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12.09.17

Planned STP bed cuts in London ‘not credible’ even with extra cash

Proposals to cut the number of beds and reduce the use of hospitals outlined by London’s sustainability and transformation partnerships (STPs) are not credible even if extra investment is made in community services, the boss of a leading think tank has said.

In a report looking at the capital’s STP plans from last October, which was commissioned by mayor Sadiq Khan earlier this year, the King’s Fund found that “heroic efforts” will be necessary to manage rising demand with existing capacity as London’s population follows project growth trends.

While the think tank found many similarities between these STP plans and those produced in the rest of England – with shared ambitions to prioritise prevention and early intervention, redesign services and reconfigure hospitals – they include some “contentious” proposals to cut beds and reduce hospital use.

“Our detailed assessment of these proposals concludes that even if additional investment is made in community services, cuts on the scale proposed are not credible. Indeed, with the population of London projected to increase in coming years, heroic efforts will be needed to manage rising demand with existing capacity,” wrote Chris Ham, the think tank’s chief executive.

Expanding on this, the report said: “If the current rate of hospital use continues, the impact of demographic changes alone may require the equivalent of 1,600 to 1,700 extra acute hospital beds in London by 2020/21 to meet the population’s health needs. This is unlikely to be affordable and there would be difficulties in recruiting the extra staff needed.”

“Equally questionable” were the capital’s plans to close an expected financial gap in the region of more than £4bn by the end of the decade, which would require efficiency savings at a level never before achieved.

“Our analysis found a worrying lack of detail on how this gap would be filled and unrealistic assumptions about the level of efficiency savings that could be delivered,” explained the CEO. “Some of the STPs submitted in October 2016 acknowledged that more work was needed on their financial plans, and this task has become more urgent with the introduction of the capped expenditure process.”

Ultimately, the think tank said the plans submitted in October last year should be seen as a “starting point for debate”, although some have already moved on and carried out work to test their assumptions (but others, like in North East London, have not made any major changes since).

But Ham was keen to stress that not everything has to be done by partnerships. Much can also be achieved at a more local level in neighbourhoods, boroughs and groups of boroughs working together to integrate care and boost population-based health. “Much more” also needs to be done to engage with local government partners.

“Health and social care professionals, patients and the public, local government and other partners must be meaningfully involved in developing the content of the plans and their implementation,” the report explained.

“More attention must be given to the practical skills and resources needed to support staff to make improvements in care. STP leaders and their teams have an important role in co-ordinating service changes and creating an environment for learning and improvement.”

Khan himself can also offer a “distinctive contribution” to the STPs through his “ability to look across the capital and to provide civic leadership on issues that affect everyone”.

For example, he can lead on the prevention of ill health and health inequalities; support NHS service changes where there is a strong clinical case; help with the NHS estate reform; drive workforce changes and address concerns over the impact of Brexit; develop London as a global life sciences leader; and provide oversight on the work being done by the STPs.

(Top image c. sturti)

Comments

Pete   13/09/2017 at 12:17

Everyone working on/in STPs is under significant pressure to come up with solutions which reduce secondary care activity and capacity. Maintaining or even increasing these is not an acceptable answer and is career limiting. (Despite the fact that there is no credible evidence that boosts to out of hospital services can be achieved or that they will reduce demand in secondary care. Look at recent ACO documents from King's Fund re Canterbury, NZ.) So no wonder yet another round of unfeasible plans has been generated. It helps that an external expert such as Chris Ham can bring some reality to what's going on, but will anyone be allowed to listen to him and plan accordingly? How many times has the NHS been round this loop over recent years? And has a single plan ever been implemented which has achieved the desired outcome?

Horatio Tremoine   14/09/2017 at 09:12

simples ... invest everything in homecare and primary care prevention

Rob   20/09/2017 at 13:30

As Pete says there is no evidence of success in reducing demand for secondary care. CCG have long been pushing for secondary care to do less and primary care to do more to reduce secondary care costs. This has seen a shift in minor ops, follow up etc out to primary care. There are now complex pathways replacing simple referral and review by consultant. Costs reduction and improvement in outcomes will not come from the same primary/secondary care model we have had since the start of the NHS. The "GP knows best" model has had its day, there needs to be acceptance of self and direct referral to specialities such as Maternity, Diabetes, orthopaedics etc (it is essentially what has happened with 4 hour ED targets) this will remove work from GPs where they just act as a referral service. General Practice can then focus on management of the elderly in the community. There also needs to be rationalisation of what the NHS will actually do, especially where there is little evidence meaningful benefit.

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