24. Milton Keynes, Bedfordshire and Luton

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.

Proposed changes

The STP plans could see mergers and cuts at the three hospitals in the area: Luton, Milton Keynes and Bedford.

A&E services could be reduced in at least one of the three hospitals, 'especially overnight'.

Consultant-led maternity care could be cut in at least one hospital, meaning only 'low-risk births' could take place there.

Paediatric care at two of the hospitals could be reduced, with care concentrated for the most unwell children at one of the three sites.

A number of "limited clinical value" conditions will no longer be treated; these range from bariatric surgery to female sterilisation to eye lens implants.

Criticism

The STP has come under sharp criticism from the Mayor of Bedford and local councillors for its lack of concrete plans for the three local hospitals.

Results of an initial public consultation shows that the public is concerned about the lack of detail, use of jargon, and lack of public and local authority involvement in the plans. Many members of the public thought that there was a problem with underfunding.

Changes in who organises our care

This area has been named one of the first accountable care systems and will receive a share of up to £450 million in transformation funding. This is a new model of care that will increase integration between health and social care.

What are the proposed aims of the STP?

  • Elimination of a projected 2020/21 deficit of £311 million;
  • To bring all three hospitals under the same leadership, with integrated management and service delivery;
  • Integration across the footprint for urgent care services (including 999, 111 and GP OOH);
  • Development of an accountable care system;
  • Reviews of all clinical and non-clinical services with a view to reorganisation, in particular maternity and A&E;
  • Development of Primary Care Home work package (establishing GP clusters and community and social care teams).

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.

Consultation feedback

In July 2017, the STP organisation published details of initial consultation on the plans with staff and public. This can be found in full here.

General views included the following:

  • there needed to be more detail in the plans;
  • there was a lack of clarity of the terminology used, in particular what was meant by ‘unnecessary duplication’ of services;
  • many felt that NHS underfunding was the fundamental problem and queried where the money would come from to support and deliver change;
  • many respondents also mentioned the need for greater public and local authority involvement in the plans.

With regard to A&E the feedback was that "NHS staff and patients felt that A&E departments should be retained at all three hospital sites, and expressed concern that removal or downgrading of A&E could impact on a Trust’s viability and ability to recruit staff."

The feedback for maternity services was mixed;  many public and staff respondents said that maternity services needed to be expanded, and more staff recruited, but views on the separation of high and low risk births were mixed.

The feedback was that a paediatric emergency service "must be retained at all three hospital sites to manage injuries and assess unwell children, referring them on to another hospital where necessary."

Further information

The STP lacks details on the changes that will be needed to eliminate the deficit.

New models of care

In June 2017, Simon Stevens announced the first eight “accountable care systems”, that will each receive a share of up to £450m in transformation funding. One of the eight areas is Luton and Milton Keynes with Bedfordshire. This new model of care is designed to increase integration between hospital, community and primary care.

Hospitals

Changes are planned for the hospital sector with the three hospitals - Luton, Milton Keynes and Bedford - working more closely together, beginning with the introduction of a shared leadership and management.  The STP also set in motion reviews of all the services being delivered at each hospital.

In October 2017, Bedford Hospital Trust and Luton and Dunstable University Hospital Foundation submitted a business plan and began consultations with staff and the public on a merger.

The new single organisation would share management and clinical teams. The business plan notes that emergency, consultant-led maternity and paediatric services will stay at both sites. However, it is unclear what type of emergency service will operate at Bedford.

Pathology services will be consolidated across the three hospitals.

A 'single point of access' for all 999, 111 and Nurseline calls in the region will be created.

It should be noted that a previous review of services at Bedford hospital and Milton Keynes hospital was abandoned (after costing £8 million), although it did advocate the closure of Bedford's maternity services and its A&E department. There is now concern that the STP review will lead to the same conclusion.

Community care/primary care

CCG's in the area are seeking to make savings via restrictions on prescribing, such as on gluten-free food. Milton Keynes CCG's plans to restrict hearing aids, however, was abandoned after a backlash from experts, including the Central and North West London Foundation Trust.

Council reaction

Milton Keynes councillors have demanded that eight key issues are protected or improved. These include maternity, A&E, nurses, GP services, and mental health services.

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In early March 2017, Jim Thakoordin, an elected member to the council of governors at the Luton and Dunstable University Hospital criticised the STP.  Mr Thakoordin said: “There will be rationalisation that could result in local people from each area travelling to another hospital other than their own to access services and support. I am also worried that some key staff will either leave the NHS; become redundant; become more stressed; and the services will become more difficult to access. I believe there will be a reduction in the number of beds, meaning patients may be forced to return home or in to a care home prematurely.”