2. West, North and East Cumbria

What issues have been raised about this STP?

The end of consultant-led maternity care at West Cumberland Hospital has been proposed.

Downgrading of West Cumberland Hospital so that only low-risk services are available, with Cumberland Infirmary Carlisle providing high risk services.

Merging all acute stroke services into a single hyper-acute unit at Cumberland Infirmary, Carlisle.

Bed Cuts proposed at West Cumberland Hospital inpatient unit and eight community hospitals. Reducing bed numbers from 133 to 104.

The changes in the hospitals in this area are of concern due to issues with the ambulance service in the area; the service was ordered to make safety improvements in January 2017 by the Care Quality Commission. One of the major issues was paramedic vacancy rates.

In a letter to hospital bosses, the head of the North West Ambulance service, Derek Cartwright said he does not believe the controversial plans to transfer women more than 40 miles while in labour are clinically safe. The letter also included reservations about plans to centralise maternity consultants in Carlisle, leaving only a midwife-led unit in Whitehaven.

This area contains one of the over-spending regions targeted for additional cost-savings measures by NHS England in June 2017. Closure of wards and theatres, staffing cuts, the ending of funding for some treatments and delays in funding newly approved treatments have all been suggested as cost-cutting measures, in documents leaked to the HSJ and the Independent. Local NHS commissioners have described the plans as “thinking the unthinkable”.

What are the proposed aims of the STP

  • Eliminate the projected 2020/21 deficit of £168 million;
  • Encourage prevention, self-care and promotion of independence;
  • Invest in services which prevent, reduce or divert demand for hospital to reduce the need to send people a long way from home, and reduce hospital admissions;
  • Stabilise and expand primary care and increase the role of community pharmacies;
  • Optimise care outside hospitals through a programme to implement “Integrated Care Communities” (ICCs) and wrap around specialist community provision.
  • Overall the STP's aim is to move care from the acute sector to the community sector.

Further information

The STP for West, North and East Cumbria is more advanced than many as it has been built on the ongoing Success Regime project.

The Success Regime plan includes consolidation of the hospital sector and a public consultation has already taken place on some major changes.

In June 2017 documents leaked to the HSJ revealed discussions between NHS Improvement and NHS England on additional cost-savings measures that must be considered by 14 over-spending CCG areas. These measures are to enable them to remain within a budget known as a 'control total' for 2017/18. The target areas include Morecambe Bay CCG, part of the West, North and East Cumbria STP area. The measures under discussion include the following:

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  • Limiting the number of operations carried out by non-NHS providers so the funding stays within the NHS. Considerations differ between areas but include both limiting patients’ choice of providers, and reducing work which is outsourced by NHS trusts. In some cases it would require the NHS to find the capacity to carry out more operations.
  • Systematically drawing out waiting times for planned care, including explicit consideration of breaching NHS constitution standards. Some plan to target delays at specialties/areas where waits are currently lower than average.
  • Stopping NHS funding for some treatments, including extending limits on IVF, adding to lists of “low value” treatments, and seeking to delay or avoid funding some treatments newly approved by the National Institute of Health and Care Excellence.
  • Closing wards and theatres and reducing staffing, while seeking to maintain enough emergency care capacity to deal with winter pressures.
  • Closing or downgrading services, with some considering changes to flagship departments like emergency and maternity - though these would normally take too long to deliver savings this year.
  • Selling estate and other “property related transactions”.
  • Stopping prescriptions for some items, as suggested by NHS Clinical Commissioners earlier this year.

The commissioners in the area told the HSJ that they have been told to examine “difficult decisions” and “think the unthinkable”, including modelling changes which are normally avoided as they are too unpleasant, unpopular or controversial.