• UH Birmingham FT CEO says trust will return to “pre-Tony Blair” waiting lists without radical change
  • Argues for vertical integration of primary and secondary care, led by hospital trust
  • Comes as trust talks to Babylon Healthcare about developing a digital out-of-hospital service
  • LMC says comments and partnership are “truly frightening” and contrary to STP plans

The chief executive of the teaching trust serving the UK’s second city has declared it must drive the integration of primary and secondary care to prevent waiting lists returning to 1990 levels and specialist services being “crowded out” by emergency demand – sparking a furious reaction from local GPs.

The city’s local medical committee described the plans as “truly frightening”.

Speaking to HSJ, University Hospitals Birmingham Foundation Trust chief executive Dave Rosser said that, without drastic transformation soon, urgent demand would crowd out many specialist services at the trust within five years.

He said: “What worries me most is the pressure on our big complex services, our transplant service or big cancer services. Stuff that, frankly, for a very long distance you can only get this done at the QE [Queen Elizabeth Hospital]. If we don’t turn the tide around, there is a real danger that these programmes will be crowded out.”

Without radical change, Dr Rosser said the trust would be “getting to pre-Tony Blair waiting list times in five years”.

Dr Rosser was speaking to HSJ last week after revealing the trust was in partnership talks with digital health company Babylon Health, to help set-up a digital out-of-hospital service.

But the Birmingham Local Medical Committee has called the trust’s unilateral decision to work with Babylon “astonishing” and contrary to the “many and huge concerns” about the company’s NHS services and sustainability and transformation partnership plans for transforming primary care.

UH Birmingham FT became one of the country’s biggest trusts last year after taking over the neighbouring Heart of England FT. It now delivers most of the secondary and tertiary health service in Birmingham and Solihull from four hospitals. However, the merged trust has struggled with its accident and emergency performance, particularly at its biggest site, Queen Elizabeth Hospital.

Speaking last week, Dr Rosser said large trusts like UHB needed to drive that transformation, and vertical integration between primary and secondary care was the best model. He said the trust was “already doing primary care” in its emergency department, but the way the system classified that care was “very dishonest and old-fashioned”.

He added: “The system doesn’t support us to deliver that full package of care, and there is no taking this agenda further without bringing those two things together [primary and secondary care].”

Attempts to work with Birmingham and Solihull GPs on developing a more integrated model had been “very difficult”, Dr Rosser said, which was part of the motivation for the partnership with Babylon.

“If you look at the Birmingham system, the simple reality is if you’re going to drive the level of system transformation required… it has to be driven by UHB.”

Birmingham local medical committee executive secretary, Bob Morley, said Dr Rosser’s vision of vertically integrated care, in combination with Babylon, was “a truly frightening prospect that is going to be nothing but massively damaging for healthcare in Birmingham”.

“If UHB wants its problems sorted that will only be by working in partnership with properly resourced and fully supported general practice, not by means of an ill-thought through and destructive takeover.”

Birmingham and Solihull Clinical Commissuining Group deputy chief executive Phil Johns said he recognised that technology could help transform care and reduce urgent demand but “we need to continue to work closely with our partners to fully understand future developments and any impact it may have on local general practice”.

Dr Rosser also took aim at the current NHS financial model, which he said was stuck in the 1950s, and transformation planning, which he likened to telling people to “run faster and faster on the same hamster wheel which is going nowhere”.

He said: “If we allow ourselves to be contained by the current financial model, that frankly belongs in the 1950s… then we will never transform.”