A new NHS reorganisation, carried out behind closed doors is now upon us, as I first warned in May, in the form of Sustainability and Transformation Plans (STPs).

Following the publication or leaking of two thirds of the plans, it is now clear that the Government have spectacularly misjudged the situation by insisting on a cloak of secrecy, which has only heightened people’s suspicions. Those areas where the plans have wholly or partially been released have so far been almost universally criticised.

The principle of the STP process could have made a significant contribution to the challenges the NHS faces. Labour is not opposed to the idea of a more localised strategic oversight of the NHS and the health sector, mainly because this is what we used to have in the form of Strategic Health Authorities before they were scrapped by the Tories as part of their last disastrous reorganisation.

Nobody would object to the idea of partners from across the sector in local areas working together to transform and improve services but the process has been fundamentally flawed from day one. It has been mired in secrecy and hijacked as a vehicle to attempt impossible levels of “savings” to cover up the reality of a chronic funding crisis engulfing the health and social care sector. The farcical and counterproductive resistance to engagement with everyone from Doctors to Councils has made a bad situation worse. One third of doctors surveyed say they were not even aware STP’s existed and Councils are lining up to complain about the lack of engagement.

The simple fact is that it is not possible to improve health and social care services when health professionals are fighting a losing battle to keep the show on the road due to six years of chronic underfunding. You cannot build a conservatory on a house which is teetering on the brink of collapse due to unstable foundations. The shocking lack of measures to address this systemic underfunding in the Autumn statement wilfully fails to acknowledge the current crisis which manifests itself in the worst collective set of performance figures the NHS has ever seen.

We do not intend to oppose an individual STP if it can be genuinely shown to deliver an improved patient experience over the five years of its existence and to that end we have devised a series of tests, grouped under five convenient headings which will determine our response to each STP.

We know some STP leads have admitted that “the financial component is a strong driver” to their STP so have made the financial aspects the first area of consideration although we are concerned that this is taking priority over clinical and patient need. We will be asking if the STP is able to demonstrate what actual savings will accrue from individual parts of the plan that aim to reconfigure, centralise, integrate or close services? We will ask does the plan increase fragmentation of services through reliance on other providers? Does the plan provide funding for both transformation of services and the delivery of financial sustainability and has funding for the capital requirements and programme management of the plan been identified and secured?

If the STP can show a credible and deliverable financial plan we then need to ask what that will mean for the patients. Does the plan improve access to GP and other NHS services for patients? Does the plan contribute to the delivery of Jeremy Hunt’s vision for a 7 day NHS? What about prevention? What are the risks associated with anticipated reductions in bed numbers? We anticipate this being one of the most difficult areas for STP’s to satisfy given what we already know about closures and downgrades that seem to be financially rather than clinically driven.

We will then be asking if the plans can tackle the crisis in social care and mental health. Does the plan improve integration between health and social care? Is parity of esteem achieved? Does access and entitlement to social care improve and will the plan reduce the number of days lost to delayed transfers of care? Where does the plan leave the health service at the end of five years? Does it put it in a good position to tackle the well-known demographic changes over the next 20 to 30 years?

If the plans are to succeed they must have genuine local support across the various sectors which will be responsible for carrying out the plan. Have the local authorities been involved signed off the STP? How does it align with other priorities and the strategic needs assessment? Have GPs, CCGs and social care commissioners been closely involved in developing, evaluating and financially analysing emerging proposals?

Finally we will be asking if there has been genuine involvement and engagement in the development of the plan. Labour strongly believes the voice of patients must be heard in these decisions. Past changes to services have only succeeded where patients have had buy-in to the proposals, so we would expect consultations on these plans to include not only patients groups but also the voluntary sector, staff representatives, care providers, elected representatives, care professionals and of course the general public.

Are there open and transparent accountability arrangements in place? Will the public and other key stakeholders have the opportunity to influence the plan at an early stage and is there sufficient information for engagement with stakeholders to consider a range of options? The Government have repeatedly said there are existing rules in place for changes to existing services but STP’s as a whole but the Government have maintained that STP’s as a whole have “no legal status” which means it may be difficult to challenge plans as a whole.

Despite the warnings about the secrecy, the impossible timetables and the financial imperatives surrounding these plans the Government seem determined to press ahead with them. When the plan for your area is released the questions outlined above might be ones you want to ask your local “STP lead” about.

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  1. Paul Bunting BSc MSc says:

    What are the tests please? My tests would be (1) that the STP ought to have been debated in Parliament with an Act of Parliament instead of imposed in secret when we are supposed to have transparency. (2) The NHS should be properly funded. The Blair Government increased NHS funding up to the EU average healthcare funding level and thus radically reduced Hospital waiting times but the Tories have decreased NHS funding so that it is now at the very bottom of the EU healthcare funding league table below all neighbouring EU countries’ healthcare funding levels which is why NHS waiting times and outcomes are getting worse instead of better. (3) The STP if it improves services may be allowed but not if it closes down local services. (4) A&E and Maternity Units are targeted for being closed down in rationalisations but these Departments are the last things that should be closed down because both receive emergency patients and it is suspected that lengthening the distance of journeys from one town or borough to another’s Hospital may increase morbidity, deaths, and serous maternity complications (see the case of Lewisham Hospital where judicial review stopped the A&E and Maternity units being closed down by commissioning on the grounds that it was a long way for Lewisham residents to travel in an emergency to other South London Hospitals). (5) I would abolish the commission function of the NHS invented by the Tories in 1990. They do not understand the taxpayer’s public services but understand only customer and shop and their attempts to impose customer and shop on the NHS has caused chaos in the NHS with severe underfunding depleting the numbers of GP practices, hospital doctors and nurses while increasing the administration charge on the NHS budget from the 5% it used to be, up to 15-20% or more to no benefit to patients or the NHS and now to no benefit to the private bidders driven towards bankruptcy instead of profit. This 15-20% or more of the NHS Budget would be better spent on training and recruiting more doctors and nurses, reducing hospital waiting times, and improving the care of the patients.This STP thing should be opposed hook, line and sinker because it is just a cover for severe and dangerous cuts in services and NHS England should be ABOLISHED for launching it in secrecy instead of the transparency to which the taxpayer is supposed to be entitled. NHS England (incompetent as it is) is part of the problem of escalating administration costs to no benefit to the patients.

  2. Nigel James says:

    Dear Justin, I am profoundly disappointed in this article. It seems to betray a total lack of understanding of where the Tories are going. The above comment does show a better understanding. Accountable Care Organisations and the STPs are part and parcel of the privatisation agenda. Each area is expected to show that the plans are financially sustainable even though funding is being drastically reduced. Every Labour activist worth their salt knows that privatisation is driven by defunding, rationing and making a service perform less well. Then the public will clamour for change and privatisation will be thrust upon us as the answer. Don’t play political games the STPs need stopping because they are not genuinely designed to improve the running of the NHS.

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