Worcestershire feels pressures of ageing population

What is the issue?

The NHS in Worcestershire, which has an annual health budget of about £900m, is facing a series of challenges to provide sustainable services for its 570,000 residents.

Worcestershire Acute Hospitals Trust carries out more than 95,000 planned and emergency operations each year, with 140,000 A&E attendances and about 500,000 outpatient appointments.

The trust has significant financial challenges. It needs to find £50m savings over three years as part of the £200m efficiency target for Worcestershire as a whole.

An ageing population with more complex needs and a national shortage of middle grade and specialist doctors add to the pressure to reconfigure acute services. A clinically led joint services review has been set up to examine the best way forward.

What is unusual about the region?

The acute sector in the county accounts for more than half of the total NHS spending in the county and is split across Worcestershire Acute Hospitals Trust’s three sites: Worcestershire Royal Hospital, Kidderminster Hospital and Treatment Centre and the Alexandra Hospital in Redditch. Both the Worcester Royal and the Alexandra Hospital have A&E departments.

Worcestershire has an older population than the rest of England; its elderly population is growing at more than 3 per cent annually.

About 19 per cent of people in the county are aged over 65 compared with 16 per cent nationally and the number is expected to increase by 30,000 over the next 20 years. About 40 per cent of the population live in the large rural areas of the county.

The trust could not afford the cost of providing 24/7 consultant care with its current service configuration, even if there were not a national shortage of medical staff.

What is being developed?

The county’s NHS managers and clinicians face having to reconfigure services, including an inevitable centralisation of some.

Worcestershire Acute Hospitals Trust has already begun centralising some services, including heart attack and stroke, in the past 18 months. More than 100 clinicians from across the region are leading the joint services review, to draw up a new configuration for acute services.

A shortlist of options is expected to be revealed in October and it is likely to include proposals to have a single A&E for the county, with the other hospital sites focusing on non-urgent work.

What is the likely outcome?

A key factor is the existence of a 30-year private finance initiative scheme at the Worcestershire Royal Hospital, which costs the trust about £13.6m a year.

The PFI deal will run until 2032 and will cost more than £720m in total. There is no PFI scheme at Kidderminster Hospital or at the Alexandra Hospital.

HSJ understands emergency and urgent surgery as well as high-risk paediatric, maternity and obstetric services are likely to move to the Worcester Royal with a single A&E.

But there could be a migration of elective activity, including routine surgery, outpatients and diagnostic services to the Kidderminster and Alexandra Hospitals.

HSJ has been told NHS Worcestershire has also been in talks with other NHS organisations, including University Hospitals Birmingham Foundation Trust, about alternative provision of some services.

Read the full briefing at www.hsj.co.uk/briefing to find out:

• Details of financial challenge facing Worcestershire
• The scale of opposition to reconfiguration plans
• Workforce challenge of 24/7 services