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Leaders consider ‘difficult decisions’

Closing wards and services, blocking choice of private providers, systematically extending waiting times, and stopping some treatments are all being considered under a national programme targeted at the health economies with the highest overspends.

The controversial measures are currently being discussed privately by national NHS England and NHS Improvement officials, with senior local NHS leaders, as part of the new “capped expenditure process”. The principle of the process, introduced this year, is to “cap” NHS spending in the targeted areas so that they meet control total budgets in 2017-18.

NHS leaders from areas covered by the process have been told to examine “difficult decisions” and “think the unthinkable”, including modelling changes which are normally avoided as they are too unpleasant, unpopular or controversial. HSJ has spoken to senior officials in most of the areas.

No proposals have yet been formally approved or rejected, sources said, but ideas under consideration across several areas include:

  • Limiting the number of operations carried out by non-NHS providers so the funding stays within the NHS.
  • Systematically drawing out waiting times for planned care, including explicit consideration of breaching NHS constitution standards.
  • Stopping NHS funding for some treatments, including extending limits on IVF, adding to lists of “low value” treatments, and seeking to delay or avoid funding some treatments newly approved by NICE.
  • Closing wards and theatres and reducing staffing, while seeking to maintain enough emergency care capacity to deal with winter pressures.
  • Closing or downgrading services, with some considering changes to flagship departments like emergency and maternity.
  • Selling estate and other “property related transactions”.
  • Stopping prescriptions for some items, as suggested by NHS Clinical Commissioners earlier this year.

Pushing the vanguard

A GP “super partnership”, running one of the country’s most advanced new care model vanguards, has extended its reach again.

Modality Partnership, which leads the Birmingham MCP vanguard, has taken on a GP practice based in Wokingham.

The move follows its expansion to Hull earlier this year and means the provider will be spread across five locations: Birmingham, Sandwell, Walsall, Hull and Wokingham.

This brings the provider’s coverage up to 190,000 patients across 27 different practices.