19. Herefordshire and Worcestershire

What does the STP mean for your area?

The A&E at Alexandra Hospital in Redditch will be downgraded and replaced with a single emergency centre with specialist services in Worcester, and two emergency centres in Hereford and Redditch.

This has been a particularly controversial move considering the difficulties that the Worcestershire Hospital experienced over winter 2016/2017 with major A&E capacity problems.

Maternity services are likely to be cut from Redditch, with all services centralised at the Royal Worcester site.

Bed cuts include:

A 62% reduction in the number of community hospital beds in Herefordshire.

A 44% reduction in the number of community hospital and resource centre beds in Worcestershire

An unspecified reduction in the number of acute beds in Worcestershire.

But the STP does highlight the need for a 15% increase in the number of acute beds in Herefordshire.

Overall, this amounts to a loss of 142 community beds in Worcestershire and 60 in Herefordshire, or 44% of community beds.

The community hospitals targeted are in Malvern, Pershore, Evesham, Tenbury and Bromsgrove.

The head of the NHS recently warned that slashing bed spaces amid a “sharp rise” in demand is too risky.

What are the proposed aims of the STP?

  • Elimination of a projected 2020/21 budget deficit of £336 million;
  • Prioritise investment in primary and community care;
  • Encourage behaviour change to improve the health of the population;
  • Encourage and support patients to self-manage their conditions;
  • Develop prevention strategies to reduce demand for surgery;
  • Overall the STP is seeking to move care away from hospitals, including community hospitals, and into the community and primary care.

Further information

The STP does not contain much detail on how exactly the deficit will be eliminated.

A local doctor, Dr Jonathan Wells, the former chair of Redditch & Bromsgrove Clinical Commissioning Group (CCG), has been highly critical of the STP saying that it fails to tackle key outstanding issues.

In his submission to the Redditch borough council health commission, he noted several major concerns about the plans for the Alexandra Hospital, Redditch, including:

  • Staffing problems in A&E at the Alexandra Hospital. With more services going to Worcester it will be hard to attract talented staff willing to work in what would be an environment with fewer specialities. It is still not known if a full time adult A&E at the hospital is sustainable in the long run;
  • There is no capacity in place elsewhere for pregnant women to have a choice where they give birth;
  • The lack of support services at the Alexandra due to the drain of staff to Worcester which puts acute medicine at the Redditch hospital in jeopardy;
  • Financial viability – WAHT was £59 million in debt last year, is projected to be £37 million in debt this year yet the changes will only produce savings of £3.5 million;
  • The lack of capacity at Worcestershire Royal – it simply does not have enough beds;
  • The failure to engage with University Hospitals Birmingham NHS Foundation Trust – the QE – which could help alleviate capacity problems and possibly breathe new life into the Alex.

Dr Wells also noted that there is no capacity in the system and this will be made worse as the STP removes 44% of community beds. He also highlighted that the finances do not add up.

Councillors in Ross-on-Wye have expressed their concern over the possible loss of beds in Ross-on-Wye community hospital.

Community Care:

Community care will be developed using the Multispeciality Community Provider model, one for Worcestershire and one for Herefordshire.

The STP states that "Some community hospitals may be able to operate as bedless, e.g. as a 'locality hub' for domiciliary based community services integrated with primary care."