44. Buckinghamshire, Oxfordshire and Berkshire West

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

Plans to replace nine community hospitals with four community hubs.

Horton General Hospital in Banbury could see a reduced service put in place and the closure of 110 acute beds.

Horton General Hospital's maternity will be downgraded from an obstetric to a midwife-led unit.

‘Efficiency savings’ will see a reduction in higher grade nurses and an increase in the use of healthcare assistants and physicians associates. Planned workforce increase will be 978, although the estimated increase needed is 4,526.

Changes in who organises our care

In June 2017, Simon Stevens announced the first eight “accountable care systems”, that will each receive a share of up to £450m in transformation funding.

Two of the eight areas lie within this STP - West Berkshire and Buckinghamshire. This new model of care is designed to increase integration between hospital, community and primary care.

What are the proposed aims of the STP?

  • To eliminate the projected 2020/21 deficit of £479 million;
  • Reduction in the use of acute services;
  • To create out-of-hospital services operating from community hubs via a single point of access, integrated with primary and social care;
  • To improve the health of the population, including reducing adult and child obesity, avoidable admissions through falls, and targeting alcohol, hypertension, and smoking.

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 short on detail as to how its aims will be achieved and the deficit eliminated.

In June 2017, Simon Stevens announced the first eight “accountable care systems”, that will each receive a share of up to £450m in transformation funding. Two of the eight areas lie within this STP - West Berkshire and Buckinghamshire. This new model of care is designed to increase integration between hospital, community and primary care.

Hospitals

The future of Horton Hospital in North Oxfordshire is under review, with changes to urgent care, obstetric and paediatric services likely. Options also include moving stroke services and some critical care patients from the Horton General Hospital to the John Radcliffe in Oxford.

In August 2017 Oxfordshire CCG confirmed the downgrading of Horton Hospital.

During the meeting, the Oxfordshire CCG board members voted to support the following proposals from the consultation:

  • Transfer of Level 3 Critical Care from the Horton to the John Radcliffe (JR) in Oxford.
  • A complete transfer of immediate care for suspected strokes to the JR.
  • To make permanent the temporary downgrade of the Horton maternity unit from an obstetric to a midwife led unit (MLU).
  • The permanent closure of 110 acute beds, followed by a further 36 bed closures dependent on approval by the Clinical Senate.
  • An increase in Planned Care Services at the Horton, including plans for a new Diagnostic and Outpatient facility.

Five local councils and the Keep the Horton General campaign, however, plan to continue to consult with legal representatives regarding the possibility of further action to prevent the downgrading.

Workforce changes

The STP contained details of workforce changes in the area designed to save around £34.2 million. The STP said savings would be achieved by the “use of generic support workers (across health and social care), reduction of nursing grade input, increased use of healthcare assistants and physicians associates and more flexible uses of emergency care practitioners and advanced nursing practitioners”.

Criticism

The plans for a change in workforce mix have attracted criticism; an article in The Nursing Times noted that the details of the change in workforce mix in the STP was released the day after a major new study highlighted an increased risk of death from diluting the skill mix of registered nurses with more support staff, sparking warnings about the risk of the new nursing associate role being used as a substitute for nurses.

The lack of transparency and the consultation procedure has been criticised by councils and MPs in the area. Oxfordshire's Health Overview and Scrutiny committee has criticised the STP and the consultation. Oxfordshire Clinical Commissioning group was hauled before representatives of the Oxfordshire Health Overview and Scrutiny committee to answer questions on how it had consulted on the STP.   The consultation was described as "chaotic" by campaign groups.

In December 2016, Oxfordshire City Council overwhelmingly adopted a motion calling for moves to rein in the STP project.