Public Summary (8 pages):

Executive Summary (36 pages):

The merger date is 01/04/2018 subject to approval by NHS Improvement (NHSI). As Luton & Dunstable Hospital (L&D) is a Foundation Trust (FT) and Bedford Hospital Trust (BHT) is not, to complete the transaction to create the new FT L&D will follow the NHSI acquisition process. In most measures L&D is twice the size of BHT.

The Business Case states that rising demand and workforce shortages are the drivers for change, however, given that this is part of the Sustainability and Transformation Partnerships (STP) process mandated by NHS England (NHSE) and that the STP is to make ‘efficiencies’ of 22 billion nationally by 2020, it is opinion of Hands Off Bedford Hospital (HOBH) that lack of funding is a significant factor. Given this, it is interesting to note that there is little evidence that major hospital reconfiguration, including mergers, result in any significant cost savings
It is also noted that no evidence is provided in the available briefing documents to support the claims made. Based on what we have seen, the case is based on assumptions and current collaborations.
Further, we note that the full business case is not available to the public.
While the Business Case lays out some exciting opportunities and potential benefits if it is successful, we have some concerns. The purpose of this document is to highlight those concerns and should be read in context of the overall document.


Business Case: A&E at both locations is safe

Given the national trend of downgrading A&Es to Urgent Care Centres (UCC) it is troubling that a UCC is being up-scaled while Putnoe walk-in centre will close in September, at a time when BHT is merging with L&D.
As a group we should be vigilant that in a couple of years the Trust doesn’t start routing complex 999 cases to L&D and less critical cases to the UCC. Without the challenging cases it would be difficult to attract and retain good staff to Bedford’s A&E, which could lead to unsafe staffing levels and ultimate closure.
“Accident and emergency departments in some hospitals have been replaced with minor injuries units and urgent care centres”

What impact does closing A&Es have?

“After adjustment for age, sex, clinical category and illness severity, it suggested that a 10km increase in straight-line distance is associated with around a 1% absolute increase in mortality.”



Business Case: Proposed investment in neo-natal and delivery wards in Luton & Dunstable

We need to ensure that both maternity and CONSULTANCY lead maternity care remains at Bedford hospital for the safe care of mums and babies that may end up in distress during births previously assessed as low risk

Centralisation of Services

Business Case: Possibility of centralising specialist services such as, gastro, elective orthopaedics and gynaecology

A small amount of data exists to support positive outcomes of centralising some services, but in reality it’s very little. In terms of financials, savings are low to moderate, but what it does mean is that vulnerable people have to travel further, often via inadequate public transport and their support network is located many miles away.

One example of where L&D and Bedford have centralised services is emergency Stroke services where 999 Stroke call-outs are routed to the L&D and then local residents are returned to Bedford for recovery. Feedback from the Ouse Valley Stroke Club about this service was less than glowing. Family members have difficulty in supporting patients from so far away and the levels of care themselves.

We need to ensure that any changes are EVIDENCE based and actually result in benefits to patients such as earlier discharge into adequate care environments, decreased mortality rates, better recovery.

Integration with community services

Business Case: Care jointly delivered between hospital and community teams

“…avoids ‘handovers’ and ensures best outcomes for patients. Manages rapid growth in ageing population without the need for more hospital beds. Allows staff to develop their skills to better support patients with complex needs”

There is a trend in reducing bed numbers and moving care out of hospitals and into the social care system, however there has been an 11% cut to Social Care across England against a backdrop of increasing demand and this fall in number beds.

The King’s Fund Reports:

  • The total number of NHS hospital beds in England, including general and acute, mental illness, learning disability, maternity and day-only beds, has more than halved over the past 30 years, from around 299,000 to 142,000, while the number of patients treated has increased significantly.
  • Most other advanced health care systems have also reduced bed numbers in recent years. However, the UK currently has fewer acute beds relative to its population than almost any other comparable health system.

This statement in the business case that there will be no additional community or acute beds despite increasing demand, implies that ‘Care Closer to Home’ will be employed.
‘Care Closer to Home’ runs in Devon. They have closed most of their community hospital beds, which means patients are either recuperating in (blocking) Acute beds, or, more usually, discharged straight home after very serious operations or for end of life care. Bedford Hospital leaders have admitted that there is inadequate Social Care provision. This is because Social Care funding has been cut massively in recent years. Follow this link for a video about the impacts of  ‘Care Closer to Home’
Additionally, will some services move out of free NHS provision into means tested Social Care?

Capital Investment and IMT Funding

Business Case: £150 million of additional funding required to support both Trusts’ estate redevelopment plans will ensure that the improvement can be delivered in full and sustained for the foreseeable future

No indication of whether this funding will be approved before the transaction date of 01/04/2018 as this request being run separately but concurrently to this Business Case.

Further investment is required for the implementation and delivery of digitalised solutions, again it is unknown whether this will be approved.


Business Case: There is good connectivity between the two hospitals;
“…they are just under 19 miles apart by the shortest main road driving route, and both hospitals have good road links to the M1 motorway.”
There is no mention of the appalling traffic conditions or lack of public transport available between the 2 sites and this should be considered before any services are relocated.


Consultation will be carried out for each service change as the FT goes through it’s organisational and service changes as required by law. We note though that past consultations have been:
  • Poorly publicised
  • Held at inconvenient times
  • None existent in some cases
    • Weller Wing disappeared – if there was consultation, little effort was taken to inform the public
    • Emergency Stroke Services were quietly relocated to L&D and subsequently BHT lost its dedicated Stroke Ward
    • Putnoe walk-in centre is scheduled to close with September without consultation
Part of the reason for change is to implement different models of care supported by the STP Accountable Care System ambitions – there is a nervousness that the ACSs are modeled on a US HMO/ACO. These systems join up all healthcare components in an area (Primary, Acute, Community, Prevention etc) into one organisation and budget for a given geographical population (in our case, Bedford, Luton and Milton Keynes). However, budgets are fixed which could lead to rationing, discharges too early or into inappropriate care settings, loss of services and nothing in the ACS contract prevents a large private company from coming in and taking the whole thing over.

There will be no significant clinical service changes on Day One of the merger.  Clinical service redesign will initially focus on a number of strategically important services and will be clinically led. These services will be: Cardiology, Radiology, Rheumatology, Endoscopy, Orthopaedics and Pathology services.
If you have any concerns about the merger you can:

1. Write to the CCG who makes the decisions:

2. Write to your MP, find their name and email address using your postcode:

3. Join the campaign:

4. Share this Post


#hobh #justice4NHS #BLMK #ACT #BAG #BeTheChange

Review of the Business Case for the acquisition of Bedford Hospital by Luton & Dunstable

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