Essential insight into NHS matters in the North West of England, with a particular focus on the devolution project in Greater Manchester. By Lawrence Dunhill

Gritty detail and general bumf

There has been progress of sorts on the North West sustainability and transformation plans, with HSJ getting sight of two formal submissions.

These documents, which had to be sent to NHS England last month, were always going to contain a mixed bag of gritty detail and general bumf, and the documents I’ve seen sit at opposing ends of that scale.

The leaked Cheshire and Merseyside submission was one of the more detailed STPs so far, and surprisingly little changed in the official version published today

The key controversies will surround the suggested downgrade of the emergency department at Macclesfield General Hospital (local leaders are already in damage limitation mode); one or two potential A&E downgrades between Warrington, St Helen’s and Southport; and plans to move all of Chester’s elective inpatient care to the Wirral.

This is the level of detail that NHS England, the Department of Health and Number 10 will fear, and which could turn the tide overwhelmingly against them.

Motherhood and apple pie

Lancashire and south Cumbria, on the other hand, will not be causing any trouble just yet.

A vanilla flavoured 40 page document was published for the region last week and reads as though it could have been written about any region in the country and at any point in the last five years.

The unpublished 96 page annex (which I got hold of and waded through) includes some slightly more intriguing lines, such as a “solution design programme” for east Lancashire, but stops short of setting out actual proposals.

As one senior source in the region told me, the documents are “all motherhood and apple pie”.

Everybody in the region knows major reconfiguration is needed across acute and specialist services in Lancashire, not least in central Lancashire, but we’ll have to wait until next year to see that detail.

Reading between the lines, it’s likely that vascular; cancer; maternity; neonatology; paediatrics; critical care; end of life care; and orthopaedics will be at the top of the queue.

Private investment

With many of these documents, the finances are often the most interesting bit.

Lancashire and south Cumbria says £160m will be needed over the next two years to develop new models of care and capital projects, but the submission acknowledges the need to look at other sources of private investment.

That two year timescale is interesting, and probably means the figure does not take into account the significant investment that will be needed in central Lancashire to either build a new hospital, or upgrade one or both of the current sites in Preston and Chorley.

The capital requirement in Cheshire and Mersey was calculated as £750m, which is very unlikely to be available due to the tight constraints on capital budgets at a national level.

And here lies one of the key problems with the STP process: many local leaders believe the plans are undeliverable for this reason.

This even seems to be suggested in the Cheshire and Mersey document, which interestingly, does not suggest hunting around for private investment, but instead questions whether the benefits (financial assumptions) made in the STP can be delivered without any contingency funding in place.

North by North West takes an in-depth fortnightly look at one of the NHS’s most challenged and innovative regions. There will be a particular focus on the devolution experiment in Greater Manchester, but my scope will also include Merseyside, Lancashire, Cheshire and Cumbria.

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