• Elimination of a projected 2020/21 budget deficit of £336 million;
• Prioritise investment in primary and community care;
• Encourage behaviour change to improve the health of the population;
• Encourage and support patients to self-manage their conditions;
• Develop prevention strategies to reduce demand for surgery;
• Overall the STP is seeking to move care away from hospitals, including community hospitals, and into the community and primary care.

Like other areas this 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.

To eliminate the deficit, the STP will need funding and there are few details in the document about where this funding will come from.

In July 2017 NHS England and the Department of Health announced that 15 "high-achieving" areas will receive a share of £325m in capital funding for changes to be made under the STP. Herefordshire and Worcestershire received £10m - £30m of new investment to improve hospital services. This will include investment at the Worcestershire Royal Hospital to upgrade maternity wards and theatres and children’s services and for more general and acute surgery beds and at The Alexandra Hospital in Redditch to pay for improvements to the elective care centre, endoscopy, children’s outpatients and an upgrade in theatres.

The STP includes a reduction in "individual physical access points to urgent care services". The plan is for a single emergency centre with specialist services in Worcester, and two emergency centres in Hereford and Redditch. The A&E at the Alexandra Hospital, Redditch will therefore be downgraded.

This change to existing urgent care was reiterated in an update of the STP published in July 2017 ; it was noted that there will be a review of "existing access points and the potential consolidation onto fewer individual sites." There is the possibility that a single Emergency Centre with Specialist Services (ECSS) would be established in Worcester, alongside two Emergency Centres (providing A&E functions) in Hereford and Redditch.

The STP states that "we plan to develop a single maternity service to delivering Better Births". The likelihood is that Redditch will lose maternity services and all services will be centralised at the Royal Worcester site.

The STP contains plans for a reduction in bed numbers with reductions in both acute and community hospitals, as follows:

"Herefordshire - The need for a +15% increase the number of acute beds in Herefordshire, but the potential for a reduction of 62% reduction in the number of community hospital beds."

"Worcestershire – There is potential for a small reduction in the number of acute beds and a 44% reduction in the number of community hospital and resource centre beds."

This amounts to a loss of 142 community beds in Worcestershire and 60 in Herefordshire, or 44% of community beds.

The community hospitals targeted are in Malvern, Pershore, Evesham, Tenbury and Bromsgrove.

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.

Community care will be developed using the Multispeciality Community Provider (MCP) model, one for Worcestershire and one for Herefordshire. MCPs are the starting points for the development of integrated care systems (ICS) and then to accountable care organisations (ACO).

The STP states that "Some community hospitals may be able to operate as bedless, e.g. as a 'locality hub' for domiciliary based community services integrated with primary care."

After the initial publication of the STP, a local doctor, Dr Jonathan Wells, the former chair of Redditch & Bromsgrove Clinical Commissioning Group (CCG), was highly critical of the STP saying that it fails to tackle key outstanding issues.

In his submission to the Redditch borough council health commission, he noted several major concerns about the plans for the Alexandra Hospital, Redditch, including:

• Staffing problems in A&E at the Alexandra Hospital. With more services going to Worcester it will be hard to attract talented staff willing to work in what would be an environment with fewer specialities. It is still not known if a full time adult A&E at the hospital is sustainable in the long run;
• There is no capacity in place elsewhere for pregnant women to have a choice where they give birth;
• The lack of support services at the Alexandra due to the drain of staff to Worcester which puts acute medicine at the Redditch hospital in jeopardy;
• Financial viability – WAHT was £59 million in debt last year, is projected to be £37 million in debt this year yet the changes will only produce savings of £3.5 million;
• The lack of capacity at Worcestershire Royal – it simply does not have enough beds;
• The failure to engage with University Hospitals Birmingham NHS Foundation Trust – the QE – which could help alleviate capacity problems and possibly breathe new life into the Alex.

Dr Wells also noted that there is no capacity in the system and this will be made worse as the STP removes 44% of community beds. He also highlighted that the finances do not add up.

Councillors in Ross-on-Wye have expressed their concern over the possible loss of beds in Ross-on-Wye community hospital.