Sustainability and Transformation Plans (STPs) are big news in the English NHS at the moment. They are five-year plans detailing how the health and social care organisations in local areas will work together to implement the NHS Five Year Forward View - which outlines new ways of delivering health and social care and achieving financial balance by 2020. Many campaigners around the country do not see any hope of the NHS 'achieving financial balance' given the huge £22bn black hole in the NHS budget.
England has been divided into 44 STP geographic 'footprints' made up of NHS providers, CCGs, local authorities and other health and care services. These organisations will work together to create a plan based on local health needs. We need to take STPs seriously as they will be the main route to both funding and service change from 2017/18.
As the plans and their contents become known, people are getting angry, particularly around how little public engagement there has been so far and how health professionals have been kept out of the planning process. Often local MPs and councillors have even been kept out of the loop.
The BMA released figures recently which showed that over two-thirds of doctors say they have not been consulted on the plans. They also showed that a third of doctors have never heard of STPs with more not knowing what to think because they haven't been consulted.
New BMA analysis also show that STPs will have to deliver at least £22bn in annual savings by 2020/2021 in order to balance health and social care spending across all 44 'footprint' areas, raising serious concerns about likely cuts to services and the impact on patient care. In my own patch of Lancashire and South Cumbria alone, the projected deficit in health and social care spending is £572million. It is an impossible task to make such 'savings' when hospitals are already bursting at the seams, general practice is on its knees with GP surgeries closing each week and social care is in tatters across the country due to huge cuts to local authority funding from central government.
We have an ageing population with more complex health and social care needs, and they rightly deserve high quality health and social care. However there are serious concerns about whether STPs can deliver this. As a country we can afford high quality care for all, but only if we make this a priority.
It is vital there is an urgent injection of necessary funding to support health and social care, but politicians have decided not to do this at present. Some of the plans include proposals to close hospitals, as well as to close many services across an area. Often these closures have a very flimsy evidence base behind them. Any changes like this need to be based on independent evidence that they will maintain or improve the quality of care patients receive.
It's extremely concerning that the majority of doctors have not been consulted on this issue, particularly as ministers have been so keen to insist that all stakeholders would be consulted.
There needs to be a commitment to full consultation with clinicians, patients, local politicians and the public on any proposed changes as early as possible. This is particularly important as there is no legal or clinical accountability within the STP process - 'footprints' are not a statutory part of NHS structure. The plans also need to be funded properly. NHS England has been explicit that there will be little capital or transformation funding over the coming years, which gives the plans a very limited chance of success. With the NHS already on its knees these 'transformations' are a huge distraction and many see them as a justification for more savage cuts to health and social care.
Most importantly, the priority of each and every plan has to be on improving care, not cutting it to save on the budget. The plans must not become an inadequate response to the crisis of the long-term underfunding of health and social care. The last thing we want to see is the government using these transformation plans as a cover for further starving services of resource and patients of care.Suggest a correction