16. The Black Country
What does the STP mean for your area?
Merging of Sandwell and City district hospitals by October 2018 into the Midland Metropolitan Hospital.
Only the Midland Metropolitan Hospital will have an A&E, reducing the number of A&Es in the area.
The new Midland Metropolitan Hospital maternity service will replace the Serenity Unit and labour wards at City Hospital.
The back pain and arthritis service at Walsall Manor hospital will be cut, as it is deemed to be unsustainable.
Closure of Walsall urgent care centre although it was only opened in 2016.
Changes in who organises our care
The STP includes the development of two multispeciality community providers (MCPs) in Dudley and Sandwell and West Birmingham, however the aim is to explore the use of this model across the whole population by April 2019, including in Walsall and Wolverhampton. In June 2017, a 15-year MCP contract worth £5 billion was advertised by Dudley CCG and Dudley Metropolitan Council.
- The elimination of a projected £700 million funding gap by 2020/21;
- To implement local-based models of care for each community that deliver improved access to local services for the whole population, greater continuity of care for those with ongoing conditions and more coordinated care for those with the most complex needs;
- Transition to outcomes based commissioning, which may take the form of a single, or multiple, accountable care organisations;
- Development of the new Midland Metropolitan Hospital (bringing together acute services from Sandwell and City hospitals);
- Extend collaboration between service providers to ensure continuity of care;
- Improve maternal and infant health.
Like other areas this STP aims 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.
A major component of the STP is finding savings through re-organisation of back-office functions across both commissioning and provider organisations, including payroll, support staff employment models, procurement, human resources, telephony and legal services, call centres, licensing of telephones, IT applications and hotel services.
The STP document also notes that sustainability and transformation funding could be used to buy out expensive private finance initiatives and local improvement finance trusts.
The STP contains plans for CCGs across the Black Country to combine to become one provider for mental health care. The STP also outlines proposals to save £16.7m by reducing the number of patients with mental health problems going to A&E.
The STP expects to save £7 million by reducing the number of admissions to care homes across the Black Country.
The Dudley CCG and Dudley Council area is leading the way in the development of new models of care. The area had been developing a multispeciality community provider (MCP) model of care prior to the publication of The Black Country STP, as one of 14 vanguard areas set up by NHS England. This model of care aims to integrate primary and community care and includes GP services in the model. In June 2017, Dudley CCG advertised a contract for its MCP. See New Models of Care for details.
A consultation is ongoing on the viability of a hyper-acute stroke service at Walsall Healthcare NHS Trust: this service may be consolidated in Wolverhampton's New Cross Hospital.
The new Midland Metropolitan Hospital will bring together of teams who provide acute and emergency care, however this will substantially replace emergency services provided at City Hospital in Birmingham and Sandwell Hospital. The outcome is a reduction in A&E services in the area.
Walsall CCG plans to close Walsall urgent care centre, which would save the £951,000 per annum running costs. The centre was only opened in 2016 at a cost of £1 million. Critics have said that its closure will put pressure on the other urgent care centre at Manor Hospital.
The merger of Sandwell and City district hospitals by October 2018 into the Midland Metropolitan Hospital, will lead to a reduction in number of A&Es in the area; only the Midland Metropolitan Hospital will have an A&E.
The STP includes an investment of £25 million in primary care services.
Walsall CCG has proposed a shake-up of its GP surgeries. The CCG has plans to close two GP surgeries, merge six surgeries, and end weekend and out-of-hours appointments for five surgeries. Instead, Walsall CCG is proposing to provide evening and weekend services at some hub GP practices in the borough.
In Dudley CCG, GP services are part of the multispeciality community provider (MCP) model being developed (see community services for more details).
NHS England plans for all STP areas to develop into Integrated Care Systems, previously known as Accountable Care Systems. In The Black Country STP area Dudley CCG and Dudley Council are leading the way in the development of a multi-speciality community provider (MCP) model of care, but development of an MCP is also ongoing in Sandwell and West Birmingham; the model could be expanded to the entire STP population by April 2019.
Dudley CCG has been developing an MCP model of care prior to the publication of The Black Country STP, as one of 14 vanguard areas set up by NHS England. This model of care aims to integrate primary and community care and includes GP services in the model. In June 2017, Dudley CCG advertised a contract for its MCP. See New Models of Care for details.
The contract notice issued by Dudley CCG and Dudley Council states that the 15 year contract worth £3.4 to £5.4 billion will cover all community-based physical health services; some existing out-patient services; primary medical services; urgent care and primary care out of hours services; adult social care services; mental health services; end of life care; plus IT and management activities currently carried out by the CCG. The contract will cover around 300,000 people. As this contract aimed to include GP services, it has been likened to an Accountable Care Organisation (ACO) contract. The contract also involves a capitated budget.
The contract could extend to cover more areas, including older people's care (including care homes, home care, dementia gateways and reablement services) and learning disability services (including care homes, supported living, other community based provision); mental health services (care Homes / supported living / recovery model provision); plus many other services currently commissioned from the voluntary sector and services commissioned to support the public health and/or social care commissioning operations of Dudley Metropolitan Borough Council and Dudley CCG.
The closing date for tenders was 13 July 2017 and the contract was due to begin 1 April 2018. The incumbent providers - the local GPs and the local trusts - that had developed the MCP, were announced as the lead bidders in August 2017. The CCG will take forward the bid for the contract from a consortium formed of GPs with four NHS trusts - Birmingham Community Healthcare Trust; The Dudley Group Foundation Trust; Dudley and Walsall Mental Health Partnership Trust; and The Black Country Partnership FT. It is unclear whether there were any other bidders for the contract.
There have been a number of issues surrounding the contract and the organisational changes needed in the area. The original option to create a consortium met with VAT issues. In January 2018, Dudley CCG reported that the implementation of the contract has been delayed and the contract will not be awarded until late October/early November 2018 with a start date of April 2019.