Updated: THE loss of 200 hospital beds in York and North Yorkshire is just one of the “essential” measures needed to help the region’s NHS authority save £230 million by 2015.
An independent report published yesterday on behalf of the region’s strategic health authority also did not rule out job losses and hospital closures, and warned of a “radical solution and a shift in how health care is provided” to end massive overspending by struggling NHS North Yorkshire and York.
While the commission acknowledged North Yorkshire residents enjoyed good health compared to other UK regions, it said NHS funding for North Yorkshire and York was £1,410 per patient per year – the 13th lowest per resident allocation in the country.
It added, however, that “there is no other option” to the proposals and said commissioners and providers must now focus their efforts and work together to deliver the recommendations.
The most controversial measure would see more than 200 beds lost across the region, with the threat of the closure of a general hospital, such as Scarborough or Harrogate, or community hospitals such as those in Selby, Malton and Whitby, if savings fail to materialise.
Professor Hugo Mascie-Taylor, chairman of the independent review commission, said: “We feel strongly that action needs to be taken now to redesign the model of care so patients are treated according to levels of need, to reduce hospital inpatient beds with an increase in activity and shift care from hospital to the community sector – as well as increasing efficiency and productivity.”
The recommendations are intended to guide GP commissioning groups, which will shortly take over responsibility for spending the annual billions in NHS cash, as primary care trusts are phased out.
Other recommendations include treating more people in their own homes and freeing hospital beds by using “remote diagnosis” and “treating patients using telecommunications technology”.
Savings could also be found by co-locating services and selling off hospital land and property, according to the report.
For mental care, which the commission recognised as a “critically important area of service”, it said the emphasis should shift towards preventative treatments and care through health and social care, and away from inpatient care.
The commission also felt savings would result if more were done to encourage residents to take more responsibility for their own health.
The report said: “Equally important is the focus on prevention of ill-health related to alcohol, smoking and obesity; and early intervention with families where needed.”
It also called for measures to care for elderly people, such as reducing the impact of ill-health and falls.
North Yorkshire’s over-65 population is expected to increase by 16 per cent by 2013, and by approximately 40 per cent, to 198,000, by 2020, making it almost a quarter of the overall population.
Jayne Brown, chief executive of NHS North Yorkshire and York, said: “I am pleased the report recognises that the people of North Yorkshire and York enjoy some of the best health in England, and are served by a wide range of generally good-quality health services and a high-quality workforce.
However, the report also recognises that if we are to meet the challenge of sustaining this within our means, there needs to be radical action.
“We welcome the findings of the report and we hope that it enables the new leaders of the local NHS to make the necessary changes.”
Challenge and cause for alarm
STRINGENT efficiency measures proposed for the NHS in our region have provoked a mixed reaction from politicians and health professionals.
York Central MP Hugh Bayley has called for Health Secretary Andrew Lansley to visit York for a public consultation, following the publication of a report yesterday recommending the closure of 200 hospital beds, among other major cost-saving ideas for North Yorkshire.
Mr Bayley said: “There are a lot of good ideas in the report, such as treating more patients in their own homes rather than in hospital and everyone taking more responsibility for their own health – these are good proposals.”
However, he added: “The commission has come up with a lot of radical ideas and the NHS should consult on these through local meetings throughout the city to identify what can be accepted and rejected. I would like to see Andrew Lansley come to the first of these meetings to see what he has to say.”
Meanwhile Dr Mark Hayes, chairman of Vale of York Clinical Commissioning Group, said the review was just the “tip of the iceberg” when it came to problems with health care in North Yorkshire and York.
He said: “The coming 40 per cent increase in the population who will be over 65 years old in the next four years gives us all a challenge that we must rise to.
“The commission’s report shows us a way forward built on the close co-operation of all agencies working across the health and social-care spectrum.”
Unions representing health workers in North Yorkshire have criticised the severity of the measures.
Ray Gray, regional officer for Unison, said £230 million was a “massive amount” to take out of the area’s health economy, and he expressed alarm over proposals to close beds and hospitals.
He said: “A loss of 200 beds? I thought we had learned our lesson in Thatcher’s time about putting health care into the community and found it didn’t work. You can’t just transfer it all to the community.”
Report prompts healthy debate on future policy
Dr Brian McGregor, York chairman of the GP group YOR Local Medical Committee
“High-level individuals have been involved in this and, following years of difficulty in balancing our books, if the NHS allocation formula remains the same we will have to look at radical solutions to make sure we can deliver safe solutions in the future without having to make cutbacks due to financial issues.”
Hugh Bayley, Labour MP for York Central and former health economist
“Over the last eight years the NHS budget for York and North Yorkshire was doubled from £600 million to £1,200 million now. It’s alarming that the commission identified that NHS in our region will have to make £230 million in savings by 2015.
“The report notes that funding formula disadvantages North Yorkshire and York. This is a serious issue I have been raising for a long time. I call on the Department of Health to address the funding formula.”
Dr John Crompton, North Yorkshire chairman of YOR Local Medical Committee
“I believe the review is an important step forward in understanding and addressing the issues the North Yorkshire health economy faces. Its adoption and implementation will be key if we are to continue to provide high-quality services in an affordable and sustainable way in the future.”
Kersten England, chief executive of City of York Council
“The commission has investigated one of the most important challenges of our time – how we can make best possible use of the funds available for health provision to our communities.
“The debates within the commission have been wide ranging, rigorous and lively but the two central findings – that we need to ensure provision meets the needs of all communities and that resource is best concentrated on preventative services delivered in the community - were supported by all commissioners.
“The commission’s findings resonate with our own work in York on managing the challenge of reducing resources and the demands of an increasing population of older people, who rightly want more choice and independence in later life. These two challenges will be central considerations for the health and wellbeing board for York, which will be established later this year in shadow form; and the commission’s report will be invaluable to the members of the health and wellbeing board.”
Coun James Alexander, Labour leader of City of York Council
“The NHS is having to undergo fundamental changes because of the Conservative-Liberal Democrat Government’s unwarranted £3 billion top-down restructure and because David Cameron has not honoured his pre-election pledge to increase funding to the NHS year on year in real terms.
“The result is reviews such as this that have both helpful contributions like looking at shared services, but also contributions that will cause public concern such as reducing hospital beds and rationalising the number of hospital buildings.
“Labour was out this weekend campaigning in Micklegate for David Cameron to live up to his pre-election pledges over the NHS.”
Kate Tayler, chief executive of voluntary- sector group the North Yorkshire and York Forum
“This review process has not only involved a refreshingly open discussion of the current provision but also a very high consensus of opinion about the way forward, which is extremely important as all sectors will need to work together to implement the recommendations. It is essential to take on board the whole framework if we are to reshape how health and social care is provided. In particular I welcome the emphasis on integrating voluntary-sector services into the whole pattern of care.”
Long, hard look needed on NHS
GOVERNMENT reforms of the NHS propose that GPs take on more primary care duties in a bid to free up hospitals. But a review into North Yorkshire and York NHS Trust suggests even stronger medicine will be required.
The trust has an historic debt of £18 million which the report calls ‘unsustainable’ and, to preserve future health services, it says radical steps must be taken, some as early as October.
Among the most controversial recommendations is to close 200 beds in what review author Professor Hugh Mascie-Taylor calls a radical shift in how healthcare is provided, by spending in a way that provides better value for the taxpayer.
Funding is an eternal problem in the NHS and with people living longer, that is only going to get worse. There will never be enough money to fund people’s high expectations.
But savings can be made. An argument often made is that people sometimes receive a higher level of care than their condition warrants, something GP surgeries are well placed to address.
We welcome the fact that someone has decided to grasp the nettle, but this is happening very quickly and care must be taken to debate the issues properly.
A long, hard but unemotional look is called for. One that decides what needs to stay and what can be let go. There must also be a change in mindset, with more emphasis on prevention rather than cure.
It can be quite frightening to see figures in the millions bandied around, but spending money unwisely is equally scary. The overriding concern, however, is we must not be left with worse levels of care.
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