HSJ’s must read stories on Friday

Santa’s little helper

Lord Carter’s much heralded review of NHS efficiency was finally published on Friday, outlining how the acute sector can find savings of £5bn by 2019-20.

The report is impressively wide ranging, and the Labour peer should be credited for his efforts to engage trusts and build a “bottom-up” consensus.

But the headline savings figure raises a wider question about the ability for the NHS to deliver £22bn of efficiency savings by 2020-21, as required to deliver the Five Year Forward View.

Given that about 55 per cent of NHS England’s budget is spent on the acute sector, the Carter review numbers suggest that reaching that figure will be nigh-on impossible.

Based on these figures, can we really expect the rest of the health service, including the already troubled mental health and primary care sectors, to deliver any more than £5bn?

These aren’t questions Lord Carter wanted to answer, and it wasn’t his job. “You have to ask the Olympians for the rest of the view”, he said. “I’m just one of Santa’s little helpers.”

Hoops of hope

A long running acute reconfiguration took an important step towards being implemented this week after it was approved by the boards of the trust affected and its three main clinical commissioning groups.

The proposed changes all relate to Worcestershire Acute Hospitals Trust. Mainly, they aim to consolidate some specialisms that are currently provided on two sites into one. There are still some more hoops to jump through but the hope is that the reconfiguration can be enacted by the end of the year.

The reconfiguration is interesting for three reasons.

First, it gives some indication of how other long overdue changes might play out during this parliament. Originally it was planned that the A&E in Redditch would close, to a predictable local outcry. Now the Redditch A&E will remain, but it won’t serve critically ill children, or be supported by emergency surgery. Over two to three years it will become an “emergency centre” – the second tier service recommended in a review of emergency services by NHS England medical director Sir Bruce Keogh. So you can call it an A&E, but the most risky stuff will still be stripped out and provided in Worcester.

Second, it won’t save enough money to make the local system sustainable. Worcestershire Acute has a deficit of around £60m. The trust says this scheme could save around £20m.

Third, Redditch is really a satellite of Birmingham, not Worcester. Many Redditch residents would choose Birmingham’s hospitals over Worcester, and it has been argued that poor performance in Redditch impacts on the Birmingham system more than Worcester. Local leaders are currently working out the right footprints on which to base their sustainability and transformation plans. For trusts to overlap geographies like this is not unusual. What happens if the local reconfiguration doesn’t align with the STP process?