THE BLOG

STPs - A Dagger Pointed At The Heart Of The NHS

14/09/2016 10:31
Yui Mok/PA Archive

The Government has initiated 44 Sustainability and Transformation Plans (STPs) for the NHS in England. Under this innocuous-sounding title lies a major threat the continued existence of the NHS.

There has been extreme secrecy about the actual plans of the STPs. They are not statutory bodies and so cannot be held to account. Campaigners such as unions, 38 Degrees and OpenDemocracy find there is no response to Freedom of Information requests or sometimes a note stating that no minutes are kept of STP meetings.

This lack of accountability and transparency as well as outright secrecy regarding the plans is deliberate. We know from a small number of leaks that the plans amount to a second wholesale reorganisation from the Tories, who committed to no top-down reorganisation of the NHS in their 2010 Manifesto. Worse, the STPs are the mechanisms to deliver the biggest cuts in the history of the NHS.

One of the key leaked documents (pdf) is from the North-West London STP. This shows the plan aims by 2020/21 to cut the budget by £1.3billion. This is for an area covering two million people whose current annual budget is just over £4billion. Among the projected effects of the plan is that 'patients will take more control' of their own care in their own homes. Face to face outpatient consultations will be reduced by 40% 'using new technology'. Demand for acute beds will be reduced by 500 beds. Ealing Hospital Trust's paediatric unit will close.

At the end of the six-year period it is projected that the spending on acute care will actually fall. This is despite a rising population, an ageing population and cost pressures such as the exponential rise in the drugs bill. It amounts to an enormous cut in acute care spending per person.

The STPs will have to meet financial 'control totals', that is cuts. From details gleaned elsewhere we can see that this pattern is repeated all across the country. A host of STPs have enormous projected deficits and it is a central aim of these changes is to eliminate them. By 2020/21 a number of STPs will have deficits of half a billion pounds or more, in Wiltshire, in the north-east around Durham, in Nottinghamshire, in South Yorkshire and the Black Country. Many others will have deficits of over £1 billion. Greater Manchester is projected to have a deficit of £2billion by 2020/21.

The effects will be equally devastating, with the closure of beds, of key units including paediatric, maternity and cardiovascular and of whole A&E departments which are now bearing the brunt of the cuts elsewhere in the NHS. Entire hospitals will close in The Black Country and in Leicestershire, while many others including Cheshire and Merseyside will have 'fewer beds'.
The plans are based on wilful self-delusion, that mobile phone apps will change outcomes on obesity, that Skypeing will reduce consultation times, that volunteers can take the place of trained NHS staff, that medical assessments and treatment can be conducted by ever-lower skills and pay bands. Patients will be more responsible for their own health. There is no evidence for any of this works. The Government's Vanguard pilot programmes exist but they too are cloaked in secrecy.

The greatest need for the NHS services comes from the poorest, the most elderly and the most vulnerable. This is presented as a drive towards medical prevention. It could only be achieved by preventing access to the NHS. It is planning for disaster.

Much of this reform is an attempt to put local collaboration back into the NHS after Lansley's destructive purchaser-provider split. But the Tory ideology of competition, marketisation and privatisation is as strong as ever.

The STPs will have to meet financial 'control totals' that is cuts. From details gleaned elsewhere we can see that this pattern is repeated all across the country. A host of STPs have enormous projected deficits and it is a central aim of these changes is to eliminate them. By 2020/21 a number of STPs will have deficits of half a billion pounds or more, in Wiltshire, in the north-east around Durham, in Nottinghamshire, in South Yorkshire and the Black Country. Many others will have deficits of over £1billion. Greater Manchester is projected to have a deficit of £2billion by 2020/21.

The effects will be equally devastating, with the closure of beds, of key units including paediatric, maternity and cardiovascular and of whole A&E departments which are now bearing the brunt of the cuts elsewhere in the NHS. Entire hospitals will close in The Black Country and in Leicestershire, while many others including Cheshire and Merseyside will have 'fewer beds'.
The plans are based on wilful self-delusion, that mobile phone apps will change outcomes on obesity, that Skypeing will reduce consultation times that volunteers can take the place of trained NHS staff, that medical assessments and treatment can be conducted by ever-lower skills and pay bands. Patients will be more responsible for their own health. There is no evidence for any of this works. The Government's Vanguard pilot programmes exist but they too are cloaked in secrecy.

The greatest need for the NHS services comes from the poorest, the most elderly and the most vulnerable. This is presented as a drive towards medical prevention. It could only be achieved by preventing access to the NHS. It is planning for disaster.

Much of this reform is an attempt to put local collaboration back into the NHS after Lansley's destructive purchaser-provider split. But the Tory ideology of competition, marketisation and privatisation is as strong as ever. NHS England director of STPs Michael McDonnell said, STPs "offer private sector and third sector organisations an enormous amount of opportunity". Under these conditions of insupportable cuts and marketisation, as well as the establishment of 'super trusts' and hospital chains, the STPs are mechanisms for swingeing cuts and deepening privatisation.

Labour and the entire labour movement, as well as all those who value the NHS will resist these changes with all their powers.

Diane Abbott is the shadow health secretary and Labour MP for Hackney North

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