plans for a single A&E and Maternity Unit for Coventry and Warwickshire have not been discussed or agreed as part of the STP planning process.”
However, the lack of detail in the report, the lack of a concrete denial by Professor Hardy, and the unclear language used in the report means that speculation on cuts in services has continued.
A Coventry Telegraph article noted that: "The admission that "no decisions have been made" leaves plenty of scope for cuts to be announced at a later date."
According to another Coventry Telegraph article "the man leading the plan to cut more than £260 million from local NHS spending has admitted he can’t “offer any guarantees” [that services won't be closed] amid fears for the future of services."
A major criticism from local GPs of the STP is that they were not actually involved in the planning process nor allowed to see the STP prior to publication for any comment or input.
There has been criticism of the changes to stroke services that are planned, with campaigners noting that the result will be a net loss in beds.
Prof Anna Pollert, of the South Warwickshire Keep Our NHS Public group, noted: “Reading past the flannel about ‘improvement’, the plans boil down to Warwick Hospital losing 12 acute stroke beds, and George Eliot Hospital losing 18 acute stroke beds – a total loss of 30. These losses are not being made up at UHCW, which will increase its current 30 acute stroke beds by just one, to 31. Leamington Rehabilitation Hospital’s inpatient beds will go down from 20 to 19, and George Eliot’s lost acute beds will be replaced by rehab, with six beds increasing to 20."
An article in the Coventry Telegraph highlighted the fact that GPs in Coventry and Warwickshire were excluded from helping consultants Price Waterhouse Coopers (PWC) and Professor Hardy draw up the plans.
The Coventry Local Medical Committee (LMC), which represents local GPs, said that as well as not being involved in the process, it has also been refused any foresight at the plans, despite the fact that GPs offer around 90% of health care in Coventry.
There has also been criticism of the decision by the STP board to pay consultants PwC £378,000 to draw up the plans.
In September 2017, Keep our NHS Public North Warwickshire handed over a petition calling on all the organisations involved in the Coventry and Warwickshire STP to “publish full details of the financial, workforce and site plans”.
At a Warwickshire County Council meeting of 13 December 2016 it was agreed that the Council could not sign up to the STP until:
a) There has been full public engagement;
b) It has been co-produced along with the Health and Wellbeing Boards of both Warwickshire CC and Coventry CC;
c) It is rewritten in language which is accessible to the public.