Stark Choices must be made advise Health Chiefs
"NHS must ensure effective and affordable services"

28/03/2006

NHS Chief Executives today shared with their staff and local partners proposals setting out how services will need to change to bring financial stability and improve efficiency whilst meeting the needs of patients in the future.

The NHS in Gloucestershire has consistently provided good quality services for its patients. Services have improved year on year and the NHS has met demanding national and local performance targets for waiting times and access to services, including A&E targets.

This performance has been reflected in annual star ratings where NHS organisations have achieved excellent results.

However, the NHS needs to review how services are provided and to ensure that every penny and every pound of public money is used well. We are also required to pay off current deficits and balance our books in 2006/07.

For Gloucestershire’s Primary Care Trusts (PCTs) there is a financial gap of £23m in plans for 2006/07 and these savings need to be made. Whilst this is only a small proportion – around 3.5% - of our total spend on NHS services, we need to take urgent action now.

There are also financial pressures facing the county’s provider Trusts partly due to the national requirement for all NHS organisations to reduce costs by 2.5% in 2006/07.

The Chief Executives of the county’s PCTs and NHS Trusts, explained that radical decisions and tough choices had to be made:

“We are very proud of the services we offer to patients. However, despite continuing improvements in the way the NHS provides services locally and despite additional money for PCTs in 2006/07, we cannot meet current demand and expectations within our overall funds.”

“If we are going to meet this challenge, we will have to stop doing some things now and change the way we do others. We also have to reduce our management costs.”

“We believe that now is the time to restructure our services and take difficult decisions that will benefit patients in the longer term. Failure to act now will allow the financial difficulties to build.”

“The majority of patients receive their treatment in local communities and we are fortunate in Gloucestershire to have a strong network of community based services, such as those currently provided from GP surgeries and in people’s own homes. We have been building up these services over recent years and now provide more services in the community than ever before.”

“We are also committed to providing specialist hospital services for those who need them.”

“However some services may have to be provided in fewer locations and in different settings if we are to safeguard the future of services and continue to provide good quality care for patients.”

“We know that the range of savings proposals will not be popular with everyone and there will be some bitter pills to swallow. In considering their response to these proposals, we would ask Gloucestershire residents to recognise the pressures facing the local health community as a whole.”

“Our proposals are not about any one area of service or any one community losing out. We can’t ‘cherry pick’ individual services and look at them in isolation. We have to achieve an effective and affordable local health service.”

Chief Executives are set to discuss these detailed proposals with the County Council’s Health Overview and Scrutiny Committee and local stakeholders tomorrow (29 March).

Notes To Editors

Note 1 – Financial Overview

The additional funds received over previous years have clearly been welcome. However, the majority of this money has been spent meeting the costs of new drugs, improving waiting times and meeting commitments such as the GP contract, consultant contract, pay awards, increased NI and pensions contributions and the new Out of Hours service.

By 2007/08 the financial allocation by head of population in Gloucestershire will be approximately 88% of the England average based on the below average health needs of the population in Gloucestershire. However the demand for healthcare locally does not reflect this.

Avon , Gloucestershire and Wiltshire Strategic Health Authority has now confirmed how it will be implementing national policy on NHS financial management for 2006/07. It intends to create a pool of funds to help the most financially challenged organisations in AGW pay off their 2005/06 deficits. Cotswold and Vale will receive £6.8m but overall the county’s three PCTs will lose a total of £6.5m from their expected 2006/07 allocations.

The underlying difficulty is compounded in 2006/07 by financial pressures facing the county’s provider Trusts. Significantly there will be a large reduction in the prices paid to acute hospitals through the national tariff next year.

Gloucestershire Hospitals NHS Foundation Trust will be paid up to £17m less, than it will receive this year for the same number and case-mix of patients. Gloucestershire Partnership NHS Trust is forecasting a £5.2m deficit in 2006/07, whilst Gloucestershire Ambulance Services NHS Trust is forecasting a shortfall of £1.5m in the same period. These figures include the national requirement to make a cash efficiency saving of 2.5% in year.

NHS organisations in Gloucestershire have already introduced strong controls to improve their efficiency and reduce their costs. These include controls on recruitment and spending on goods and services, controls on use of Bank and agency staff and spending on areas such as training.

Note 2 – Services currently provided by the NHS

When looking at the range of services provided it is clear that the NHS locally faces tough choices when deciding on how services should be provided in the future and where reductions can be made.

Front line NHS services can be broadly grouped under six headings: Primary Care (including GP practices, community pharmacy, NHS dentistry and optometry services), Community Services (including therapy services, district nursing, specialist community nursing services, health visiting, specialist community based services for people with mental ill-health and learning disabilities and community hospital services), Ambulance Services (Emergency, Patient Transport and Out of Hours Services), General Hospital Services (including A&E), Specialist Mental Health and Learning Disability In patient services, Specialist Commissioning (e.g. bone marrow transplants, burns care, specialist surgery for children).

Note 3 – Range of proposals

The range of proposals describes changes, not only to hospital based services, but also across the range of services provided in the community. It will be for each organisation to agree its business plans for the future.

The list below represents some of the changes which we propose to implement. The full list will be discussed with Gloucestershire County Council’s Health Overview and Scrutiny Committee on 29 March. We have divided the list below in to two phases – proposals we feel we need to implement during 2006/07 and those for 2007/08 and beyond. All of our proposals are aimed at reducing costs and ensuring quality of care.

Proposals for 2006/07:

• Not proceeding with piloting the Nurse Led Ward at Cheltenham General Hospital
• Reducing the number of follow up outpatient visits
• Rationalising mental health inpatient services for adults and older people onto two sites
• Day Hospitals and Day Services – concentrate resources on health needs only
• Reducing staffing and/or opening hours at Minor Injury Units to reflect periods of low demand at Dilke Memorial, Berkeley and Tewkesbury Hospitals (and consideration given to North Cotswolds)
• Further reviewing of the roles of Community Hospitals in Cotswold and Vale PCT area. Reviewing the roles of Community Hospital services in the Forest of Dean and the role of Winchcombe Hospital
• Improving rehabilitation and reducing length of stay by increasing rehabilitation in patient’s own home and in community facilities e.g. at Winchcombe and Dilke Memorial Hospitals. This will lead to a reduction in hospitals beds and the closure of Delancey Hospital in due course
• Reducing management costs across the PCTs as part of reconfiguration proposals
• Redeployment of Ambulance staff and vehicles from Newent to other parts of Gloucestershire to reflect demand
• Reviewing access to Ambulance Patient Transport Services
• Ensuring more effective and efficient drugs prescribing across the board
• Ceasing to fund GP practices for GP appraisals
• Ceasing to fund PCT discretionary GP locum payments

Proposals for 2007/08 and beyond :

• Rationalising in-patient acute services onto one site where it is clinically and cost effective to do so. The services to be considered are:
• Oral and maxillofacial
• Vascular
• Gynaecology
• Urology
• Paediatric (children’s) (not outpatient or assessment services)
• Obstetric (not outpatient or community based services but includes hospital services)
• Reviewing arrangements for trauma and emergency care
• Determining the most effective location for the delivery of Breast Services

Note 4 - Relevant national guidance

NHS Improvement Plan

NHS White Paper: “Our Health, Our Care, Our Say”