HSJ’s round-up of Wednesday’s must read stories

STP gets moving

Commissioners in Nottinghamshire are some of the first out of the gate on implementing plans in their STP to shift activity from acute settings to the community.

A message to staff at Nottingham University Hospitals Trust has revealed 13 services that clinical commissioning groups in the area plan to decommission at NUH, and another 17 services where the model of delivery could be redesigned.

The CCGs’ ambitious plan will see all the services re-tendered by July 2017 – a timetable some people think is unachievable.

Commissioners say the trust, one of the largest in the country, will be able to bid for the services but it also faces the risk that another community provider could enter the local market.

Service change in Nottingham has proved controversial in the past, such as when commissioned changes to the trust’s country-leading dermatology service ultimately led to the service collapsing completely and patients having to travel to Leicester.

Commissioners will want to avoid a repeat of that.

Trust merger date set

Birmingham Children’s Hospital and Birmingham Women’s Hospital foundation trusts are going “full steam ahead” to merge by 1 February next year, their joint chief executive has said.

Sarah-Jane Marsh also said a £16m capital loan from the Department of Health over the next three years will be used for work on the women’s hospital estate.

Ms Marsh took over running both trusts in July 2015, and the trusts confirmed their plans to merge last December. This was shortly after a £70m programme to rebuild the women’s hospital was scrapped by the new leadership.

In July, HSJ reported that the trusts intended to merge “early next year” following approval by both boards.

The chicken/egg question

The NHS’s equivalent of the chicken or the egg dilemma is: what comes first – investment in primary care or reduced demand for acute services? Because the latter can’t happen without the former, but the former needs the latter to happen first to free up the resources to pay for it.

Happily, the chicken/egg dilemma doesn’t really matter very much, and has an answer, which is that the egg came first, as chickens evolved from earlier species of egg laying birds.

But for the NHS, the rising cost of hospital services and the inability to invest in primary care matters a great deal, and has no simple answer.

All of this played out satisfyingly succinctly on Twitter on Wednesday.

Robert Morley, Birmingham GP and chair of the city’s local medical committee, tweeted: “There’s nothing in the Birmingham and Solihull STP that isn’t deliverable by simply closing a couple of expensive and redundant hospitals.”

The extent to which the remark was tongue in cheek is unclear, which is one of the pitfalls of informally microblogging on the finer points of health policy.

In case he was serious, acute trust chief executive Dame Julie Moore got stuck in: “These will be the hospitals coping with 10 per cent rise in A&E, 7 per cent increase in GP referrals and 250 per cent rise in DTOCs?”

“Ah but the STP is going to solve all that; simple, as I said :)”, Dr Morley replied.

Of course it is.