The NHS is facing a 'humanitarian crisis'. This was the message from the Red Cross as we entered the New Year. It may have sounded a bit dramatic, but reports from across the country certainly suggest that services are facing significant pressures.
As a result, we are seeing growing calls from doctors, NHS bosses and local councils to inject further funding into the system, with campaigning groups, and some in the Labour Party, arguing that recently published local reform plans - so-called Sustainability and Transformation Plans (STPs) - are a way of avoiding this reality and driving through dangerous cuts instead. Last year, in this publication, the then Shadow Health Secretary, Diane Abbott called them 'a dagger pointed at the heart of the NHS', and claimed they should be resisted at all costs.
This view was fueled by NHS boss Simon Stevens' original decision to ask local leaders to not discuss the plans until they were finished. The resulting vacuum in public knowledge was quickly filled by leaked documents and speculation. This culminated in August, when campaigning group 38 Degrees pulled together all the publicly available information about STPs - including the leaked documents - and argued that they were secret plans to dismantle the NHS.
This is a powerful story, but it does not sit easily with the vision originally set out by Simon Stevens - that STPs would help local areas to reform services to better provide what local populations need. For Stevens, the STPs would provide an organised response to the problems faced by the health and care system, which range from growing demand and an ageing population, to rising costs and poor co-ordination between different parts of the system.
So which of these stories is true? Are STPs dangerous 'Secret Tory Plans', or can they help fix the crisis faced by our health and care system?
At IPPR we have looked at all 44 of the STPs to answer these questions. The plans are undoubtedly light on practical details and heavy on jargon, but the reality behind them is much more complex than many critics contend.
Some of the arguments made by 38 Degrees and others ring true, particularly in relation to how the government has been knowingly underfunding the NHS. At IPPR we have long-argued this is the case and our analysis of the STPs confirms this - some local deficits could reach as high as £2 billion by 2020.
However, claims that the STPs are malicious plans devised by the government to privatise the NHS and prevent people accessing services are harder to justify.
Firstly, the government has been notable in its absence from the STP process, and has displayed a general lack of leadership and action on tackling the crisis hitting our health and social care services.
In addition, while our analysis identified that 45% of the STPs do clearly refer to closing hospitals or some of their services (and it is likely that other areas will also develop similar proposals), it does not necessarily follow that these changes are only motivated by money, and will automatically leave local people worse off.
In London, around 400 lives a year are being saved since stroke services were concentrated in fewer locations. This is because patients have access to highly trained, more experienced medical staff and the best equipment. There is growing evidence that services such as A&E and specialist surgery could also be improved in this way.
Hospital closures are notoriously unpopular with the public, but the reality is that people prefer to receive treatment elsewhere when possible. For example, only 7% would prefer to die in hospital. Changes which could help people realise these preferences, such as bringing together GPs, mental health services, social care and diagnostic testing in local 'hubs' so that people can access services closer to home, have been widely overlooked by STP critics.
Few outside of the government continue to deny that the health and care system needs more funding. But funding alone won't be enough. The NHS needs to change in order to be fit for the 21st century. However, the case for reform is little understood or supported by the public. Now is the time for the government to stop blaming GPs, junior doctors and local councils for the problems of the health and care system, and ensure that along with a much needed cash injection, local STPs get the hearing they deserve.
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