• Elimination of the projected financial gap which by 2020/21 will be more £286 million. The solutions outlined in the STP are expected to deliver £245 million in savings, but will require £120 million to enact;
• Improve prevention services to improve the health of the area;
• Enhance primary and community care;
• Simplify urgent and emergency care system;
• Reduce the cost of services;
• Ensure effective and efficient planned care;
• Overall the STP is focused on reducing admissions to the acute care sector and moving care into the community.

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

The CCGs in Staffordshire ran a public engagement exercise at the end of 2016 on the future of community hospitals (My Care My Way - Home First). The results can be accessed here. This consultation has come under significant criticism from campaigners, local councillors and the Independent Reconfiguration Panel.

Three short on-line surveys ran from 4 September 2017 to 1 October 2017 on community ENT, gynaecology and ophthalmology services.

The CCGs within this STP have consulted on access to primary care; the consultation closed 8 February 2018.

The STP plan includes ambitious targets for the reduction in non-elective activity, including a 30% reduction in A&E attendances and a 20% reduction in A&E admissions.

The closure of one of the three A&E departments in the county is planned. The HSJ reports that the part-time A&E at Stafford Hospital is the most likely to close. It would be replaced with a 24 hour urgent care centre.

A reconfiguration of minor injuries units is planned with 75% of the activity transferred to the community and 25% to local A&E. This is designed to save £4.3 million.

A major programme to close community hospitals in Staffordshire is within the STP and by March 2017 was well underway. The STP mentions that community hospitals will lose 167 hospital beds - 85 at Longton and Cheadle and 20 at Haywood Hospital. This is designed to save £4.2 million. However, by April 2017 beds had been closed at Bradwell, Cheadle and Longton. Leek Moorlands Hospital is also now under threat of closure, with the announcement in May of bed closures within weeks.

The process of community bed closures was referred to the Independent Reconfiguration Panel as campaigners and councillors were concerned that the consultation process (My Care My Way - Home First) was not sufficient. The IPR's report was damning noting that the CCGs had a ‘reactive, incomplete and ill-focused’ approach to closing community hospital beds.

The ‘My Care, My Way – Home First’ consultation was aimed at keeping patients out of hospital wherever appropriate, and led to the closure of more than 100 beds at Longton Cottage, Haywood, Bradwell, Leek and Cheadle; the CCG had claimed that the closures were temporary, however the IPR report notes that the CCGs financial plans rely on the beds remaining closed.

The IPR report said that the CCGS had failed to make the case for change and ‘tied themselves in knots about engagement and consultation’.

The STP includes the plan to convert 20% of inpatient orthopaedic cases to day cases at Stoke and Burton hospital, with 1% of all other inpatient stays converted to day cases. The aim is also to reduce the length of hospital stays. Post-surgery, the STP aims to have a 30% reduction in follow-up attendance and a 50% cut in cost of follow-ups

The STP includes the establishment of a multispecialty community provider (MCP) to deliver integrated community care.

The STP outlines the development of "Integrated Care Hubs delivering integrated, place based care around groups of GP practices serving populations of 30,000-70,000."  According to the document, groups of GP practices will work together with support from other "community, social, voluntary and independent providers to provide new models of community-based urgent care, services for those with long term conditions and for people identified as complex or frail." The proposal includes the ‘clustering’ of local practices to create 23 locality hubs across the area.

In June 2017 the HSJ reported on discussions between NHS Improvement and NHS England on what certain over-spending CCG 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 Staffordshire. 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.

Under NHS England plans all STP areas will develop into Integrated Care Systems (ICS), previously known as Accountable Care Systems (ACS). This is a new model of care that aims to integrate hospital, community and social care and could involve a new type of contract and capitated (i.e., fixed budget) funding. For further details see our pages on New Models of Care and Accountable Care Organisations.

This STP includes the establishment of a multispecialty community provider (MCP) to deliver integrated community care; this is an initial step towards an ICS.