NHS IN CRISIS: How will Notts close £500m 'black hole'?

King's Mill Hospital, part of Sherwood Forest Hospitals NHS Trust in Sutton. Transformation plans to save the NHS from a funding crisis are expected to have a huge impact on our hospitals.
King's Mill Hospital, part of Sherwood Forest Hospitals NHS Trust in Sutton. Transformation plans to save the NHS from a funding crisis are expected to have a huge impact on our hospitals.

Nottinghamshire health bosses are so far claiming they won't have to cut hospital services, despite numerous others areas already admitting major cuts to services are required.

Research funded by campaigns organisation 38 Degrees released on Friday revealed that Nottinghamshire needs to find £500 million in saving over the next five years, and despite claims that the service foresees resizing of 'hospital footprints', so far those in charge of transforming the NHS into a sustainable service have not admitting any cuts to acute services at our hospitals.

The report is part of national analysis describing a crippling funding crisis in the NHS which is forcing more than half of healthcare areas to cut acute services - but campaigners are saying health bosses aren't being transparent enough about their plants to save billions over the next five years.

Some 23 out of 44 healthcare 'footprints', including Nottingham and Nottinghamshire has revealed that 'configuration' changes are needed under their Sustainability and Transformation Plans (STPs).

The plans are being produced across the health service under partnerships between CCGs, trusts and local authorities, to steer local services.

In Nottinghamshire, our health commissioners expect a 'do-nothing' deficit of half a billion - needing a total of £2.3 billion a year to maintain services as they are now.

According to draft STP plans seen by the Chad, our local trusts may need "acute service consolidation" and "resizing of the acute hospital footprint".

Analysis by Incisive Healthcare said the plan "doesn't describe what this would mean for patients" but historically "consolidation" and "resizing" mean cuts to hospital services.

Another Nottinghamshire STP document claims our health service's key issues concern finance, and states that current services are 'unsustainable'' and 'unaffordable.

The presentation by Nottinghamshire County Council continued: "We don’t currently have fully developed solutions for this... We don’t allocate or use public funds to best effect."

A Five Year Forward plan document (link below) goes on to suggest major changes would involve developing better payment systems based on patient outcomes (meaning CCGs get less money per patient if care if treatment is less successful), 'shifting resources' to out-of-hospital services, including and 'demand management' - hinting at a discouragement of patients from attending hospital either by signposting other services or better preventative services and promoting better lifestyles.

A number of unpublished STPs were uncovered by an FOI request, and the draft plans spell out huge cuts across the health service to meet funding shortages, but in many cases individual plans for local areas are still vague.

Laura Townshend, Director at 38 Degrees who used crowdfunding to drive the investigation, said: “This is new evidence that plans are being made to close local NHS services. We all rely on these services, yet we are being kept in the dark.

"These proposed cuts aren’t the fault of local NHS leaders. The health service is struggling to cope with growing black holes in NHS funding. These new revelations will be a test of Theresa May’s commitment to a fully-funded National Health Service.

"The NHS belongs to all of us - so local people in Nottinghamshire should get a say in any changes to their local services. That’s why hundreds of thousands of us have joined the 38 Degrees campaign calling for Health Secretary Jeremy Hunt to commit to full public disclosure of plans for each and every one of the 44 areas across England.”

No confirmed plans for downsizing

For the Nottingham and Nottinghamshire 'footprint', a gap of £500 million must be closed, and initial comments from our health services have denied plans for consolidation and downsizing, suggesting that research doesn't properly represent the local picture.

But compared to other areas, cuts may be unavoidable to meet the £500m target.

According to Incisive Healthcare's research, Hertfordshire & Essex's STP is looking to scrap pre-existing plans for a new hospital to meet its target savings of £234m - less than half of Nottinghamshire's.

Dorset's plan said to meet £158 million of saving 'hospital beds are at risk', and Leicestershire & Rutland's plans to bring down its five-year 'black hole' of £700m is to end acute services from one of three hospitals.

Other areas are considering selling surplus land and estates, cutting staff and closing or downgrading A&E departments.

Nottinghamshire County Council's deputy chief executive and director of Health and adult social care, David Pearson is one of only four out of 44 STP leaders in the country to be appointed from a local authority, while most of the country's transformation plans are being lead by health chiefs.

He told the Chad: "The transformation of services is rarely just one big dramatic closure."

"Overall what we are trying to do in building our plan is to make sure we get people the right care, at the right time, in the right place. There's plenty of evidence that people aren't getting that.

"What is clear is that the need in our changing population is rising at a greater rate than the money available to provide it.

"A lot of what we are doing in Notts is to make the public purse stretch - we're doing everything we can to keep people at home if possible, many who say they would rather not be in hospital is possible.

"We've established multi-disciplinary teams with different practices focusing on people's different risks and needs. Secondly we've got the care co-coordinators helping people.

"These things, alongside variations in practice, are better for patients while also delivering us savings."

A major part of the plan is the merging of King's Mill and Queens Medical Centre's controlling bodies, which may see departments shared across the two hospitals - but there are 'no plans' to close any hospitals in Nottinghamshire, said Mr Pearson.

"The acute service consolidation point is already in the plan - Sherwood Forest Hospital Trust and NUH would merge, and this will in turn inform the sustainability and transformation plan.

"107 beds have already been cut from Sherwood Forest Hospitals trust - but we only need as many hospital beds as we need, so the direction of travel is to care for people as close to home as possible and not needing to expand hospital beds, and to even reduce beds, but that doesn't mean the closure of a hospital in Nottinghamshire."

"There isn't anything in the plan about closing a major hospital, which is what they're talking about elsewhere."

An NHS England spokesman said: "This is a unique exercise in collaboration. It is hardly a secret that the NHS is looking to make major inefficiencies and the best way of doing so is for local doctors, hospitals and councils to work together to decide the way forward in consultation with local communities.

"Proposals are at a draft stage but we expect all local leaders to be talking to the public and stakeholders regularly - it is vital that people are able to shape the future of their local services.

"No changes to the services people currently receive will be made without local engagement and, where required, consultation."

To sign the 38 Degree petition to make STP progress public, go to the |38 Degrees website|click here}.

View a PDF copy of Nottinghamshire's Five Year Forward plan here.

Draft plan outlines areas of concern:

According to a Nottinghamshire STP draft presentation, local funding issues are based on a shortfall, with annual increases in NHS revenue rising in line with inflation (2-4 per cent), but not covering the continuous increase in demand (an additional 2-5.5 per cent).

Nottinghamshire's main areas for bad performance:

• A&E waiting times,

• Ambulance Red 1 response times

Key issues faced by the area:

• Sustainability and affordability of services

• Workforce – particularly in primary care and some specialties

• Fragmentation / duplication / gaps in services

• Nottingham University Hospitals and Sherwood Forest Hospitals merger

• National outlier for high spending but poor outcomes in mental health, Genitourinary and Musculoskeletal departments.

Areas where funding can be better used:

• Handoffs and delays within / between organisations

• Thresholds for treatment in different settings (primary, residential, acute and community care)

• Mental and physical health parity of esteem (spend doesn’t match overall population need)

Plans for change:

• Development of new payment mechanisms linked to outcomes.

• Preventative, proactive care that enables health and independence resulting in the management of demand for services.

• Active cost management and increased productivity through workforce change, asset management

• A new model of out-of-hospital care with resources shifted to support this, enabling the resizing of the acute hospital footprint

The STP concludes for improving finance and efficiency:

"To gain clarity on the pathway to financial sustainability as a system brought about through demand management; active cost management and increased productivity; aligning resources and incentives with collective decision making; developing new contracting and payment models; service and pathway transformation
resulting in improved value; together with a new model of out-of-hospital care enabling the resizing of acute hospital services."