Leaked STP document reveals A&E downgrade plans

HSJ has seen a version of the region’s STP 21 October submission to NHS England, which outlines a range of projects to close a financial gap of around £900m by 2021. 

The document, which appears to be the final submission, refers to the downgrade of the emergency department at Macclesfield District General Hospital to a minor injuries and illnesses unit as part of a “remapping” of services at East Cheshire Trust.

The document says there will be a formal “major service review” at Southport and Ormskirk Hospital Trust, and includes options that could reduce the number of 24 hour A&E departments across three acute trusts.

It also refers to major service reconfigurations between Countess of Chester Hospital Trust and Wirral University Teaching Hospital Foundation Trust, including a project to consolidate all elective inpatient care at Clatterbridge Hospital.

The submission, which is described a ”live document subject to regular revision”, acknowledges that many of the plans could face “public resistance and political challenges”.

The plan says there will be a focus on demand management and prevention schemes, with an ambition to tackle high rates of respiratory disease, obesity, alcohol abuse, teenage conceptions, mental health problems and diseases associated with ageing.

Meanwhile, a range of future collaborative models are being considered across the different support services in the region, ranging from “setting up a single wholly owned subsidiary organisation for manufacturing and dispensing medicines” to outsourcing dialysis services to a satellite provider.

 NHS England has told STP leaders not to publish their full plans, but some areas have defied this instruction.

The Cheshire and Mersey region has been divided into three “local delivery systems”, called North Mersey, Cheshire and Wirral, and the Alliance. The detailed sections of the STP document are split between the three areas.

North Mersey – Liverpool, South Sefton and Knowsley

The major aspects of the plan for this area are already in the public domain, having been part of the Healthier Liverpool programme.

These include the proposed merger of Royal Liverpool and Broadgreen Hospitals Trust, Aintree University Hospitals FT and Liverpool Women’s FT, and the introduction of a shared electronic patient record.

The submission to NHS England refers to a reconfiguration of 35 adult acute services across the trusts, a significant scaling up of telehealth and assistive technologies, and the development of an “accountable care system” by 2021.

Leaders in North Mersey are also seeking a financial “control total” for the area, which would arguably lessen its involvement in the wider STP.

Cheshire and Wirral

There are four acute trusts in this patch, and the document refers to the creation of four “accountable care organisations” working in a “collaborative”.

This would be overseen by a “single C&W strategic commissioner”, while a raft of back office consolidations are planned. In some cases this would lead to reduced staff numbers.

The document highlights the current configuration of acute services in Cheshire as being particularly unsustainable.

It refers to a downgrade of the emergency department at Macclesfield hospital, run by East Cheshire Trust, with a minor injuries and illnesses unit provided in its place.

It also suggests that Macclesfield’s elective care and women’s and children’s services would be networked or supported by Stockport FT and University Hospital of South Manchester FT, and says there is an “intention” to transfer high risk general surgery to Stockport from April.

A “remapping” of emergency and elective care is also suggested for Mid Cheshire Hospitals FT, based on a “strategic relationship” with University Hospital of North Midlands.

Countess of Chester Hospital Trust and Wirral University Teaching Hospital FT have already begun discussions over the development of single clinical services, which could include the downgrade of one high dependency unit.

The document also reveals proposals to consolidate all elective inpatient care at Clatterbridge Hospital, which is part of Wirral University Teaching Hospital Foundation Trust.

There is also work to develop a shared care record across the footprint, and reduce spending on specialised services by £35m.

The Alliance – St Helens, Warrington, Halton, Knowsley, Southport & Formby, West Lancashire

The document appears to give a range of options for reconfiguring emergency services across Southport and Ormskirk Hospital Trust, St Helens & Knowsley Teaching Hospitals Trust, and Warrington and Halton Hospitals FT.

One model suggests that three trusts retain a 24 hour “type 1” A&E, while another suggests that all sites would be 24 hours, but high acuity patients would be treated on one site. A third model suggests a single 24 hour “type 1” site, with the other sites “reprofiling” their opening hours.

All the suggested models note that “new models of A&E delivery” will be considered for Southport and Ormskirk.

The document also proposes a range of single service models across the trusts, a range of “federate” services to reduce agency staffing costs, and elective ward closures due to reduced levels of delayed discharge.

There is also a “vision” for Whiston Hospital to be the single hyper-acute provider for stroke care, and a potential downgrade of one of three high acuity paediatric units.