6. Coast, Humber & Vale
What issues have been raised about this STP?
Closures of minor injury units at Alfred Bean, Withernsea and Hornsea hospitals. Campaigners have warned that people will face a 40-mile round trip to Hull or further to Beverley if the planned changes go ahead.
local GPs called for a rethink, pointing to the rurality of the area and its poor transport links.
Possible closure of A&E at Scarborough General Hospital24 beds cut at Bridlington Hospital and Withernsea Hospital
Closure of wards and theatres, staffing cuts, the ending of funding for some treatments and delays in funding newly approved treatments have all been suggested as cost-cutting measures, leaked to the HSJ and the Independent. Local NHS commissioners have described the plans as “thinking the unthinkable”.
The North Yorkshire County Council Scrutiny of Health Committee warned of an over-emphasis on deficit reduction coupled with a lack of understanding about the impact of the cuts. The cuts could see the downgrading of ‘consultant-led maternity and paediatric services’.
What are the proposed aims of the STP?
- Elimination of a projected 2020/21 deficit of £420 million;
- Implementation of "new integrated multi-disciplinary locality teams" leading to a re-configuration of community care;
- Increase in preventative care programmes, including an increase in digital technologies for self-care;
- Reduced bureaucracy;
- Reduction in A&E visits and admissions;
- Overall the STP's aims are to reduce the deficit by moving care away from the hospital sector and into the community and by reducing bureaucracy.
The STPs do not include detailed plans on how the deficit is going to be eliminated, particularly in the light of an ageing population.
Acute services are delivered by York Teaching Hospital Foundation Trust, Hull and East Yorkshire Hospitals Trust, and Northern Lincolnshire and Goole FT. The trusts plan to move to a new way of payment within the region. The plan is to abandon payment by results based on national tariffs and move to a cost and risk based contract for acute providers, along with an STP-level control total. The STP plans to invest the savings made from reducing the bureaucracy associated with the payment by results approach to other areas in the STP.
There are also plans for the acute trusts to consolidate certain services, including pathology, pharmacy, procurement and imaging.
The STP calls for an assessment of the way certain areas work both "clinically and operationally" beginning with dermatology, ophthalmology, orthopaedics, orthodontics and maxillo-facial. These specialties make up around 50% of appointments in the area.
The STP outlines that it is possible that there will be changes to the hospitals, in particular in Scarborough and in North East Lincolnshire and Goole region. No specific changes have been detailed, although there have been reports that the A&E at Scarborough is to close, however this has been refuted by the York Teaching Hospital Foundation Trust.
The STP outlines changes in the four regions that make up the footprint, as follows:
The STP plans an integrated multi- disciplinary team structure (called a Multispecialty Community Provider - MCP) to be implemented by October 2017. This will bring together social care and primary care under a single organisation.
Vale of York:
An Accountable Care System (ACS), which is hoped will ensure patients are cared for as close to home as possible to reduce the use of hospital care. New mental health in-patient facilities are planned for the local area in 2019.
Hull and East Riding of Yorkshire:
Integrated multi-disciplinary locality teams will be in place from April 2017, bringing together a number of services together including GPs, community services, mental health and adult social care.
North and North East Lincolnshire:
Accountable Care Partnerships (ACP) will be developed, with local teams bringing together community services, mental health services, social care, public health, GPs and acute providers.
In North Lincolnshire the approach will be delivered through three care networks and in North East Lincolnshire the model is being provided across two areas.
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 the Vale of York, Scarborough and Ryedale. 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.
North Yorkshire County Council is one of a small number of local authorities that is covered by three STPs. A report by the North Yorkshire County Council Scrutiny of Health Committee dated 18 November 2016 highlights a number of concerns raised about the STP process. This include:
- A lack of governance and democratic accountability
- A lack of engagement of non-NHS organisations and the general public
- An over-emphasis upon deficit reduction
- A lack of understanding of the impact of funding cuts in other areas for partners, such as public health, social care and housing
- Doubts as to whether the STPs will be able to deliver the promised financial and performance improvements
- A shortage of the capital funding needed to transform and modernise health services, especially in 2017/18 and 2018/19
Specific local concerns include:
- the STP could result in the downgrading of accident and emergency, consultant-led maternity and paediatric services
- and a reduction in accessibility to specialist health services and increased journey times.