33. Sussex and East Surrey

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 STP contains very little detail of the exact changes that will be put in place to eliminate the deficit in the area.

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

Some form of hospital reorganisation is planned.

Stroke care could be merged into a "hyper acute stroke unit" in Brighton after an 18 bed ward in Crawley and the stroke ward at the Princess Royal were closed.

The STP states that £112 million in social care efficiencies have been identified.

Changes to who delivers your care

The STP contains plans to implement new models of care, including Accountable Care Organisations and Multispeciality Community Providers.

Extra cost-savings needed

This area contains some high-spending CCGs that NHS England has targeted with suggestions for additional cost-saving measures to ensure they remain within their 'control totals' (or budget) for 2017/18; this is part of what is known as the Capped Expenditure Programme (CEP). As a result:

Patients at risk of a heart attack could be denied vital tests and potentially life-saving operations under plans to make £55m of budget cuts.

Senior NHS sources in this area have disclosed that they are also being forced to "think the unthinkable" and consider proposals to:

  • Ration knee arthroscopy operations, cataract removals and tonsillectomies
  • Introduce “lifestyle rationing” so that patients who are obese and smoke will have to lose weight and stop smoking before they can have, for example, a knee replacement to treat their arthritis
  • Shut beds or even whole wards in community hospitals
  • Restrict patients’ access to hearing aids and IVF treatment

For more information, see below.

Criticisms

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.

What are the proposed aims of the STP?

  • Elimination of a projected 2020/21 deficit of £864 million;
  • To increase 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.

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 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 investment, 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 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.

 

hospital-1802679_960_720

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 over-spending CCG 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; this is the capped expenditure process (CEP). The 14 CEP 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.

Criticisms

Campaigners have been critical of the lack of public engagement in the plans and secrecy that has surrounded the STP's development. As of July 2017, there was no public consultation process underway on the STP. Campaigners also believe that the STP will lead to numerous cuts in services.