Midlands STP plans 'unified leadership' for three hospitals

Instead the plans suggest the creation of a “trusts’ joint governing vehicle” across the area’s three acute providers: Bedford, Milton Keynes and Luton and Dunstable.

The document, an extensive summary of the STP the area submitted to NHS England on 21 October, does not say whether the three organisations propose to share a chief executive, chair or other senior leadership.

The plan was released by the Bedford Borough Council’s mayor, Dave Hodgson. In a statement he said he had published it after hearing from “deeply concerned” residents and councillors and said “we cannot have continuing secrecy about these plans”. It is now the fifth STP to be published – all by councils or councillors, in definance of NHS England’s guidance that they should not be published until they have been checked centrally.

The STP shows that no formal decision has been made on the long-standing debate in the patch over. whether to close or downgrade either of the accident and emergency units at Bedford or Milton Keynes hospitals.

Instead the plans says it will “transpose” the work of the “Healthcare Review”, a previous review of hospital configuration, which recommended that Milton Keynes become a major trauma centre with Bedford losing obstetric maternity and most emergency surgery The review was never ratified, and was ceased as the STP process got under way.

It says Pauline Philip, Luton and Dunstable Hospital Foundation Trust chief executive and the STP lead, will now lead a new secondary care services transformation board. In the next two months it expects to make a “decision on the way forward with the Healthcare Review” It said capital investment would also be “confirmed within the same period”.

In its risk register the STP flags as red the “lack of political support” for secondary care reconfiguration, adding it plans to “continue ongoing dialogue with council partners”.

The STP also intends to:

• Create an accountable care system to commission and deliver NHS services, which it hopes councils will become part of “in the future”. This will create a “common integrated model for hospital care, community health services, primary care and social care through a place based approach”, focused on populations of 30,000 to 50,000. This would also see primary care delivered at scale through partnerships or mergers.
• Develop a new digital programme at a cost of almost over £52m that will converge the IT systems across all three hospitals on the patch, and enable a “system-wide” view of capacity across the entire region from care homes to ICU beds.
• Implement a “single coherent clinical operational model” across the three hospital sites for “speciality clinical services”. Clinical support services such as pathology, therapies and pharmacies will also come together under single clinical leadership with expectations to save £4.5m alone from creating a single pathology service.

Louise Jackson, a Labour borough councillor and the portfolio holder for public health, told HSJ that the council “had few options for influencing” the STP plans. She continued: “I feel that NHS England don’t want to talk to us. It’s wrong, elected members are shut out of the process - there is no political voice there. It is hard to integrate services if you don’t trust your partners and that trust has been eroded with NHS England.” She added that NHS England is at risk of approving proposals that are “unacceptable to the public”.

Bedford Hospital’s hospital has been subject to speculation for several years – in 2012 it was recognised that the trust is unsustainable in its current form.

Responding to the “unplanned” publication of the STP, Ms Philip said: “It is really important to say that no decisions have been taken in relation to service change or reconfiguration – both in terms of clinical services and for support services (both administrative and clinical support services) in terms of hospital, GP and primary care, community care, mental health services and social care.

“The STP provides us with an opportunity, first, to be frank about the pressures being faced by our health and social care services and, second, to agree the principle of working together to meet the challenges we face.

“Nothing is excluded, but equally no decisions have been made at this stage.”