40. Bath, Swindon and Wiltshire

What does the STP mean for your area?

The STP proposes a single urgent care service for the area.

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.")

In official documents leaked to the HSJ and reported by the Independent, cost cutting measures for the Bath, Swindon and Wiltshire 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 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;
  • According to the STP, there is a move away from a "reliance on hospital-based care to self-care and management of individuals in a community setting and in their own home using assistive technology".

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.

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 and B&NES has recently awarded a Prime Provider contract for a range of community and preventative services and is in discussions with local providers regarding the nature of care models.

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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 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, 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.