Another one of the six actual planned new hospitals from Boris Johnson’s “fake forty” new hospitals promised last summer seems set to be rushed through with minimal scrutiny or consultation, and do far more harm than good to local services and capacity.
As local health chiefs and too many local politicians in Leicester, Leicestershire and Rutland (LLR) apparently opt to turn a blind eye to the gaps and weaknesses in the plans, and grasp the promised £450m rather than risk delays, local campaigners are faced with the latest of a succession of half-baked plans that could leave the area desperately short of resources for decades to come.
In 2014 a Strategic Outline Case, bizarrely entitled Better Care Together, proposed shutting one of University Hospitals Leicester’s (UHL) three hospitals, axing 427 beds, with Leicestershire Partnership Trust, expected to take on the care of 250 “beds worth of activity” without any additional bed capacity.
Two years later health bosses in LLR drew up a hopelessly impractical “Sustainability and Transformation Plan,” again cutting from three to two acute hospitals and closing 243 acute beds at Leicester General to focus services at Glenfield and Leicester Royal Infirmary, at a cost of £280m. The STP also proposed to axe 1,500 hospital jobs, recruit 234 extra primary care staff, and cut 38 beds from two community hospitals.
The ill-founded hopes of closing 13% of available beds in the patch soon perished in the winter pressures that followed, but local NHS leaders have clearly learned nothing, and remain stubbornly resistant to planning seriously for the future. The latest plan would also leave the area desperately short of beds, and community and primary care services saddled with extra, unfunded, demand.
University Hospitals Leicester and local commissioners have now plunged into a consultation on a gigantic but unconvincing Pre Consultation Business Case (PCBC), which is due to end on December 21, despite concerns raised by local campaigners of the restrictions that will limit the normal processes of a full public consultation during the Covid 19 pandemic.
But perhaps more worrying is that the PCBC, drafted in obsessive secrecy, was finalised last year and eventually signed off in January – just before the Covid pandemic struck in full force. All of the “public engagement” it refers to was years ago, in a different time completely.
And rather than pause the already delayed process a little longer to allow a proper evaluation of the longer-term implications of the pandemic for the design and capacity of hospital services, the decision was taken in September to rush ahead with a 12-week consultation on a £450m scheme that will irreversibly change local hospital services by selling off land and buildings. Only a flimsy 4-page preface to the PCBC makes even passing reference to Covid-19.
It appears from the bland words of the PCBC that the management has changed its tune on bed numbers, and is now advocating an increase: “A bed model has been produced to support the reconfiguration plans and the proposal is to increase the current level of beds from 2,033 to 2,333. Therefore there are no proposals to decrease bed numbers.”(PCBC p11)
However a closer look at the actual proposals reveals that the 300 additional beds are largely imaginary, and there is NO plan to build any additional beds at all. The diagram (PCBC p6 and p254) shows that the equivalent of 161 beds is supposed to be covered by “planned efficiency”, 41 are to come from converting “non-clinical space”, 28 involve simply re-labelling 28 existing rehabilitation beds, and the remaining 70 beds in “additional contingency wards” are not funded, and would only be subsequently built if required (not clear where). The PCBC states “the Trust will, if necessary, address this in later years through CRL funding for what equates to 2.5 wards.” (PCBC p7).
All of the PCBC’s hyper-optimistic assumptions were made pre-Covid, and take no account of the new requirements for social distancing, reducing numbers of beds in ward spaces, diversion of staff to deal with peaks of Covid infection impeding the smooth implementation of efficiency measures, or the emerging chronic problems and pressures on services of patients suffering “Long Covid” in the aftermath of the virus.
A core assumption is that previous planning norms of aiming for 85% occupancy of acute beds would be discarded, and a new ‘normal’ occupancy rate of 90% – and 93% for day case and elective care – adopted. This was a risky assumption prior to Covid, but the pattern of bed use during 2020 gives a glimpse of the problems that require this element of the PCBC to be re-thought and revisited.
Neither the bed numbers nor the occupancy levels will be those assumed. The Trust responded to a Freedom of Information Act request to give a bed count of 1,848 beds available overnight on January 31 2020 – comprising 1,678 general and acute beds and 170 maternity beds.
However this is misleading. NHS England’s winter sit rep reports show that the Trust reported just 1592 core general and acute beds open on that day, bolstered by 91 temporary ‘escalation beds’ to give a total of 1,603.
Even this lower figure is an exaggeration of the actual capacity of UHL acute beds since Covid. UHL figures reported to NHS England’s Covid 19 daily situation report showed the Trust had an average of just 1,086 acute beds occupied from April to the end of June, while Department of Health statistics show an even lower average of 984 (67% of the 1,454 general and acute beds available).
The Covid sit reps show that UHL bed occupancy rates increased to an average 1,275 in the next two months, but it’s clear that the hospital has not been able to make full use of its full bed capacity – even in the less demanding summer period since Covid struck.
The impact of this will be felt in the growing delays in treatment for cancer, cardiac and all of the non-Covid conditions that previously made up the main caseload of the hospitals. No matter how shiny and new a £450m hospital may be, if the two sites wind up with insufficient capacity to treat the ongoing future numbers of Covid patients as well as handling routine care and emergencies, the new scheme will not properly equip LLR for the future.
This is not the only glaring flaw in the PCBC, which does not comply with Treasury Green Book guidance which calls for “do minimum” options to be considered. Its costings are based on outdated 2019 figures – as other hospital projects escalate in cost.
It’s clear that the plan is being railroaded through for political reasons, to grab the cash on offer whatever the consequences; local people are likely to rue the day their leaders took such a short-sighted decision.
* The Lowdown will follow this and similar hospital projects.
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