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Hospital cuts planned in most of England Hospital cuts planned in most of England
(about 2 hours later)
Hospital services in nearly two-thirds of England could be cut or scaled back, BBC analysis of local plans shows.Hospital services in nearly two-thirds of England could be cut or scaled back, BBC analysis of local plans shows.
The proposals have been made by NHS bosses as part of a national programme to transform the health service and save money across 44 different areas. The proposals are part of a programme to transform the health service and save money across 44 different areas.
The BBC found 28 affect hospital care, from full closures to centralising services such as accident and emergency and stroke care on fewer sites. The BBC found 28 proposals affect hospital care, from full closures to centralising services, such as A&E and stroke care, on fewer sites.
Ministers argue patients will receive better care in the community. NHS England argue patients will receive better care in the community to compensate for the hospital cuts.
Alongside cuts to hospital care, the proposals include the creation of "super" community hubs of GPs, care workers and district nurses, seven-day access to GPs and getting hospital specialists to run clinics in the community. The proposals also include the creation of "super" community hubs of GPs, care workers and district nurses, seven-day access to GPs and getting hospital specialists to run clinics in the community.
But the King's Fund think tank, which has also carried out its own review, warned a lack of investment meant these ideas were not always credible.
The government is investing more money in the health service, but a fund set up to pay for changing services has been used to tackle NHS deficits, figures released on Monday showed.
The BBC analysis found:The BBC analysis found:
The King's Fund went on to warn that community services in many areas were already "feeling the strain" and could not cope with an increase in workload. Overall, a third of the 44 plans look to reduce the number of hospitals providing emergency care, while in another third of areas they have said they will consider moving non-emergency care to fewer sites.
And the think tank said further reductions in the number of hospital beds could de-stabilise services that were already "stretched to their limits" following the difficult winter.
Need help finding out which region you are in? See the map at the foot of the page.Need help finding out which region you are in? See the map at the foot of the page.
Will the plans work?
The King's Fund think tank, which has also carried out a review of the plans, warned that a lack of investment meant the ideas being put forward were not always credible.
The government is investing more money in the health service, but a fund set up to pay for changing services has been used to tackle NHS deficits, figures released on Monday showed.
The King's Fund warned that community services in many areas were already "feeling the strain" and could not cope with an increase in workload.
And the think tank said further reductions in the number of hospital beds could destabilise services that were already "stretched to their limits" following the difficult winter.
Prof Chris Ham, the think tank's chief executive, said they were still the "best hope of delivering essential reforms" in the NHS, as care needed to be moved out of hospital.
This is seen as vital because the ageing population and growth in long-term conditions, such as dementia and heart disease, mean people are more likely to benefit from support in the community to stay well rather than inpatient hospital care when their health deteriorates.
How the transformation programme works
The proposals - known as sustainability and transformation plans - have been drawn up as part of NHS England's five-year strategy to release £22bn of efficiency savings by 2020.The proposals - known as sustainability and transformation plans - have been drawn up as part of NHS England's five-year strategy to release £22bn of efficiency savings by 2020.
Reviews were set up in early 2016 and consultations on major changes will take place later this year with the hope implementation will follow soon after. Reviews were set up in early 2016 and consultations on major changes will take place later this year with the hope that implementation will follow soon after.
But the King's Fund warned the changes could be subject to legal challenges. But the King's Fund warned that the changes could be subject to legal challenges.
How closing hospital services can be good Is extra money needed?
A £1.8bn pot set aside this year for funding transformation has been used to shore up NHS trust finances as they struggle to balance their books.
A Department of Health spokesman maintained that the extra money being invested in the NHS this Parliament still gave the health service enough funds to change the way it worked.
"These NHS plans - developed by local doctors, hospitals and councils working together with the communities they serve - will help patients get better care," he added.
But others have questioned whether this will be enough. The NHS budget is forecast to rise by about 1% a year above inflation on average during this Parliament - much less than the 4% average the NHS has enjoyed throughout the rest of its history.
New technologies
There is a lot of support for the concept of moving care out of hospitals. It is hoped it will help keep people well and living independently in the community.
NHS England, which is overseeing the plans, said they offer the best hope of improving patient care in a sustainable way.
"They will allow the NHS to take advantage of new technologies, adopt successful practice more widely, and make practical improvements in areas that we know matter most to patients," a spokeswoman added.
Jeremy Taylor, chief executive of patient group National Voices, said while the process was "not without flaws", the overall vision had the potential to meet 21st Century needs.
"More than 70% of the NHS budget is spent on people with at least one long-term condition. This is a severe challenge to a system originally set up to provide reactive care for spells of illness."
The benefits of scaling back hospital services
Stroke care in London is now world class - and it is all because some services were shut down.Stroke care in London is now world class - and it is all because some services were shut down.
The capital's stroke care was overhauled in early 2010. Instead of being spread across 30 hospitals as they used to be, services are now centralised on eight "super sites".The capital's stroke care was overhauled in early 2010. Instead of being spread across 30 hospitals as they used to be, services are now centralised on eight "super sites".
It has meant patients get fast, 24-hour access to the best care, saving hundreds of lives a year.It has meant patients get fast, 24-hour access to the best care, saving hundreds of lives a year.
If a stroke is suspected, a patient is immediately taken to one of the eight centres. There they are assessed by a stroke specialist and given a brain scan within 30 minutes of arrival.If a stroke is suspected, a patient is immediately taken to one of the eight centres. There they are assessed by a stroke specialist and given a brain scan within 30 minutes of arrival.
However, Prof Chris Ham, the think tank's chief executive, said they were still the "best hope of delivering essential reforms" in the NHS, as care needed to be moved out of hospital. Need more help finding your local NHS area?
This is seen as vital because the ageing population and growth in long-term conditions such as dementia and heart disease mean people are more likely to benefit from support in the community to stay well rather than inpatient hospital care when their health deteriorates.
'Sustainable change'
But Prof Ham said this could not be done without extra funding - and urged the government to find the money to invest in the services to enable transformation to happen.
A £1.8bn pot set aside this year for funding transformation has been used to shore up NHS trust finances as they struggle to balance their books.
"Local plans must be considered on their merits, but where a convincing case for change has been made, ministers and local politicians should back NHS leaders," Prof Ham said.
A Department of Health spokesman maintained the extra money was being invested in the NHS this Parliament gave the health service enough funds to change the way it worked.
"These NHS plans - developed by local doctors, hospitals and councils working together with the communities they serve - will help patients get better care," he added.
And a spokeswoman for NHS England said current plans offered the best hope of improving patient care in a sustainable way.
"They will allow the NHS to take advantage of new technologies, adopt successful practice more widely, and make practical improvements in areas that we know matter most to patients," she added.
"These proposals are all about putting collaboration at the heart of our care system, with health and local government working more closely together than at any time since the NHS was created. Everyone in the NHS wants help to ensure we can all get excellent care whenever we need it."
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1. Northumberland, Tyne and Wear1. Northumberland, Tyne and Wear
2. West, North and East Cumbria2. West, North and East Cumbria
3. Durham, Darlington, Tees, Hambleton, Richmondshire and Whitby3. Durham, Darlington, Tees, Hambleton, Richmondshire and Whitby
4. Lancashire and South Cumbria4. Lancashire and South Cumbria
5. West Yorkshire5. West Yorkshire
6. Coast, Humber and Vale6. Coast, Humber and Vale
7. Greater Manchester7. Greater Manchester
8. Cheshire and Merseyside8. Cheshire and Merseyside
9. South Yorkshire and Bassetlaw9. South Yorkshire and Bassetlaw
10. Staffordshire10. Staffordshire
11. Shropshire and Telford and Wrekin11. Shropshire and Telford and Wrekin
12. Derbyshire12. Derbyshire
13. Lincolnshire13. Lincolnshire
14. Nottinghamshire14. Nottinghamshire
15. Leicester, Leicestershire and Rutland15. Leicester, Leicestershire and Rutland
16. The Black Country16. The Black Country
17. Birmingham and Solihull17. Birmingham and Solihull
18. Coventry and Warwickshire18. Coventry and Warwickshire
19. Herefordshire and Worcestershire19. Herefordshire and Worcestershire
20. Northamptonshire20. Northamptonshire
21. Cambridgeshire and Peterborough21. Cambridgeshire and Peterborough
22. Norfolk and Waveney22. Norfolk and Waveney
23. Suffolk and North East Essex23. Suffolk and North East Essex
24. Milton Keynes, Bedfordshire and Luton24. Milton Keynes, Bedfordshire and Luton
25. Hertfordshire and West Essex25. Hertfordshire and West Essex
26. Mid and South Essex26. Mid and South Essex
27. North West London27. North West London
28. North Central London28. North Central London
29. North East London29. North East London
30. South East London30. South East London
31. South West London31. South West London
32. Kent and Medway32. Kent and Medway
33. Sussex and East Surrey33. Sussex and East Surrey
34. Frimley Health34. Frimley Health
35. Surrey Heartlands35. Surrey Heartlands
36. Cornwall and the Isles of Scilly36. Cornwall and the Isles of Scilly
37. Devon37. Devon
38. Somerset38. Somerset
39. Bristol, North Somerset and South Gloucestershire39. Bristol, North Somerset and South Gloucestershire
40. Bath, Swindon and Wiltshire40. Bath, Swindon and Wiltshire
41. Dorset41. Dorset
42. Hampshire and the Isle of Wight42. Hampshire and the Isle of Wight
43. Gloucestershire43. Gloucestershire
44. Buckinghamshire, Oxfordshire and Berkshire West44. Buckinghamshire, Oxfordshire and Berkshire West