39. Bristol, North Somerset and South Gloucestershire

What does the STP mean for your area?

The STP aims to reduce the number of acute beds in the area by 30%.

At a council meeting in January 2017, the council concluded that the STP's aim to cut £305 million from the Bristol area's NHS funding will result in fewer hospital beds, closure of services and less frontline staff. £104 million in cuts has yet to be identified.

In official documents leaked to the HSJ and reported by the Independent, cost cutting measures for the Bath and North East Somerset 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 £305.5 million;
  • Elimination of duplication of services across the region;
  • Implementation of a new model for prevention, self-care and early diagnosis;
  • Implementation of integrated primary and community care;
  • Reduce the use of the acute care sector.
  • Overall the STP aims to reduce the use of the acute sector and increase treatment in the primary/community sector.

 

Further information

Bristol City Council believes, among other things:

'1. That the cuts demanded by central government of £305 million are unfeasible and that there is no safe way of implementing such reductions.

  1. That the only way to provide adequate integrated health and social care is through adequate funding.
  2. That central government should increase NHS funding to at least 10.1% of GDP, to match the average of other EU countries.
  3. That the government must address the crisis in social care funding, to allow councils to provide the adult social care needed to keep people well in their own homes and reduce the unnecessary costs of keeping people in acute hospitals when they could be supported in the community.
  4. The STP does not have democratic accountability....

The STP is lacking vital details about how the plan will be realised. In December 2016, the chief executive of Weston Area Health NHS Trust – which runs Weston General Hospital – James Rimmer admitted details in how the plan will come to fruition were lacking, and he said it is ‘being worked through and will follow in due course’. He added: “The plan is incomplete and does require alterations. It’s not uncommon not to have all the answers five years in advance. There’s still work to be done.”

Acute care

Projects are underway investigating changes to the care pathways in the areas of: musculoskeletal (MSK); trauma & orthopaedic; and stroke. Other areas being investigated for savings are pathology, consolidation of corporate services, urgent care and specialised services.

Community

A major focus of the STP is the integration of primary and community care. The plan is to develop facilities in the community to allow mental and physical health services to be delivered locally from “Clustered” GP Premises. These centres may be embedded within the premises of other public sector bodies.

The STP notes: "at the core of our approach to integration of health and social care is the development of cluster based care, operating with community multi-disciplinary teams and improved care coordination, focused on proactive case management of those at greatest risk within our population."

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 Bath & North East Somerset. 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.