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Boost GP services before cutting beds, says Stevens

Plans to cut the number of hospital beds will only be allowed to go ahead if commissioners are able to demonstrate that they are putting money into GP services or that the cuts will benefit local healthcare, NHS England will announce today. 

NHS England chief executive Simon Stevens will give a speech later today setting out a series of 'tests' local plans will need to pass before cutting hospital beds, which include 'demonstrat[ing] that sufficient alternative provision, such as increased GP or community services, is being put in place'. 

Commissioners will also be allowed to cut beds if they can demonstrate that the beds are being used inefficiently, or new drugs are helping to reduce admissions.

Mr Stevens will tell delegates at the Nuffield Trust Health Policy Summit today that it cannot be assumed it is 'OK to slash many thousands of extra hospital beds - unless and until there really are better alternatives in place for patients'.

It comes after the 44 regional 'sustainability and transformation' plans (STPs) - which are local blueprints for the future of the NHS in England - have been criticised  for proposing widespread reduction in hospital beds as part of ambitious savings targets.

The tests for bed cuts to be announced by Mr Stevens include: 

  • 'Demonstrate that sufficient alternative provision, such as increased GP or community services, is being put in place alongside or ahead of bed closures, and that the new workforce will be there to deliver it; and/or
  • Show that specific new treatments or therapies, such as new anti-coagulation drugs used to treat strokes, will reduce specific categories of admissions; or
  • Where a hospital has been using beds less efficiently than the national average, that it has a credible plan to improve performance without affecting patient care (for example in line with the Getting it Right First Time programme).'

Mr Stevens will tell delegates: 'More older patients inevitably means more emergency admissions, and the pressures on A&E are being compounded by the sharp rise in patients stuck in beds awaiting home care and care home places'.

But he will add: 'There shouldn’t be a reflex reaction opposing each and every change in local hospital services [because]... there’s a huge opportunity to take advantage of new medicines and treatments that increasingly mean you can be looked after without ever needing hospitalisation.'

The Royal College of Emergency Medicine said in an official statement: 'With attendances and admissions ever increasing, patients presenting at a later stage of life with more acute symptoms, and bed occupancy currently over 95% - way above the safe limit of 85%, all the evidence points to the need for more beds. This is not to mention the impact cuts to social care have had.

'We already have the lowest number of acute beds per capita in Europe, along with a poor ratio of doctors to patients, yet we appear to be on a downward trend. If we are to get back to safe levels of bed occupancy it should be obvious that we need more beds.'

And BMA chair Dr Mark Porter said it was 'astounding that NHS leaders are still talking about cutting the numbers of beds even though we know that patients are being already unfairly let down by a huge lack of beds in our hospitals'.

He added that as it stands, 'there is a real risk that the STPs are... being used as a cover for delivering cuts, starving services of resource and patients of vital care'.

Healthcare charity coalition National Voice said no hospital beds could be cut before there was more money invested in health and social care to allow areas to 'double-run' services.

Director of policy Don Redding said: 'That money is not available - paradoxically, transformation funds have been sucked up to plug hospital deficits. Neither is there an immediately available workforce for primary and community care. The numbers of GPs and qualified district nurses continued to fall.'

Speaking at the same conference, Labour's shadow health minister Jonathan Ashworth will call on the Government to find £2bn to invest in social care for next week's Budget announcement.

He will say: 'One of the biggest drivers of problems for the NHS is the crippling cuts to social care over the past seven years. You simply cannot slash £4.6 billion from social care provision and not expect it to impact the frontline.

'This Government must act in the Budget next week. There is general consensus that social care now requires an immediate £2bn funding boost.'

What are STPs?

At the end of 2015, NHS England tasked regional teams, CCGs, trusts and local authorities with forming regional footprints, and then write plans for how the NHS Five Year Forward View would be delivered within them.

The Forward View, published in 2014, set out plans to achieve savings worth £22bn from the NHS budget between 2015-2020, in part by investing ‘a much higher proportion’ of its budget on GP services.

Some 44 footprints were formed, and the Sustainability and Transformation Plan (STP) were prepared and submitted to NHS England during 2016.

As previously reported by Pulse, each plan had to adress ‘sustainability and quality’ of general practice, including both ’workforce and workload issues’.

Readers' comments (9)

  • The drivers of admission are legal anxiety, 111, lack of continuity and more old people, these are difficult to tackle in the current environment.

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  • Yeah, get a hydraulic pump because that is the only thing left that might give any boost without the need for improving finances.

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  • Simon has just created clauses that make certain that if STP goes 'belly up', as we know it will, he will not be blamed.

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  • Everyone has a bed and it is at home! We need to use hospitals only for acutely ill patients or scheduled treatment. There is this obsession about numbers and more is better. Once a patient is in hospital they are institutionalised and problems that did not exist suddenly appear. Not knowing where the toilet is and being afraid to ask until too late and the patient now has incontinence. Poor disturbed sleep leads to confusion and then questions about can they be safely discharged. Means tested social care leads to assessment by the continuing healthcare team at greater cost. Sir Muir Gray talks about a value based healthcare system which is allocative technical and personal value, a test we should apply to all the plans rather than the knee jerk make savings at all costs! The STP's appear to have just re-hashed all the existing plans but not fundamentally challenged the "why" we are in this situation. The determinants of health are housing education and employment yet we focus on the number of beds, which is a political hot potato. There needs to be honest debate as to what is affordable and what is not. Continuing with the charade that it will all work if we had more money makes no sense. The country is bust. the current debt is £1.8 Trillion!! and rising at £5170 a second. The plans will never address the basic flaw that a tax funded free at the point of delivery business model is unsustainable.

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  • There are more acutely ill patients therefore we need more beds .It's the demographic . How it is paid for is a political decision.

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  • Shouldn't these provisions been made made years ago, before bed occupancy rates were in the high 90's?
    Same thing happened years ago with psychiatric care. Wards were shut BEFORE adequate provision was established in the community
    They will never learn!!

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  • Vinci Ho

    I stick to my argument all these cuts deep into the core on public services , health and social care , education , police force , prison service etc are now to be continued as a STP for the potential financial consequences of Brexit. Remember , no Brexit , no Auntie May as the prime minister (of course , not implying Lord Vader was any better!)

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  • David Banner

    Joe Public, who has had his op cancelled twice due to "no beds", and whose mother has been an inpatient for a month because of social care cuts, will never understand the twisted logic of STPs and reducing bed numbers.

    Blue Sky thinking like this might add up on paper, but will lead to chaos on the ground. Even with (unlikely) more Primary Care investment, the reality will still be a GP on a visit to a frail elderly patient who cannot stay at home, is too ill for respite, and will need admission.

    The country must make a choice, either an economy-wrecking massive cash injection (such as Gordon Brown tried), or throw the towel in on an unaffordable NHS.

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  • Council of Despair

    'Boost GP services before cutting beds, says Stevens' or better still - talk about it, promise to do it but then don't bother. It's called politics.

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