24. Milton Keynes, Bedfordshire and Luton
What does the STP mean for your area?
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.
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).
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."
The STP lacks details on the changes that will be needed to eliminate the deficit.
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.
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.
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.
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.
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.”
The STP includes plans to create a shared citizen record for both health and social services to make integration easier. There is also mention of the creation of an accountable care organisation (ACO) model for the area, which will transform commissioning and the supply chain in the area.