Stroud Against the Cuts member Caroline Molloy submitted questions to the Gloucestershire County Council meeting on Wednesday 14th September. The same council meeting featured a debate on this topic prompted by a submission of petitions seeking to retain 24 hour opening at Stroud and Cirencester MIUs totalling 5,345 signatures (read more about Stroud Against the Cuts' position in our submission to the Gloucestershire Care Services' Review of Minor Injuries and Illness Units). The answers have now been published (see the full set of public questions and answers via a PDF)
Question: Minor Injury Unit proposed closures, Sustainability & Transformation Plans.
Gloucestershire’s emergency services have already had cuts to Cheltenham A&E provision. We now face proposed widespread cuts to district hospitals acute/urgent provisions, AND a separate Out of Hours healthcare review with no guarantees that the same level of local service provision will be maintained, AND a separate ‘Sustainability and Transformation Plan’ being prepared now, in unminuted meetings of chief executives and so on, which is explicitly about delivering £100s of millions of cuts to NHS services locally as part of the Five Year Forward View. Whilst recognising the short term issue is one of staff shortages, and pressure from central government to come up with heroic levels of savings, I would like to ask the council's position on the following:
1. The Kings Fund have said “major acute sector reconfiguration rarely saves – and frequently costs – money, and sometimes also fails to improve quality”. The Kings Fund has also said: “Some reconfigurations make bold assumptions about managing demand and reducing length of stay. There is certainly scope to do this but experience suggests it is difficult and that unless very significant reductions in overhead costs can be made, it cannot be assumed that out of hospital alternatives are any cheaper. The direct costs of hospital care may in fact be lower unless significant costs can be shifted to carers or social care – neither of which are easy. In any case, switching to community settings just to save money risks increasing the burden on carers and adding to pressures on social care services, or disguising what are effectively poorer quality services”. Can the council advise how these risks will be avoided?
ANSWER (via Cllr Dorcas Binns): Acute Sector reconfiguration is something which the council has been a consultee on in the past, and where, in the case of Cheltenham Accident and Emergency night time closure, councillors have expressed concerns. Ultimately, however, these are matters which the council has no power to decide, and are the responsibility of the NHS
2. Nigel Edwards of Nuffield Trust said this month that healthcare senior financial managers think there are “big risks around implementation and governance” of these Sustainability and Transformation Plans and adds “Later in the process, some of the proposals may come as an unpleasant surprise to patients and communities.” My research into these plans nationally leads me to fear the closures of minor injury units at night, coming on top of the Cheltenham A&E downgrade and as yet unspecified further cuts to face to face healthcare services and units in Gloucestershire as part of the Sustainability and Transformation Plan, threaten the long term survival of many of our district hospitals. I fear they become nothing more than glorified nursing homes/pharmacists - or flogged off and sold for housing. Can the council guarantee that we will not lose our district hospitals, as full hospitals with medical beds and acute treatment options? What will it do to make sure this doesn’t happen?
Answer (via Cllr Dorcas Binns): The Council does not control the NHS. Questions about their future plans should be addressed to Gloucestershire Care Services NHS Trust.
3. What opportunity have councillors had to see the Sustainability and Transformation Plans as they are developed (drafts submitted to NHS centrally in Jan, April and June)? Does the council feel it has been able to fulfil its democratic obligations to represent the public, given the widespread criticisms of this planning process?
Answer (via Cllr Dorcas Binns): Gloucestershire’s STP is the responsibility of the NHS, rather than the County Council, although we do input into them, particularly on issues like adult socialcare, which are our responsibility. I expect that the NHS will publish the plan when it is completed, but it would be unusual to publish a document in draft. No doubt when it is published they will invite a wide variety of stakeholders to comment, including councillors.