21. Cambridgeshire & Peterborough
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.
Possible downgrading of the emergency department at Hinchingbrooke Hospial.
The potential merger of Hinchingbrooke Hospital and Peterborough and Stamford Hospitals
Possible closure of the minor injury units (MIUs) at Ely, Doddington and Wisbech.
Papworth Hospital will move onto the Cambridge Biomedical Campus in 2018.
Extra cost-cutting planned
This STP contains one of the CCG areas with the highest over-spend, as a result it is being asked to take additional cost-cutting measures to remain on budget. In official documents leaked to the HSJ and reported by the Independent, cost cutting measures for the Cambridgeshire and Peterborough area will include:
- Longer waiting times for elective care;
- Closure of wards and theatres;
- Staffing cuts;
- Ending funding for some treatments and prescriptions;
- Delaying or avoiding funding newly approved treatments.
Already, there are proposals to cut NHS funded IVF-treatment and to introduce a minimum 12 week wait for adults to receive non-urgent treatment in secondary care.
For more information see below.
What are the proposed aims of the STP?
- Elimination of a projected 2020/21 deficit of £504 million;
- Keeping people well and investing in home-based care;
- Development of three rural urgent primary care hubs;
- Development of centres of clinical excellence for orthopaedics and stroke;
- A patient choice hub for managing procedures across the system rather than in organisations and larger GP practices;
- A review of A&E services;
- Development of the area using an Accountable Care Organisation as a model.
Like other areas the 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.
According to the STP the deficit can be eliminated and a small surplus produced of £1.3 million.
However, this STP is very light on details of just what changes will take place and how these will eliminate the deficit.
This STP is reported to be the most challenging area out of all 44 footprints.
Local MP Cambridge Daniel Zeichner criticised the funding gap in the plan.
"Huge savings are anticipated through reducing the number of people who are readmitted to hospital, but that, in turn, depends on a significant improvement in current social care provision.
"I believe that these plans are wildly optimistic and unlikely to be achievable. There is a £43m hole in this plan”
In primary care, GP surgeries are to be encouraged to work together in larger federations.
The STP includes a review of A&E services. The report says while Specialist Emergency Centre will remain at Addenbrooke’s and an Emergency Centre at Peterborough, Hinchingbrooke will “retain its A&E and will continue to be able to manage the current caseload of minor injuries and major medical cases, with a physician-led service”.
In June 2017 the HSJ reported on discussions between NHS Improvement and NHS England on what certain CCG areas will be required to do to enable them to spend less money and remain within a budget known as a 'control total' for 2017/18; this is the capped-expenditure process (CEP). The 14 target CEP areas include Cambridgeshire and Peterborough. The measures under discussion include the following:
- 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.
As part of the CEP, in September 2017, Cambridgeshire and Peterborough CCG announced that it was instigating a minimum 12 week wait for referral to secondary care for non-urgent treatment. NHS Cambridgeshire and Peterborough CCG has already announced plans to scrap free IVF services until April 2019.