THE scale of the issues facing the NHS in Herefordshire has been highlighted in a leaked document.

The Hereford Times has seen a confidential draft of the Herefordshire and Worcestershire Sustainability and Transformation Plan, which is a five year plan being developed by the NHS health services in the two counties.

But the organisations behind the draft say it is too early to say what exactly they are planning to do.

The leaked document said the local system has become too dependent on reactive bed based care that results in reduced wellbeing, a poor patient experience and higher cost of services.

Herefordshire has one Clinical Commissioning Group (CCG) responsible for buying health care services, and one acute hospital trust. Worcestershire has three CCGs and one acute hospital trust.

The draft highlights how if nothing is done to change the way the NHS service is delivered, there will be a funding gap of £311m by the end of 2020/21 across the two counties.

The focus is on delivering more care at home to reduce the need for admission to hospitals, and suggests that some community hospitals could become bedless to emphasise 'own bed instead.'

The draft says: "Some community hospitals will operate as bedless, e.g. as a 'locality hub' for home based community services integrated with primary care. This may include the co-location and integrated delivery of community teams with primary care based services and/or 24/7 primary care."

The draft also says the most pressing challenge across both counties is to address the poor performance in terms of meeting the four hour emergency access standard.

And the plan highlights three options, one of which includes closing existing access points and consolidation on fewer individual sites, 'resulting in a significantly reduced demand for expensive agency resources and simpler access routes.'

The sites that would need to be considered as part of this option are the existing minor injury units (Kington, Ledbury, Leominster and Ross-on-Wye), the out of hours GP hubs (Hereford, Leominster and Ross), and the Herefordshire Walk in Centre at The Kindle Centre, by Asda.

The draft said in Herefordshire there is a need for a 15 per cent increase in the number of acute beds (from 226 to 260), but the potential for a reduction of 62 per cent (from 97 to 37) in the number of community hospital beds.

A spokesman for Herefordshire Clinical Commissioning Group (CCG) said the draft will be refined before they go on to engage more widely with the public.

He said: "We are awaiting feedback to help us refine the plan before we then go on to engage more widely.

"We are planning to start a conversation with the public on the themes and ideas in the STP and there will be opportunities, wherever possible, to help shape these as we move forward. Again to reassure people no major or significant changes to how we provide services will be made without full and proper engagement."