In September I wrote about the NHS Sustainability & Transformation Plan (STP) process. I suggested the size of the financial challenge was known and that I wasn't expecting much new to solve it. This week the Bristol, North Somerset and South Gloucestershire Plan has been published. There are no surprises, but there are a few things of concern.
The Bristol Health Services PIan, 12 years ago, achieved a lot of change; but what did not happen was the promised substantial increase in primary and community services to reduce pressure on A & E. We must do better.
There is a lot in the STP and its six appendixes. It reads better than some and does set out the questions to answer but it looks to me that we are no nearer any answers. It is not a firm plan that will help reassure or indeed focus people's concern about what will be different.
Overall what is proposed is worthy of serious consideration - and hopefully that is what will now happen with a long and honest period for genuine engagement with public, patients and staff.
Some credit is due as the local leaders are among the brave few who have made a genuine estimate on the size of the financial problem.
If nothing changes in the way care is delivered then in 2020/21 there will be a gap in funding of £305m. If we get transition funding and take steps to improve efficiency and implement better models of care then the gap reduces to £104m. This is a lot but it makes a lot of assumptions and to me it still looks optimistic. There remains a big gap to fill.
For Bristol South the greatest problem is with availability and sustainability of primary care. That is where investment is needed; and if we can get primary care and community care better resourced then in time there will be reduced pressure in acute care. In reality things look to be getting worse, with an impending GP surgery closure, rather than better.
My concerns over the future for GPs led me recently to ask Jeremy Hunt about protecting the additional money allocated nationally to support the development of GP provision. I hope he can provide an assurance that this dedicated funding won't get lost.
I fear now we are part of this wider footprint of the STP, the needs of south Bristol will get overlooked. I can see scarce funds being diverted to resolving long standing problems with the finances of hospitals in Weston-super-mare and in North Bristol.
There are problems with social care in Bristol and I was amongst those imploring the government to agree extra funding to offset some of the huge cuts made in local authority budgets. It did not happen, and the STP offers no help.
And then there is "governance". It sounds dry and boring but actually it is the most fundamental issue - who will agree and implement this plan on our behalf and how do we hold them to account? You have to ask how can any process secure agreement between the 15 major organisations in the STP, when each has its own culture and aspirations. This fragmented mess results from the widely discredited Health & Social Care Act and ways have to be found to get around it. But as the STP rolls out who is accountable for what? I have no idea and I suspect nobody else does.
Changes improve care only if they are implemented properly with the necessary funding.
Changing care models only works by making patients part of the design and implementation of that change. You often hear the talk about involving patients, but rarely is it done well.
And this cannot be about the money. Making care better does not make it cheaper - that is a myth. Often improving services takes investment and double running costs and may add cost rather than reduce it.
There is so much to discuss and evaluate. The first of the regular meetings at which the STP will be discussed is next week, and I hope the next stage will be the widest and most open of consultations. I hope many of my Bristol South constituents will take part.