Essex was selected as a Success Regime area because of increasing financial deficits and repeated shortfalls against some of the national service targets.

A diagnostic review in December 2015 identified the main priorities for system-wide improvement

Some of the main points from the diagnostic review

The market town nature of Essex created five relatively small hospitals all providing a similar range of services for a population size that in other areas would be served by one or two hospitals.

This duplication is not only expensive; it is unsustainable in terms of clinical staffing. In several hospital specialties, including emergency care, clinical staffing levels do not reach nationally recommended standards.

There are national shortages of specialists, for example in emergency care, maternity and children’s services. There are also shortages in community nurses, social care workers and GPs. Essex has the added challenge of competing with the London job market.

One of the cost pressures common to all three hospitals is a higher than average spend on agency and locum staff in order to manage gaps in clinical rotas.

Between 2012/13 and 2015/16, the rise in A&E attendances was 4.6%, compared with the national average of 1.6%.

Similarly, emergency admissions increased by 3.9%, compared with a national average increase of 2.7%

The unprecedented rise in emergencies, while visible in crowded emergency departments, affects the whole hospital. As more people come into A&E, more people are admitted, adding to pressures on wards, scans, tests and operations.

But, it’s not all about hospitals and A&E

The diagnostic review identified considerable potential to develop services in local communities that, based on national evidence, could avoid emergencies and hospital admissions.

Recommendations from the diagnostic review

The following top six areas for action were agreed on 1 March 2016:

• Address the clinical and financial sustainability of local hospitals

• Accelerate plans for changes in urgent and emergency care, in line with national recommendations

• Join up community-based services – GPs, primary, community, mental health and social care – around defined localities or hubs.

• Simplify commissioning, reduce workload and bureaucracy e.g.: reduce the number of contracts from over 350 to around 50.

• Develop a flexible workforce across disciplines, organisations and geographical boundaries.

• Improve information, IT and shared access to care records.