30. South East London
What does the STP mean for your area?
The STP is very limited in details of changes that will be made.
There will be changes to community care, including the development of 23 Local Care Networks (LCNs), which will bring primary, community, specialist teams working in the community, mental health and social care colleagues together to manage the health and care of local populations of between 50,000-100,000.
An integrated urgent care system is planned to be in place by 2018.
The STP aims for an increase in births at home and a reduction in the number in labour wards.
As this area has one of the highest over-spends it has been targeted by NHS England and NHS Improvement for extra cost-control methods. These could include:
- Longer waiting times for elective care;
- Closure of wards and theatres;
- Staffing cuts;
- Ending funding for some treatments and prescriptions;
- Delaying or avoiding funding newly approved treatments.
What the proposed aims of the STP?
- Elimination of a projected 2020/21 deficit of £854 million;
- Development of local care networks (LCNs) to establish multi-disciplinary networks;
- To increase in focus on prevention to improve the health of the population;
- Reduction in pressure on A&E by using alternatives;
- Increased collaboration across the footprint;
- Overall, the STP aims to avoid the need for new hospital beds by reducing A&E visits and hospital admissions and by moving care away from the acute sector to the community sector.
The STP is short on details of how the deficit will be eliminated at the same time as maintaining levels of care.
A full report into the STP by the campaign groups Save Lewisham Hospital Campaign and Lambeth Keep our NHS Public is available here.
South East London STP board has been criticised for spending money on consultants; the organisation spent £1.8 million on consultants from Price Waterhouse Coopers.
The STP will invest in the development of 23 Local Care Networks (LCNs), which will incorporate all 246 GP practices. LCNs are similar to multispecialty community providers (MCP) and bring primary, community, specialist teams working in the community, mental health and social care colleagues together to manage the health and care of local populations of between 50,000-100,000.
According to the STP, by 2018 an integrated urgent care system will be established, bringing together the whole system, including a new 111 service. This will include a single out of hours number and access to a clinical hub, and will promote the use of alternative services in the community, including district nurses and community pharmacy.
The STP aims for an increase in births at home and reduce the number in labour wards.
Develop roles such as care navigators and physician associates who can reduce some of the demands on GP time.
The STP outlines the increased use of digital technology. It is proposing the introduction of “algorithmic decision support tools” to aid its 1.67 million population and to have “universally deployed digital alternatives to face-to-face care in primary care and outpatient services.”
Changes across the area
In June 2017 the HSJ reported on discussions between NHS Improvement and NHS England on what the CCG areas with the highest over-spends will be required to do to enable them to spend less money and remain within a budget known as a 'control total' for 2017/18; the capped expenditure process (CEP). The 14 CEP target areas include South East London. The measures under discussion include the following:
- Limiting the number of operations carried out by non-NHS providers so the funding stays within the NHS. Considerations differ between areas but include both limiting patients’ choice of providers, and reducing work which is outsourced by NHS trusts. In some cases it would require the NHS to find the capacity to carry out more operations;
- Systematically drawing out waiting times for planned care, including explicit consideration of breaching NHS constitution standards. Some plan to target delays at specialties/areas where waits are currently lower than average;
- Stopping NHS funding for some treatments, including extending limits on IVF, adding to lists of “low value” treatments, and seeking to delay or avoid funding some treatments newly approved by the National Institute of Health and Care Excellence;
- Closing wards and theatres and reducing staffing, while seeking to maintain enough emergency care capacity to deal with winter pressures;
- Closing or downgrading services, with some considering changes to flagship departments like emergency and maternity - though these would normally take too long to deliver savings this year;
- Selling estate and other “property related transactions”;
- Stopping prescriptions for some items, as suggested by NHS Clinical Commissioners earlier this year.
The commissioners in the area told the HSJ that they have been told to examine “difficult decisions” and “think the unthinkable”, including modelling changes which are normally avoided as they are too unpleasant, unpopular or controversial.