Notts NHS lays out plan for swathe of £600m cuts

Organisations, including Nottinghamshrie County Council, Mansfield & Ashfield CCG and other health commissioners have collectively planned how to improve the quality of care in the county, and to make the service sustainable it it faces a potential ‘do nothing’ shortfall of £628 million by 2021.

The new five year plan (viewable here) states that ‘operational efficiency will not be enough to close the gap alone and therefore transformational change to the model of care will be required.”

So on top of £313m of ‘per patient’ cost reductions and system initiatives, the NHS must remove £200m of costs with ‘transforming the model’ of care.

This will ‘aim to both reduce the demand for healthcare and shift activity into lower cost settings of care within the community and closer to people’s homes.”

Plans also include £185m of new initiatives and a £20m fund to help with the cost of Sherwood Forest Trust’s PFI deal.

STP identifies five local ‘high impact’ areas for change:

1. Promote wellbeing, prevention, independence and self-care

2. Strengthen primary, community, social care and carer services

3. Simplify urgent and emergency care

4. Deliver technology enabled care

5. Ensure consistent and evidenced based pathways in planned care.

David Pearson, STP lead for Nottingham and Nottinghamshire, said: “The health and care organisations in Nottingham and Nottinghamshire have come together over the last few months to find ways to change services in our City and County - using the money we have in the best way - to prevent ill health, modernise services, joining them up to provide the right care in the best place. We aim to keep people independent and at home, but with excellent specialist care available when they need it.”

“We know that if we do not change the way we do things, the gap between what we want from health and social care and what can be delivered will grow as ‘doing nothing’ means we will have a shortfall of more than a £600m in our budgets.”

Councillor Alex Norris, Chair of the Nottingham City Health and Wellbeing Board, said: “Now that our plan has been drafted, all organisations involved with the STP want to talk to those people who live and work in Nottingham and Nottinghamshire about how it can be improved and what needs to be done to make this happen. We will be listening to many individuals and organisations over the coming weeks and months, including patients, service-users and carers, particularly around any changes to services and to understand the support that people want and need to help them live healthier, more independent lives.”

The STP published today is the draft plan submitted to NHS England on October 21. This plan will continue to be developed, it is not final is a reflection of local organisations’ current thinking about what needs to be done to improve health and wellbeing, the quality of care and local services, and address the financial challenge.

The five-point plan for high-impact areas includes £66m in direct savings, but the main savings are hoped to be made in preventative areas and wellbeing, the best course of action to reduce impact from conditions such as diabetes, heart disease and respiratory disease.

A core initiative to improve well-being is with new ‘self-care hubs’ within the community, requiring millions in investment and hoped to roll out by April 2017.

The plan will also push towards “scaling up GPs in consolidated locations” by 2019.

A new model for staffing will mean addresing the ‘skill mix’ for each care function - ‘to increase advanced and enhanced levels’ and reduce other skills for other areas.

And although there will be a 24 per cent rise in the care workforce over five years the NHS will save £12m on future pay costs. “These savings are accounted for in organisational finance plans and this work will support delivery of the STP transformation workstreams and initiatives,” says the STP document.

“Significant reductions elsewhere are indicated that will contribute to closing the financial gap based on the assumption that primary and community care or self-care will increase in capacity and capability.

“Further efficiencies could be achieved by reducing agency costs and non-patient facing staff who have not been included in

the model to date.”

Councillor Alan Rhodes, Leader of Nottinghamshire County Council, said: “Our NHS is something to be proud of and we all need to work together to protect it. We are faced with big challenges if we want a service that will work for all of us well into the future. Doing nothing is not an option because rising demand for health and social care services is outstripping resources.

“We have already been changing the way we provide social care services in Nottinghamshire by working with health to join up teams and reduce duplication. The aim is to keep people out of hospital and care homes by planning services better and providing the right care, at the right time. The STP sets out how this work will continue over the next five years. People may have concerns that STPs have been worked on behind closed doors, but the process has been restricted by Government guidelines. I would urge people to get involved with the public engagement process that will take place soon.”