We all know there are big changes ahead for the NHS with each borough now responsible for buying services for local areas. Clinical Commissioning Groups (CCG) made up of GP Practice Leads in each borough will now be responsible for buying services for local areas which was previously done by managers at Primary Care Trusts(PCTs). They will be supported by Business Support Units and CCGs will need to be in place by April 2013
A National Commissioning Board (NCB) has been set up to oversee all the CCGs, allocate resources and provide guidance. They replace the previous Strategic Health Authorities (SHAs) Monitor, the body that currently regulates NHS Foundation Trusts will now oversee aspects of access and competition in the NHS.
There was an important announcement this Monday from the NHS Office of Trust Adminstrator on South London Healthcare NHS Trust which is overspending by £1million each week.
The report stated that whilst the issues start with the Trust, there is a challenge across the system meaning the solutions cannot come just from within South London Healthcare NHS Trust but that the solutions need to be developed with health and social care partners in the wider system. The following changes were recommended:
There should be changes in the way services are provided in south east London. Specifically, changes are recommended in relation to community-based care and emergency, maternity and elective services:
• Community Based Care – The Community Based Care strategy for south east London should be implemented to deliver improved primary care and community services in line with the aspirations in the strategy. This will enable patients to receive care in the most appropriate location, much of which will be closer to, or in, their home.
• Emergency care – Emergency care for the most critically unwell patients should be provided from four sites – King’s College Hospital, St Thomas’ Hospital, Queen Elizabeth Hospital and Princess Royal University Hospital. Alongside this, services at University Hospital Lewisham, Guy’s Hospital and Queen Mary’s Hospital Sidcup will provide urgent care for those that do not need to be admitted to hospital. Emergency care for those patients suffering from a major trauma (provided at King’s College Hospital), stroke (provided at King’s College Hospital and Princess Royal University Hospital), heart attack (provided at St Thomas’ Hospital and King’s College Hospital) and vascular problems (provided at St Thomas’ Hospital) will not change from the current arrangements.
• Maternity care – There are two options under consideration to ensure that a high quality of care is provided for women needing to be in hospital during pregnancy and for women when giving birth. Obstetric-led deliveries could be centralised in line with critical emergency care across King’s College Hospital, St Thomas’s Hospital, Queen Elizabeth Hospital and Princess Royal University Hospital; alternatively, there could also be a ‘stand-alone’ obstetric-led delivery unit at University Hospital Lewisham. All other maternity care will continue to be provided in a range of locations across south east London.
• Elective care – An elective centre for non-complex inpatient procedures (such as hip and knee replacements) should be developed at University Hospital Lewisham to serve the whole population of south east London. Alongside this elective day cases procedures should continue to be provided at all seven main hospitals in south east London; complex procedures should continue to be delivered at Kings’ College Hospital, Princess Royal University Hospital, Queen Elizabeth Hospital and St Thomas’ Hospital, and specialist procedures at Guy’s Hospital, King’s College Hospital and St Thomas’ Hospital. Outpatient services should be delivered from a range of local locations.
In order to deliver this transformation programme, the recommendation is that South London Healthcare NHS Trust be dissolved and other organisations should take over the management and delivery of the NHS services it currently provides. In addition to the proposals for Queen Mary’s Hospital Sidcup outlined above:
• The Queen Elizabeth Hospital site should come together with Lewisham Healthcare NHS Trust to create a new organisation focused on the provision of care for the communities of Greenwich and Lewisham.
• There are two options for Princess Royal University Hospital. The first is an acquisition by King’s College Hospital NHS Foundation Trust, which would
enable the delivery of service change, enhance the services offered at the site and strengthen the capacity of the site to deliver the necessary operational improvements. This is the preferred option at this stage. However, an alternative option is to run a procurement process that would allow any provider from the NHS or independent sector to bid to run services on the site.
The report also recommends that the Department of Health writes off the debt associated with the accumulation of deficits at South London Healthcare NHS Trust. By 31 March 2013, this is estimated to be £207m.
The consultation process starts on 2nd November so do make your comments known.
I understand that things can’t stay as they are with the Trust loosing £1m per week. With any change that is driven by cost cutting comes the worry about which services will be cut and how the funds are prioritised. I also worry what the recommended acquisition of Princess Royal University Hospital by King’s College Hospital NHS Foundation Trust will do to investment projects at King’s and it is important that money isn’t caught up in this acquisition leaving them unable to invest and improve the services at King’s in the future.
With the rising birth rate at King’s there are huge pressures on the maternity services there and they often close their doors to anyone outside of their catchment area. Centralising obstetric-led deliveries in line with critical emergency care across King’s College Hospital, St Thomas’s Hospital, Queen Elizabeth Hospital and Princess Royal University Hospital will put increasing pressure on these hospitals when there is already is a huge pressure on space already. For maternity services, as well as the proposed stand-alone’ obstetric-led delivery unit at University Hospital Lewisham perhaps part of the solution is for a stand alone midwife led unit in the Dulwich area to relieve some of the pressure on maternity services in SE London.
You will be able find details of how to have your say when the public consultation begins on 2 November at www.tsa.nhs.uk