Our 2017 report, Delivery Costs Extra, found that almost all STP plans prioritised improving prevention and shifting care into the community. In many cases this was in conjunction with plans to reform the provision of acute and community hospital services, including reductions in bed numbers.
Most plans were also explicit that these changes were intended to not only reduce hospital activity, but to also deliver financial savings – despite significant evidence challenging the concept that shifting care into the community generates major savings.
Therefore, alongside our data analysis, we also submitted FOI requests to all 44 STPs, to establish what assessment each had made of its overall bed capacity and whether they have any current plans to reduce it in the future. Specifically, we requested the following information:
- the number of available overnight and day beds at trusts within their footprint counted as part of the STP’s planning
- the number of available community beds
- any plans to reduce or increase the number of beds within the footprint by 2020/21
- any reviews, consultations or impact assessments pertaining to changes in bed numbers
Of the 44, 32 responded directly to the request. Of those 32, all but 11 argued that there were grounds to exempt the information as the number of beds within STP footprints could be calculated using NHS England data. Of the 11 that did respond with bed numbers, just three discussed plans to change the number of beds within their footprint. The vast majority of STPs responded that there were no plans to change the number of beds at trusts as part of the local plan.
Although several STPs provided us with detailed breakdowns of their current bed stock, as well as plans for further changes to bed numbers, in most cases STPs provided neither. Given the nature and purpose of STPs, and the fact that many plans involve major changes and reconfigurations of local services, proper engagement and transparency is essential.
However, most STPs directed us to an NHS England dataset that does not include an STP breakdown and required a separate exercise to match trusts to their relevant footprint in order to calculate the number of beds within an STP. Moreover, whilst A&E data is now published at STP level, most other datasets are published only at national and trust level, a situation which should be addressed by NHS England as soon as possible.
Secondly a number of STPs responded that they had not yet assessed the number of beds within their footprint, or within each of their constituent Trusts. These included the West Yorkshire and Harrogate STP and the Frimley Health and Care STP, which was rated ‘outstanding’ in the NHS England progress dashboard. The BMA remains concerned that many STPs, including the most advanced, are unable to share an assessment of their local health assets.
Thirdly, whilst several STPs clarified that local plans did include bed closures, and offered information on the extent and underlying rationale for these cuts, the majority suggested that there were no plans to close beds at trusts in the footprint.
However, as clarified in this report, in 29 of the 44 STP footprints bed numbers have reduced over the last three years, in some cases very dramatically, and the likelihood that there are no further closures to come seems extremely slim. Several STPs also have plans to conduct reviews of their acute services which, depending on their outcome, may generate plans for future reductions in bed numbers within certain STPs.