25. Hertfordshire and West Essex

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

Almost 30 hospital beds will be lost when two wards of St Albans City Hospital are shut.

An £8.5 million fund to reduce bed-blocking has been cut, although this was a key component of the STP.

Local stop smoking services have been cut. Action on Smoking and Health has warned this will end up costing the NHS significantly more in the long term.

Herts Valley CCG and East and North Hertfordshire CCG have instigated a number of cost-savings measures, some very controversial, such as obese patients made to lose weight and smokers having to give up smoking in order to be referred for non-urgent treatment.

IVF treatment has been cut across the region.

Development of Hemel Hempstead hospital into a community hub; the current urgent care centre is being downgraded to an urgent treatment centre in December 2017.

Finances

This STP could have a deficit of £550 million by 2020/21, yet the STP contains few details of how savings are going to be made. This area is really struggling financially; the East and North Hertfordshire Trust reported a deficit of £28 million in early 2017  and Herts Valley CCG has reported record deficits. The Princess Alexandra Hospital, Harlow needs £150 million over next ten years and West Hertfordshire Hospital Trust needs £178 million for critical work.

Changes in who organises our care

There are plans to create an accountable care partnership model of care in West Essex.

What are the proposed aims of the STP

  • Elimination of a projected 2020/21 deficit of £550 million;
  • To improve health and well-being and reduce demand for services;
  • Integration of primary and community services;
  • To reduce demand for hospitals and move care out of hospital;
  • To reduce variation in hospital care;
  • Overall, the aim of the STP is to reduce the use of the hospital sector and increase the use of community and primary care sector.

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.

Further information

The STP lacks detail on how the deficit is going to be eliminated, yet care and services maintained.

Finances

The CCGs in this STP area have high deficits and are seeking to make rapid savings to balance their books. Herts Valleys CCG in particular is in a precarious financial position, and is heading for a record deficit unless it makes “controversial decisions” to cut patient services.

Furthermore, the local hospitals are in dire need of heavy investment to enable them to continue functioning. The Princess Alexandra, Harlow needs £150 million to create a “functioning hospital” for the next 10 years.

The West Hertfordshire Hospital Trust needs £178 million for critical backlog maintenance, loan repayments and to address urgent capacity and compliance needs. The STP document is not clear on where the money for this will be found.

Controversial decisions for rationing were announced in October 2017 by East and North Hertfordshire CCG and Herts Valley CCG; patients who smoke or who are obese could face an indefinite wait for non-urgent surgery, although there may be exceptional circumstances. Obese patients will have to reduce their weight by 15% in nine months and smokers will have to have given up for at least eight weeks. The CCGs aim to save £68 million a year with these changes, plus a ban on prescribing gluten-free food, over-the-counter medicines and female sterilisation.

Herts Valley CCG cut funding for measures that prevent delayed discharge from hospital. Worth £8.5 million, the measures are key to the implementation of the STP.

Other cost-saving moves by Herts Valley CCG include, the withdrawal of funding from the Nascot Lawn Respite centre, downgrading the urgent care centre at Hemel Hempstead Hospital to an Urgent Treatment Centre from 1 December 2017, and stopping IVF treatment for the next year.

East and West Hertfordshire CCG has cut its funded IVF treatment from three courses to just one.

Hospitals

An “agreement in principle” has been reached for West Hertfordshire Hospitals to “formally” be part of the Royal Free London Foundation Trust hospital group by April 2018.

Greater partnership working between East and North Hertfordshire and The Princess Alexandra hospital, with the trusts looking to create “pan-provider” pathways across vascular surgery, paediatric urology, specialist cancer surgery and others, as well as integrating back office support services.

In the STP there is also the potential redevelopment of Hemel Hempstead Hospital into a community hub/local hospital facility in the final year of the STP period.

Community care

Collaborative commissioning between the three CCGs in the footprint, with the aim for each to save 20% by 2021.

The creation of an accountable care partnership in west Essex including some parts of an MCP and PACS models of care.

Workforce

The STP notes that there will be changes to the workforce with £109 million of savings identified from “other provider productivity/staff changes”. The plan does not specify if staffing numbers will be cut. It says it will “develop short term actions and long term strategies” to help solve agency, recruitment and retention issues as well as matching staffing plans with new care models.