A devastating ‘Demand & Capacity Review’ analysing the problems facing acute and community services and primary care in Norfolk and Waveney’s Sustainability and Transformation Partnership (STP) has been compiled by the Boston Consulting Group at a cost of £500,000.

It has underlined the fundamental under-funding of local services and the need for more beds in all three acute hospital trusts, two of which are currently rated as “inadequate” by the Care Quality Commission..

The report pulls no punches, pointing out that the “fragmented commissioning landscape” (which of course was worsened by the 2012 Health and Social Care Act) is under financial pressure. Despite rhetoric at the end of last year about Norfolk and Waveney being an “aspirant integrated care system,” there are only limited plans for integration.

If things stay as they are the STP area could wind up with a £140m deficit and a shortage of 500 beds by 2023. Moreover in moving towards any coordination and strategic planning, say the consultants, the local NHS is “starting from behind”. Across the STP area there will likely be a £95m in-year deficit in 2018/19. Indeed the largest acute trust, Norfolk & Norwich University Hospitals, which last year rejected NHS Improvement proposals for a “control total” of a £10.7m surplus and opted instead to aim for a £55m deficit, is now having to revise that figure upwards, and in January projected a deficit of £58.8m for the year.

The report states that making matters worse is the fact that the Trust is “carrying a significant PFI cost, contributing to a structural deficit”.

Boston Consulting argue that “All hospitals see high volumes of non-elective work,” not least as a result of “excess demand” for primary care of 9%, and a declining GP workforce, which they say contributes to higher levels of demand for emergency hospital care.

There is a severe pressure on bed numbers, with hospitals swamped with emergency admissions: “Non-elective demand is growing 4-8% and will fill available elective capacity within 2-3 years.”

However there is also a problem of inadequate services outside hospital, resulting in large numbers of “Medically Fit For Discharge” (MFFD) patients occupying upwards of 160 beds in the three acute trusts.

Boston Consulting argue that if a series of interventions across the whole local NHS were successful “a total of 180 beds could be freed”: however this would require the transfer of 130 beds “or bed equivalents” into the community – and would require investment and of course workforce to deliver.

Even if all this were done, the prospect is that 120 more acute beds would be needed by 2022/23 – 85 of them in the crowded Norfolk & Norwich – and 20 more beds in Norfolk Community and Health Care trust.

Boston Consulting calls for steps to ensure the three acute trusts are enabled to collaborate together rather than compete:

“The acutes must now build from what they have already achieved, mobilise as a collective and work towards clinically led, integrated approaches to care delivery.”

Although many of its proposals seem over-optimistic, this consultant’s report breaks from the norm in offering a brutally frank assessment of the situation, and at least attempting to take account of the full cost of the measures necessary to enable health care providers to cope. In other areas more evasive reports are failing to get to grips with the scale of the problems.

The Lowdown will continue to follow this and similar far from integrated health systems as they assess the possibilities of moving towards “integrated care” as required by NHS England’s Long Term Plan

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