Bedford Forum’s Concise BLMK STP Discussion Paper

SUMMARY OF NHS Sustainability and Transformation Plans (STPs)

Pre-Consultation Discussion paper   1 March 2017


STP is a National initiative to improve the way health and social care is designed and delivered  In the Bedfordshire, Luton and MK area (BLMK), there are 3 main aims.

  1. Better Health and Wellbeing outcomes 2. Better Quality of care delivered   3. Better Value for Money

The 5 BLMK priorities

The BLMK STP submission to NHS England in October 2016, set out 5 main areas of focus

  1. Prevention
  2. Primary, community and social care ( GPs and Social Services )
  3. Sustainable secondary care ( Hospitals )
  4. Technology
  5. System redesign

BLMK are particularly focussing on priority 3, but recognise that it is closely linked with priority 2.

Some Statistics

Almost 1 million people live in the BLMK area – 166,252 in Bedford Borough, 274,022 in Central Beds 214,710 in Luton, and 261,762 in Milton Keynes . Primary care is delivered through 110 GP practices. BLMK residents also access general and specialist care from around 12 hospitals outside the area.

The Challenges

An unbalanced healthcare system – Around 80% of our healthcare is delivered in the community by our GPs . However, 65% of our clinical staff are working in our 3 hospitals which account for 60% of our costs. Only 9% of our clinical staff work in primary care.

A growing and changing population –  the BLMK population is growing almost twice as fast as the national average. An increase of 160,000 people (a 17% increase) is expected over the next 15 years. Geographically, the fastest anticipated growth is in Central Bedfordshire and Bedford Borough.  The 85+ age group is forecast to grow faster than the rest of the population. Also births are expected to increase, so that our hospitals will need to accommodate an additional 1,000 births per year .

Ethnically diverse – the BLMK area includes some of the most ethnically diverse populations in the UK, With some parts having much higher percentages of non-white populations than the national average and also much higher levels of births to non-British mothers than the national average. This diversity increases the range and types of health care services we provide and how they are accessed .       

Health inequalities – General health and wellbeing vary greatly across BLMK. In the most deprived areas life expectancy for men is 9 -12 years less than in the least deprived areas. For women the gap is 10 years . These health inequalities are unacceptable and BLMK are committed to tackling this to ensure that everyone lives longer healthier lives.

Increasing demand – Greater numbers of people are living with long term health challenges, illnesses or disability . Depression and severe mental illness are also on the increase. Bad lifestyle choices are causing increases in obesity, alcohol-related and smoking-related illnesses and early deaths.

Pressure on Services – BLMK hospitals are struggling to meet demand whilst meeting national standards, particularly in waiting times for GP appointments, which can then aggravate waiting times in A&E.

Financial Challenges – The health and social care system across BLMK is facing a significant financial challenge. In spite of planned increases in funding, we anticipate annual deficits of £311 million by 2020/21 if we do not change the way we deliver health and social care in our area. The situation is unsustainable .

Workforce – The BLMK workforce is ageing and faces major challenges in recruiting sufficient staff across a wide spectrum of skills ranging from GPs to specialist consultants .

BLMK current thinking

In the light of the numerous challenges, BLMK must think differently about how it delivers health and social care. No change is not an option . To meet rigorous national clinical and safety standards whilst also being sustainable in terms of BLMK workforce and finances, BLMK need to redesign the hospital services to be delivered across the three existing sites in Bedford, Luton and Milton Keynes. This will involve these three hospitals working more closely together to provide an integrated service. To ease the pressure on our hospitals, BLMK are also looking to see if there are any services that can be moved out of our hospitals and delivered effectively in the community. The STP team, working closely with our hospital staff, have established 6 key areas to focus on to ensure that the services BLMK provides meet national standards and are sustainable.


Focus 1.        EMERGENCY CARE

The numbers attending A & E departments in the BLMK area are much larger than in the past. The population is growing and many people are attending A & E because they cannot get an appointment to see their GP. A&E Departments were not designed to cope with today’s numbers. A redesign is needed. The possibility of enabling our A&E teams to work together to run some services from fewer sites, especially overnight, is being considered. Also, it is possible that some interventions could take place outside of our hospitals with the aim of improving the responsiveness and quality of urgent care. This would enable hospital A&E departments to focus on those patients with serious issues requiring surgery, specialist services or monitoring. Ideas include:

  • Using a Clinical Hub telephone network of clinicians and shared care records to provide informed triage to guide patients to the most appropriate service for their needs.
  • Providing a 24/7 single point of access for people to call ( NHS 111) for unscheduled care and to book GP appointments.
  • Delivering rapid access care close to home including GP out of hours services and urgent paramedic support.
  • Making GP services easier to access and enabling them to offer a more comprehensive range of staff such as pharmacists and paramedics.

(Return to Introduction)


Focus 2.        PLANNED CARE  (i.e. Booked appointments)  

In hospitals, periodic high levels of demand for emergency services also has an impact on the planned care,  due to resources being diverted to deal with the emergencies. BLMK need to plan a level of resources that will be acceptable to patients and that meets national policy on delivering safe, effective care 7 days a week, including meeting the NHS standards for planned care and cancer services. In some areas, BLMK needs more specialist resources andBLMK need to design  services in such a way that BLMK are able to protect planned care, which may mean separating it from emergency care.

(Return to Introduction)



It is essential that BLMK provide the best possible quality of care and that BLMK services meet rising national standards. This must be achieved even in the most complex and specialised cases. One possible way forward is to split particular specialisms into separate functions, which could then be delivered in centres of excellence on different hospital sites. For example, for any particular speciality, it may be better to offer a good basic service at all three sites, but then also provide certain highly specialised aspects at just one site.

(Return to Introduction)


 Focus 4.        CARE CLOSER TO HOME   

Part of the BLMK vision for the future is for more healthcare to be delivered closer to people’s homes. Not only would this improve access to healthcare for local people but it would also help to ease the pressure on our hospitals and allow then to focus on those patients who are in the greatest need of specialist care and support. When patients have a condition requiring treatment, they generally go through a number of stages which may include assessment, consultation, diagnostic testing, an operation or other treatment, and follow-up outpatient care. It might be better to provide some of these stages in a local setting as close to home as possible. In a number of cases it would be possible for assessment, consultation, diagnostic testing, and follow-up care all to be done in a local setting, with just surgery or other treatment being done in a hospital. This might be possible for example for patients with conditions in Ear Nose and Throat, Dermatology, or Ophthalmology . In addition healthcare services for some long term conditions could be provided in a local setting, so that people don’t need to come to a hospital site .

(Return to Introduction)


Focus 5.        MATERNITY   (Obstetrics)  

Each year, nearly 13,000 babies are born in the BLMK area . BLMK currently run full consultant-lead Obstetrics units at all 3 hospitals. BLMK are trying to assess whether this is sustainable , especially as we are struggling to find enough specialist paediatric doctors to cover this service across 3 sites. BLMK must also meet national standards on the availability of obstetrics specialists and ensure that women are offered choice in their maternity care pathway. BLMK are considering whether it would be possible to address the above issue by concentrating services associated with high risk births on just 2 hospital sites. This may result in some women travelling further.

(Return to Introduction)



The paediatric (children’s) services at our hospitals are also facing staffing and capacity pressures. To resolve these problems, we are considering whether it would be possible to separate out different aspects of paediatric care and provide different models of care at each of our hospitals.  If we do this, care for very high risk conditions could be concentrated at one or two sites. By focusing high risk emergency paediatric care in one location, BLMK could create a centre of excellence where specialist doctors and nurses  can share expertise and experience to provide the very highest standards of care for children.

(Return to Introduction)

The Next Steps

BLMK need to gather your feedback on our initial thoughts and ideas . Your views will be collated into a “What we have heard so far” document that will capture public, staff and clinical views and help to inform the development of a formal “Case for Change” document that we have to produce as part of the STP process. The “Case for Change” document will take into account the feedback and outline the key challenges and opportunities and the latest thinking from clinicians around the best way forward.

The ”Case for Change” will be publicly available from May 2017. Further consultations will follow the publication of this document. BLMK stress that no decisions have been made as yet. Formal consultations will be made on major service changes that impact on staff or patients.

Providing your Feedback

BLMKwould like you to answer the following questions in relation to “Our Current Thinking” above.

  • What do you think of the ideas presented ?
  • Which issues should we be tackling as a priority and why ?
  • Are there any focus areas for transforming care that we should be considering ?
  • In order to tackle the challenges we face, to what extent do you think that far-reaching change is needed in the way we deliver hospital care ?
  • Do you have any additional comments or suggestions around the ideas presented?
  • Do you have any alternative ideas or suggestions about how we should tackle these challenges ?

(GO TO the Concise Questionnaire)