The NHS crisis: controversial changes may be coming to Wiltshire's health services - sooner or later?

Written by Tony Millett on .

Later this month leaders of the new NHS grouping that includes Wiltshire, go to London to hear the official response to their draft Sustainability and Transformation Plan (STP) that will also cover Swindon and Bath & North-East Somerset.  This so-called 'footprint' for the STP reorganisation is known in NHS-speak as BSW.

This response matters as an approved STP brings with it extra funding from a £2.1 billion central fund for the NHS in England.  In the first month of the new financial year, Great Western Hospitals Foundation Trust was £100,000 adrift from its target.  And that included a month's share of the promised STP funding - without that money they would have been £788,000 in deficit.

The majority of Trusts across England finished the last financial year in deficit.  As the graphic [below left] from the Health Foundation shows, this situation has been deteriorating over the past four years

BSW's plan is at a formative stage and its workings are largely below the radar - though it is said to be "all consuming" as regards Wiltshire CCG's executive team.  There are some hints as to what will be coming Wiltshire's health services way in the near-ish future.

[Click on image to enlarge it][Click on image to enlarge it]The NHS Chief Executive, Simon Stevens, floated the idea of 'combined authorities' that could emerge from decisions made under the STP.  These would probably unite commissioners and providers - for instance a CCG and one or more hospital trusts.  

Another set of initials introduces the Integrated Care Organisation (ICO) - joining social care departments and hospitals.  An ICO in Salford is already being formed and 400 council staff have been moved to the Salford Royal Foundation Trust's payroll.  At least stabling them with the hospital trust rather than the local Council will avoid further politicising health services.

One thing is certain: STPs will involve 'controversial changes' - so much so that Stevens has promised 'safe harbour' for NHS leaders who make those decisions.  This means, it seems, that NHS national bodies will sign those leaders up for a period of 'three, four, five years' - so they can survive in the face of any fierce public or political firestorm in reaction to their decisions.

Perhaps that is what the CCG's outgoing Chief Accountable Officer, Deborah Fielding, meant when she told her board (May 24): "The next couple of years are going to be really difficult for CCGs."

In some recent minutes of Wiltshire CCG committees there are hints at how stringent (some would say ruthless) the STP regime is going to be.  Talking about human resources matters, one executive notes that " would be even more important to support staff with the advent of the STP and the Accountable Care Organisation."

Does this mean the CCG or the STP grouping have decided to go down the Accountable Care Organisation (ACO) route?  A CCG can contract a single ACO (made up of hospitals, charities and private companies) to arrange and provide all health care for the CCG's population.  And, with the CCG's responsibilities then reduced, its staff is slimmed down accordingly.

At a CCG meeting in February there was a warning too about other members of the STP grouping: "The Committee discussed the STP and it was reported that Swindon and BaNES have an estimated funding gap of £70million for 2016/17.  An action plan needs to be in place by June 2016 to address this gap."

And discussing 'affordability' of services and the CCG's budget, the Chief Finance Officer said: "...with the 2016/17 population growth, it was essential that more people were kept out of hospital.  It was necessary to reduce hospital capacity in order to keep admissions down."

Does this fit the 'by-pass' theory of supply and demand?  In terms of traffic management, if you build a new by-pass it will fill up with cars.  But the theory does not explain where the cars were before the by-pass was built.  

If this theory is applied in reverse to a reduction in hospital capacity - that is closing wards or even hospitals - it presumably means that with fewer hospital beds there will be fewer people needing to be in hospital.   

But the theory certainly does not explain where those people who are now ill enough to be admitted to hospital will go when there are no beds for them.  Not everything can be treated at home.

Seen from GWH - at the northern end of the BSW 'footprint' - there is a very different view of hospital capacity - see separate story.