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.

The STP has to eliminate a projected 2020/21 deficit of £260 million and the board believes this can be achieved by:

• The reconfiguration of hospital services (Saving £110.7 million);
• A reduction in the number of A&E admissions and a shift to urgent care centres;
• Increased focus on prevention services to improve the health of the population;
• Movement of care away from hospitals into the community.

The STP board says of its own plan, "An ambitious system wide care strategy has been developed with full engagement of clinicians and wider stakeholders to provide better quality of care and outcomes for patients in the longer term. This is a rare example of a whole system approach underpinned by strong collective leadership."

To date no consultation that specifically covers the STP plans appears to have been conducted by the CCGs involved. Individual CCGs have 'Get Involved' sections on their websites, where comments can be left and events are advertised.

The STP includes plans for the closure of A&E services at either Darlington Memorial Hospital or University Hospital of North Tees in Stockton on Tees. After the decision has been made, the hospital that keeps its A&E will join the James Cook University Hospital in Middlesbrough in becoming ‘specialist hospitals’ offering acute emergency care.

James Cook University Hospital will provide a 24 hour consultant service with the other providing a 16 hour service.

Both hospitals will provide specialist care, acute surgery and potentially consultant led obstetric and inpatient paediatrics.

The James Cook hospital will continue to host the major trauma centre.

The hospital that loses its A&E will continue to offer the following:

• Day care and outpatient elective care
• Urgent care services
• Frail elderly assessment unit
• Short stay paediatrics
• Specialist elective care
• Midwife led obstetric unit

Friarage, Hartlepool and Bishop Auckland hospitals will provide similar services, although only the Friarage site in Northallerton will retain its A&E.

According to the STP other additional savings will be made by consolidation of hospital services, including obstetrics and inpatient paediatrics and pathology.

Mental health inpatient services are to be closed at Friarage Hospital and the CCG suggests it is because it wants to strengthen community mental health services for adults so more people can be supported at home. The CCG says that the decision was made after extensive public consultation.

Under the STP a number of Multispeciality Community Providers (MCPs) will be set up covering populations of 30,000-50,000 and this in combination with more care in the community is listed as saving £4.92 million.

A new £80 million care model contract for community services is under procurement by several trusts and a consortium formed by the county council the HSJ revealed. The Scarborough and Ryedale CCG has shortlisted these groups for it’s 7 year contract.

Mental health inpatient services are to be closed at Friarage Hospital and the CCG suggests it is because it wants to strengthen community mental health services for adults so more people can be supported at home. The CCG says that the decision was made after extensive public consultation.

Under NHS England plans all STP areas will develop into Integrated Care Systems (ICS), previously known as Accountable Care Systems (ACS). This is a new model of care that aims to integrate hospital, community and social care. For further details see our pages on New Models of Care and Accountable Care Organisations.

A new £80 million care model contract for community services is under procurement by several trusts and a consortium formed by the county council the HSJ revealed. The Scarborough and Ryedale CCG has shortlisted these groups for it’s 7 year contract.

The Council has expressed concerns that the scale of the plans could see rural communities losing out on funding to larger urban areas.

A report by the North Yorkshire County Council Scrutiny of Health Committee on the 18 November 2016 raised a number of concerns raised about the STPs.

• A lack of governance and democratic accountability;
• A lack of engagement of non-NHS organisations and the general public;
• A lack of understanding of the impact of funding cuts in other areas for partners, such as public health, social care and housing;
• Doubts as to whether the STPs will be able to deliver the promised financial and performance improvements;
• A shortage of the capital funding needed to transform and modernise health services, especially in 2017/18 and 2018/19.

Specific local concerns about the STP include:

• that it could result in the downgrading of accident and emergency, consultant-led maternity and paediatric services;
• reduced accessibility to specialist health services and increased journey times.

Local campaign groups have warned that forcing people to travel further to their A&E is putting “lives at risk”.