What does the STP mean for your area?

There is a current 3% shortfall in acute beds at Brighton’s Royal Sussex County Hospital

Stroke care will be merged at one site: Princess Royal in Haywards Heath

The STP document acknowledges that there is a 3% shortfall in acute beds that needs to be rectified until the plans to enhance community services have been put in place to reduce the demand on hospital services.

Campaigners are concerned over the affect that £530 million worth of spending cuts will have on services and believe that there will be widespread cuts to services.

In official documents leaked to the HSJ and reported by the Independent, cost cutting measures for the Sussex and East Surry area 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

For more information, see below.

 

What are the proposed aims of the STP?

  • Elimination of a projected 2020/21 deficit of £864 million;
  • Increase in integration of care;
  • Improvements in self-care and prevention services;
  • The development of community hubs to reduce the demand on hospital services;
  • Shared patient records.
  • Overall, the STP focuses on reducing demand for hospital care and moving care into the community.

 

Further information

The plan contains few details of the changes that will be needed to save money and there is little detail on the impact for patients of hospital reconfiguration. The STP outlines the need for £491.5 million, although it only lists suggested sources for this money, primarily 'commercial capital partnerships & commercial loans'.

The STP divides the area into three 'places' - Coastal Care, Central Sussex & East Coast Alliance, and East Sussex Better Together. Each 'place' is to be developed with a different model of care. The plans are designed to cut £530 million of spending leaving a deficit of £60 million by 2020/21.

The STP also notes that £112 million of social care efficiencies have been identified.

Coastal Care

This 'place' will form an accountable care organisation (ACO) with a single budget.

Urgent care will be redesigned.

The aim of the changes is to reduce spending on hospital care by £44 million by 2020/21.

Central Sussex & East Coast Alliance

This 'place' is set to be with a Multispeciality Community Provider (MCP).

The aim of the changes is to reduce spending on hospital care by £80 million by 2020/21.

East Sussex Better Together

This 'place' will form an accountable care organisation (ACO) with capitated funding and pooled budget.

The aim of the changes is to reduce spending on hospital care by £44 million by 2020/21.

Hospitals

Community

The STP will create ten community hubs that will support care outside of hospital in an effort to reduce A&E admissions and the need for hospital care. The STP notes that the funding will come from 'Commercial capital partnerships & commercial loans'.

Changes across the area

In June 2017 the HSJ reported on discussions between NHS Improvement and NHS England on what certain STP areas 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 target areas include Sussex and East Surrey. 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.

Campaigners have also been critical of the lack of public engagement in the plans and secrecy that has surrounded the STP's development. As of mid-February 2017, there was no public consultation process underway on the STP.