29. North East London

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 A&E department at the King George Hospital will be downgraded to an urgent care centre in Summer 2019.

This will leave the borough of Redbridge without an A&E. Although alternative A&Es are not geographically far away, heavy traffic can mean it takes between half an hour and an hour to reach them.

This area is predicted to see a 50% fall in GP numbers; to cope with this there are plans to recruit physician associates as well as have some of the work load taken up by the 111 phone service and pharmacists. Local GPs fear that this will reduce the standard of care.

Lack of investment and severe cuts

This STP will need an enormous capital investment of £500-£600 million, however it contains few details of where this funding is going to be obtained. GPs, nurses, managers and other staff in the borough of Tower Hamlets have warned that severe cuts will have to take place in services for the required savings to be made.

Changes in who organises our care

There are plans for an Accountable Care System (ACS) in Barking, Dagenham, Havering and Redbridge by April 2018, and City and Hackney CCG will expand its current pilot devolution to an ACS.

What are the proposed aims of the STP?

  • Elimination of a projected 2020/21 deficit of £578 million;
  • To promote disease prevention and self-care;
  • Development of accountable care organisations;
  • Reconfiguration of urgent and emergency care and reduction in the time people spend in hospital and in the number of emergency admissions;
  • Integration of community, primary and social care to increase care closer to home.

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.

Further information

The STP will need capital investment of £500m-£600m, but does not contain details of exactly how the capital funding for the changes outlined is going to be obtained and how exactly the £587 million deficit is going to be eliminated.

The STP includes plans for the “pooling of health and social care budgets” and a “single leadership team” responsible for both the development of accountable care systems and business as usual activities. This process of integration within the STP is not running smoothly, in September 2017 NHS England threatened City and Hackney CCG with legal directions if it does not support the STP and the appointment of a single accountable officer to cover all CCGs within the STP.

Included in the STP is a request for “flexibility on health and social care funding arrangements and freedom to break from existing regulation”.

Community

The STP suggests that there are significant opportunities for out of hospital services to be delivered using local authority estate, such as children’s centres and libraries.

The development of accountable care systems (ACS) is a major part of the STP, with an ACS planned to go live in Barking, Dagenham, Havering and Redbridge by April 2018 and City and Hackney CCG will expand its devolution pilot to an ACS.

ACS explained

hospital-1802680_1920

Primary care

The STP’s intentions for primary care include a plan for practices to have onsite diagnostics and to cater to a population of no smaller than 10,000-15,000.

The area is struggling to recruit enough GPs, with a forecast 50% fall in GP numbers within the next five years. The STP contains plans to recruit and train more than 100 physician associates to work in GP practices to try to plug the gap in GPs.

Pathology

Further consolidation of pathology services is planned and increased automation. Homerton Hospital is likely to lose its pathology department, according to an article in the Hackney Gazette.

Criticism

Speaking to the Hackney Gazette, Nick Mann GP said the STP was “the final nail in the coffin” for the NHS: “Our local STP plans to cut the number of GPs from 600 to 400, backfilled by a 111 phone service directing you to ‘self-care’ websites, a pharmacist, or a non-medically qualified individual.”

In December 2016 GPs and other health professionals in the area signed a statement calling for the STP process to be halted.

Speaking to the House of Lords committee on NHS Sustainability in November 2016, Tower Hamlets LMC chair and GPC member Dr Jackie Applebee said the predicted loss of GPs in the area was ‘eye watering’ and ‘horrific’, and plans to recruit physician associates would mean ‘a real deterioration in quality of care’.

Council reaction

In February 2017, Hackney Council's head of Health and Social Care, Councillor Jonathan McShane, refused to endorse the STP until he got more concrete proposals on the cost-cutting in the plan. In reply, a spokesman for the North East London (NEL) STP  told the Hackney Gazette that the plans “have just not got to that point”.

The London Borough of Waltham Forest refused to recommend sign up to the NE London STP raising a number of concerns which are detailed in paragraphs 3.19-3.21 of the minutes of the Cabinet meeting of 17 January 2017.  Concerns include 'the rushed process and tight deadlines has not yet enabled any meaningful engagement, and must be addressed before the STP is finalised'.