• UH Birmingham FT to review 16 clinical services after taking over neighbouring trust
  • Trust flags opportunity to centralise specialist services and deliver “lower complexity care close to where people live”
  • Trust says any subsequent reconfiguration will not involve closing hospitals or A&Es

One of the largest hospital trusts in the country is carrying out a major clinical review that could lead to the centralisation of more than a dozen services.

University Hospitals Birmingham Foundation Trust took over its neighbour, Heart of England FT, in April this year.

The proposed review, detailed in a paper to UHB’s July board meeting, covers 16 clinical services, including orthopaedics and cardiology.

It will consider opportunities to “consolidate the most specialised care to concentrate rare professional expertise and expensive equipment”, while “delivering lower complexity care close to where people live”.

Most of these changes could occur by shifting service around sites within the expanded trust. But others, such as gynaecology, paediatrics or orthopaedics, would also involve working with other providers in the region.

The new organisation now has an income of £1.5bn and provides the majority of acute services across Birmingham, Solihull and much of the surrounding area.

Queen Elizabeth Hospital is the trust’s major tertiary centre, with three smaller hospitals, Heartland, Good Hope and Solihull, acquired as part of the takeover. 

In the lead up to the takeover of Heart of England, the trusts had proposed centralising a few subspecialist services but this latest proposal is far broader.

The paper stated that after making the case for change for a few specialities as part of the merger, there was now an opportunity “to quantify, prioritise and then deliver the benefits of working at a greater scale across the new trust”.  

The paper also stated that the review would not involve the closure of any emergency departments, any of the four major hospital sites, a reduction in overall hospital beds or clinical staff, or “compromise on the quality of care we provide in any of our clinical services”.

Specific services under the clinical review include:

  • Interventionist radiology
  • Plastic surgery
  • Neurology
  • Nephrology and renal medicine
  • Cardiology
  • Vascular surgery
  • Diabetes
  • Gastroenterology and liver medicine
  • Upper GI
  • Pharmacy
  • Clinical oncology
  • Ophthalmology
  • Radiology
  • Urology
  • Pathology
  • Trauma and orthopaedics

The first services likely to see changes would be those where staffing shortages are greatest, where there were variable outcomes across different sites or where “the same service is provided across multiple sites but the volume of activity indicated there should be a consolidation for quality and efficiency”.

The trust declined to comment further on the clinical review, referring HSJ back to the board paper. 

UH Birmingham FT has inherited some long standing difficulties with the takeover of the Heart of England hospitals, the most pressing of them financial.

In 2017-18, before the merger, the trust reported a £24.3m surplus.

Now the newly merged trust is planning for a £38m deficit in 2018-19, nearly all of it attributable to Heart of England services.

The trust needs to make £35.6m in savings this year to reach that target.