• Elimination of a projected 2020/21 deficit of £311 million;
• To bring all three hospitals under the same leadership, with integrated management and service delivery;
• Integration across the footprint for urgent care services (including 999, 111 and GP OOH);
• Development of an accountable care system;
• Reviews of all clinical and non-clinical services with a view to reorganisation, in particular maternity and A&E;
• Development of Primary Care Home work package (establishing GP clusters and community and social care teams).

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.

In July 2017, the STP organisation published details of initial consultation on the plans with staff and public. This can be found in full here.

General views included the following:

• there needed to be more detail in the plans;
• there was a lack of clarity of the terminology used, in particular what was meant by ‘unnecessary duplication’ of services;
• many felt that NHS underfunding was the fundamental problem and queried where the money would come from to support and deliver change;
• many respondents also mentioned the need for greater public and local authority involvement in the plans.

With regard to A&E the feedback was that "NHS staff and patients felt that A&E departments should be retained at all three hospital sites and expressed concern that removal or downgrading of A&E, could impact on a Trust’s viability and ability to recruit staff."

The feedback for maternity services was mixed;  many public and staff respondents said that maternity services needed to be expanded, and more staff recruited, but views on the separation of high and low risk births were mixed.

The feedback was that a paediatric emergency service "must be retained at all three hospital sites to manage injuries and assess unwell children, referring them on to another hospital where necessary."

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.

In June 2017, Simon Stevens announced the first eight “accountable care systems”, that will each receive a share of up to £450m in transformation funding. One of the eight areas is Luton and Milton Keynes with Bedfordshire.

Changes are planned for the hospital sector, with the three hospitals - Luton, Milton Keynes and Bedford - working more closely together, beginning with the introduction of a shared leadership and management.  The STP also set in motion reviews of all the services being delivered at each hospital.

In October 2017, Bedford Hospital Trust and Luton and Dunstable University Hospital Foundation submitted a business plan and began consultations with staff and the public on a merger.

The new single organisation would share management and clinical teams. The business plan notes that emergency, consultant-led maternity and paediatric services will stay at both sites. However, it is unclear what type of emergency service will operate at Bedford.

Pathology services will be consolidated across the three hospitals.

A 'single point of access' for all 999, 111 and Nurseline calls in the region will be created.

It should be noted that a previous review of services at Bedford hospital and Milton Keynes hospital was abandoned (after costing £8 million), although it did advocate the closure of Bedford's maternity services and its A&E department. There is now concern that the STP review will lead to the same conclusion.

CCGs in the area are seeking to make savings via restrictions on prescribing, such as on gluten-free food. Milton Keynes CCG's plans to restrict hearing aids, however, was abandoned after a backlash from experts, including the Central and North West London Foundation Trust.