STRUCTURE: Monitor has lifted a troubled foundation trust out of special measures, after it agreed to make radical changes to achieve savings of £28m by 2020.
The reviewers say the changes will require implementation funding of £48m, which may have to be sought from the Department of Health or Greater Manchester devolution project budgets.
But they add that a further £216m would be needed to address the Tameside and Glossop health and care economy’s combined deficits that are set to build up over the next five years.
Under the plans, the trust’s budget would more than double to £414m, after it takes on social care staff. It would move to a capitated payment system.
The proposals have been supported by local commissioners, who have now been asked to lead on the plans.
The review, conducted by PwC and released by Monitor, said the trust would become the first “fully integrated care organisation with a capitated contract”.
The ICO would include:
- five locality teams, to bring together GPs, mental health, community care, social care, hospital doctors and the voluntary sector;
- GPs potentially joining the trust as salaried staff after 2016-17;
- the development of new care professionals called “extensivists”, who would specialise in caring for patients with complex problems; and
- an integrated urgent care service with a single point of access. The emergency department would be retained.
The trust has a projected deficit of £23m, while the Tameside and Glossop health economy is set for a combined annual deficit of £70m by 2020, largely due to “underfunding” in social care, the review found.
It predicted that £28m of health and social care savings could be achieved through the ICO model, making the trust financially sustainable and reducing the economy’s combined deficit to £42m.
The reviewers said the remaining deficit should be apportioned jointly between commissioners, with the trust bearing the “downside risk” under a capitated contract.
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They did not produce detailed plans to address this shortfall, but said estates reconfiguration, back office consolidation and a “culture of continuous financial and operational improvement” could help reduce the gap.
The new model would bring major changes to planned care at the trust, with “all subspecialty services in both medicine and surgery” provided on a networked basis with other hospitals, as well as outpatient services in dermatology, breast surgery, ear, nose and throat, and ophthalmology.
These changes will complement the region’s Healthier Together plans, which will see emergency and high risk general surgery moved to Stockport, PwC said. Meanwhile, discussions are taking place about shifting some planned care in the other direction.
On maternity services, which currently incur “very high” clinical negligence premiums, the review said potential savings from closing the unit would be “marginal”.
It said any decision over its future should be made after NHS England’s maternity review is published, but warned that new guidelines due to be published by the Royal College of Obstetricians and Gynaecologists may render the service “unviable”.
PwC believes new services could be launched within 12 months, but says the local councils’ scrutiny panels should determine whether a public consultation should take place, which could delay this.
Karen James, Tameside’s chief executive, said: “We’re delighted that we’re coming out of special measures, as we’ve worked really hard to improve the patient experience here. This is a fantastic opportunity to continue addressing the challenges we have.”
David Dean, senior director of transformation and turnaround for Monitor, said: “It is good news we have been able to take the trust out of special measures and our decision reflects the progress that’s been made. However, there is still a lot of work to do and we will continue to support the trust to ensure that its progress maintains.”
Monitor report and information provided to HSJ
17 September 2015