40. Bath, Swindon and Wiltshire

What does the STP mean for your area?

Health planners are trying to reduce NHS deficits and think about ways to re organise care. However getting the large deficits under control could prevent facilities being developed that can cope with the health and care social needs of local people.

Proposed cuts

This area was targeted by NHS England for additional cost-cutting measures due to its high-spending. The measures are to ensure that it remains within its control total (budget) for 2017/18.

Proposed closure of ‘place of safety’ units (for people in ‘extreme mental distress') in Sandalwood Court Swindon and Fountain Hospital Salisbury. The Green Lane Hospital in Devizes will serve the entire county.)

Changes in who organises our care

The STP proposes new models of care, including a move to accountable care systems in Swindon and Wiltshire. In Bath and North East Somerset a contract for the vast majority of community care and preventative care has been awarded to Virgin Care. Virgin Care is acting as a multispeciality community provider (MCP) - a new model of care.

What are the proposed aims of the STP?

  • Elimination of a projected 2020/21 of £290 million;
  • An increase in preventative care;
  • Integration of health and social care;
  • Further integration of back-office functions;
  • New models of community and primary care.

Like other areas they plan to transfer services out of hospital and into the community. The concern is that financial pressure will mean that cuts in hospital care will be made, helping to achieve savings, but without proper investment in community health services.

Further information       

The STP is very limited on details of how exactly the deficit is going to be eliminated and what changes will be made to services. Approaches across the area, include a "shared approach" to recruitment for bank and agency staff in order to reduce the money spent on temporary staff; all back office functions reviewed to see the potential for sharing services across the three acute trusts, including payroll services and the supply purchasing; and there will be a review of property and buildings - includes "identifying quick wins" in the form of upcoming lease breaks.

Hospitals

The report states that there are no plans to merge the three acute trusts - Salisbury District Hospital, the Royal United Hospital in Bath and Great Western Hospital in Swindon - due to the long distances between them, but there will be a collaboration between the trusts to "ensure 'at risk' services remain sustainable.

Outpatient services will be extended and will include a trial geriatrician model to "improve the care and management of frail and elderly people, better access to mental health assessments and improved assessment and prevention of alcohol-related conditions."

Urgent Care

There are plans to establish one point of triage with one call centre for 111 across the footprint. NHS 111 call handlers will continue to give advice but will also have the ability to directly book GP appointments

Community care

The STP proposes that the Swindon area will progress to an accountable care system during the planned period. In Wiltshire discussions are ongoing into a new care model, however B&NES has recently awarded a Prime Provider contract for a range of community and preventative services to Virgin Care and is in discussions with local providers regarding the nature of care models.

In addition, there are plans for general practices to come together in networks providing services to 20,000 to 50,000 people, with a number of "Primary Care Urgent Care hubs" will be established to support seven-day working. There will also be more widespread use of telehealth/telecare to manage more patients in the community.

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Changes across the area

In June 2017 the HSJ reported on discussions between NHS Improvement and NHS England on what certain over-spending areas will be required to do to enable them to reduce spending and remain within a budget known as a 'control total' for 2017/18; this is the capped-expenditure program (CEP).  The 14 target CEP areas includes Bath, Swindon and Wiltshire. 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.