I have written before about Jeremy Hunt's opaque and secretive reorganisation of the NHS, which is being drawn up behind closed doors at this very moment through Sustainability and Transformation Plans (STPs).
Despite my best efforts, there still seems little appetite among the media to talk about STPs, but I think that will change when the outcome of this project becomes clear. Following the publication of the NHS "reset" (otherwise known as NHS Improvement: Strengthening Financial Performance & Accountability in 2016/17), we can finally be a lot clearer about what is in store for local health services and it doesn't look good.
The "reset" sets out three areas where action will be required to improve the financial position of the NHS. The first two; tackling excessive paybill growth and implementation of Lord Carter's recommendations on back office efficiency savings are discussed in my last post about the "reset."
But it is the third that should cause us most concern. It tells us that "by the end of July, STPs should have reviewed services which are unsustainable" and proposes "the consolidation of unsustainable services... with a view to take early decisions to re-provide at nearby units." This in other words means that some "units" or hospitals will be closed and that it will happen sooner rather than later.
Whatever the rationale behind these closures or mergers might be, it is completely unacceptable that these plans are being drawn up without any scrutiny. There can be no explanation for such an abject failure to provide any kind of transparency, other than a fear from Ministers about what the reaction of the public will be. My concern is that once the plans are published, any changes will be presented as a fait accompli.
The STP plans were initially due for submission by the end of June, but after I probed Ministers as the deadline began to approach, I was told that "the degree of detail that will be provided by 30th June will vary" and promised that sign off of the plans would occur "in a series of waves over the coming weeks and months." When the plans are finally be published any drafts submitted to Ministers should be open to public scrutiny and consultation.
The third priority of the "reset" goes on to state that STPs should also have "developed plans to re-provide these services in collaboration with other providers." And if that isn't a euphemistic enough reference to privatisation for you, the Business Plan of NHS Improvement goes on to outline a priority to "explore" and "facilitate" new private sector partnerships.
CCGs that have been placed in special measures are to be subject to a series of potential interventions including being disbanded altogether. However it is the reference to "Accountable Care Organisations" (ACOs) as a potential replacement for CCGs that will set alarm bells ringing. ACOs are commonplace in the USA and whilst the official language over here is about them looking at "place based" working, the fact that on the other side of the Atlantic they are intimately connected to the private insurance system is bound to raise questions about where this is heading.
As the respected Health Service Journal has reported, NHS Improvement also said the NHS sometimes "underutilised" the private sector and that "a new work programme" would examine the "most promising" areas for greater collaboration. It plans to look at "outsourcing of new, novel or restructured clinical services" and "independent sector management models."
Further issues arise with NHS Improvement's powers to intervene in failing regimes such as the removal of autonomy over key spending decisions. The Department of Health will also reserve the right to exchange surplus assets for cash for any providers under a programme of financial special measures.
Be in no doubt the Government have amassed a huge range of tools to reshape the NHS by hook or by crook but because they have passed responsibility onto the 44 STP footprint areas, you won't see Jeremy Hunt or Theresa May standing up in Parliament to announce or even to defend hospital closures or the further creeping privatisation of health services. However we should be under no illusion that it is their policies that are responsible and we should do everything possible to hold them to account.