• Eliminate the projected 2020/21 deficit of £168 million;
• Encourage prevention, self-care and promotion of independence;
• Invest in services which prevent, reduce or divert demand for hospital to reduce the need to send people a long way from home, and reduce hospital admissions;
• Stabilise and expand primary care and increase the role of community pharmacies;
• Optimise care outside hospitals through a programme to implement “Integrated Care Communities” (ICCs) and wrap around specialist community provision.

Like other areas this STP plans 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.

As this area was an ongoing Success Regime project, public consultation on several changes were well underway when the STP was published. The Healthcare for the Future consultation closed at the end of December 2016. This consulted on changes to maternity care, children's services, community hospital inpatient services, emergency and acute care, hyper-acute stroke care and emergency surgery and trauma services. The results of the consultation can be found on the North Cumbria CCG website.

The STP for West, North and East Cumbria is more advanced than many as it has been built on the ongoing Success Regime project, which brings together Cumbria CCG; North Cumbria University Hospitals Trust; Cumbria Partnership Foundation Trust; North West Ambulance Service; specialist providers and GP federations.

The Success Regime plan includes consolidation of the hospital sector and a public consultation has already taken place on some major changes. The consultation ran until 19 December 2016.

As one of the most advanced areas in terms of STP, the area has been awarded capital funding of £30m - £50m to improve access to chemo and radiotherapy by establishing a brand new cancer centre, complete with new equipment at Cumberland Infirmary in Carlisle.

In addition, West Cumberland Hospital will get £30m - £50m extra capital investment to refurbish or rebuild parts of the hospital estate to bring it up to date and between £1m - £5m is going to support the development of eight Integrated Care Communities – local hubs that bring together GPs, social care, community services, mental health services and specialist hospital consultants to support people closer to where they live.

The consultation outlined a number of options to deliver savings, including abolishing consultant-led maternity care at West Cumberland Hospital (WCH).

The consultation document says that the preferred option is to leave a midwife-led unit at WCH, but it may have to move all services to Cumberland Infirmary Carlisle (CIC).

It is also proposing reforming inpatient paediatric services so that low-risk services are only available at WCH and high-risk services are only available at CIC, and moving all acute stroke services to a single hyper-acute stroke unit at CIC.

The plans also involve a reduction in beds at the WCH inpatient unit and eight community hospitals so that the number is reduced from 133 to 104.

In March 2017 Cumbria CCG's governing body decided on the following proposals:

• Initially maintain a consultant led maternity unit at both West Cumberland Hospital and Cumberland Infirmary in Carlisle, but if this is not sustainable after 12 months to have a midwife led unit at West Cumberland.
• Develop an inpatient paediatric unit for the region at Cumberland Infirmary, while having just a short stay assessment unit and some beds at West Cumberland.
• Reduce community hospital beds from 133 to 104, phasing out the beds at three units.
• Maintain 24/7 accident and emergency services at both sites.
• Develop a hyper-acute stroke unit at Cumberland Infirmary.

These decisions were put before the Council's health scrutiny committee.  Cumbria county council’s health scrutiny committee voted to refer the maternity plans to the health secretary and ask him to overturn this decision. The committee approved the rest of the CCG’s plans. Jeremy Hunt passed the decision over to the Independent Reconfiguration Panel (IPR).

In October 2017 Cumbria partnership FT and North Cumbira university hospital merged boards and management the HSJ revealed. This highlights further integration of the two trusts which was proposed in March 2017. They have agreed to joint governance and accountability structure.

In November 2017 the Independent Reconfiguration Panel (IPR) rejected Cumbria Council's objections to the changes in maternity care.

In March 2018 there are still discussions surrounding the future of the maternity services at West Cumberland Hospital. North Cumbria CCG has allowed for consultant led maternity services to continue to be held at West Cumberland Hospital for the next 12 months starting on the 1st of April this year as a trial to see if they can recruit key staff to maintain the operation of the ward. Although they have managed to keep it for now, between 100 and 200 more births will take place at Carlisle’s Cumberland Infirmary instead due to changes in pediatric care. This decision comes from a consultation that took place in March last year.

The decision to consolidate inpatients beds across 6 sites and the closure of in-patient beds at Alston, Maryport and Wigton was finalised in early 2018. The closures will take place over the rest of 2018, much to the dismay of the members of the community.

Under NHS England plans all STP areas will develop to be Integrated Care Systems (ICS), previously known as Accountable Care Systems (ACS). This new model of care aims to integrate hospital, community and social care.

For further details see our pages on New Models of Care and Accountable Care Organisations.

The plans for hospital consolidation have caused considerable controversy.

Campaign groups in the area note that it is not safe to transfer patients, including mums in labour, stroke patients and the most sick children, long distances on poor roads. The groups are  also concerned about the quality of care elderly people will receive at home if community beds close.

In January 2017 the Care Quality Commission (CQC) ordered the North West Ambulance Service (NWAS) to make safety improvements, highlighting paramedic vacancy rates among its problems. Campaigners noted that the situation with the ambulance service throws into doubt its ability to cope if the changes in hospital use are carried out.

The head of the North West Ambulance service, Derek Cartwright, has written to the Success Regime stating that he does not believe controversial plans to transfer women more than 40 miles while in labour are clinically safe. The letter was leaked to the News & Star local paper.

The letter is also reported to state that he claims transfer times quoted by the Success Regime have been underestimated, that the proposals fail to meet vital guidance on emergency caesareans and even states that paramedics could refuse to transport patients if they felt it unsafe.

But Mr Cartwright's letter reveals that the ambulance service does not support all of the preferred options put forward - and has particular reservations about the plan to centralise maternity consultants in Carlisle, leaving only a midwife-led unit in Whitehaven.

In March 2017, Cumbria Council's Health Scrutiny Committee objected to the planned changes to maternity services. Health scrutiny committee chair Neil Hughes said members were concerned:

• that the CCG could decide over the future of the maternity unit at West Cumberland without further consultation;
• about the distance pregnant women would travel between west Cumbria and Carlisle if the unit at West Cumberland is closed; and
• that proposals for a dedicated ambulance to transport them were not sufficient.