What are Sustainability and Transformation Plans?
NHS England states that they are “Local plans to improve health and care” 1 (NHS England, 2017).
“The NHS and local councils have come together in 44 areas covering all of England to develop proposals and make improvements to health and care. These proposals, called sustainability and transformation plans (STPs), are place-based and built around the needs of the local population” 1 (NHS England, 2017).
It is indisputable that there is a growing demand for acute and long term health and social care, and, on the surface, the above aims sound commendable and sensible. NHS and social care providers have often called for a return to a more joined-up way of working and at first glance, this is what the aims of the STPs seek to do. 2(March 12 2015 Independent) However, the way the plans have been developed has been dogged with controversy, and plans appear to have been developed with little consultation. Fears about cuts to local services appear to have been justified as it emerges that local services are to be reduced and “merged”, with little consultation with stakeholders involved 3 (Nursing Standard, various issues, 2017). The Kings Fund released a report in November revealing that a deepening financial crisis has forced the plans to focus “more on cost-cutting than was originally envisaged” 4 (Moore, 2017).
In reality the STPs were actually drawn up after the Chief Executive of NHS England, Simon Stevens, said that every area must have a plan in place by 30 June 2017, to completely change the way the NHS works, and clear their debts (caused by year-on-year government underfunding in real terms and rising pharmaceutical costs, coupled with an ageing population) within a year. So in fact they have always been a cost-cutting exercise designed to change the fundamental way that healthcare is delivered in this country. Sustainability and transformation, to NHS England, means closing and selling. Simon Stevens, and the Health Secretary Jeremy Hunt, are known to be supporters of privatisation with vested interest in privatising the NHS, and in fact their roles in a public owned organization are surely a conflict of interest. It is barely a secret now that STPs are the route to further privatisation of larger sections of the NHS.
The author lives on the outskirts of a large county town. Over the last few years there have been repeated attempts by the local CCG to close the local maternity services and the local Accident and Emergency department, and threats to local paediatric services in the local district hospital. So far local petitions have been successful in keeping these vital services. However, the local STP again seeks to “merge” these services with other regional hospitals, which if these plans are actioned would mean that local emergencies would have to travel many more miles for medical help, which, both local people and experts argue, will cost lives. It will also cost the jobs of local NHS staff, or some will be redeployed to other areas, and potentially some will lose specialist skills as specialist services in the local area close. This, to the author, does not look like something built around “the needs of the local population”.
The author has had to use emergency services in the local hospital in the last few years and can testify to the current pressure that the Accident and Emergency department is under. However, how the closure of these services (and therefore increased pressure on other regional hospitals) could help ease pressures is certainly not being explained in any kind of logical rationale. These plans are not unique to the author’s area and are being repeated all over the country. In fact these plans do not appear to follow recommendations put forward to Parliament that it is the social care issues which need to be addressed in order to reduce the pressures on acute hospitals 5 (Commons Select Committee, 2016). The committee has recommended investment in adult social care, including intermediate care services, in order to relieve the pressures on acute services and yet intermediate care services, particularly valuable beds, continue to be closed. Just this week a nearby facility closed in the author’s local region.
It is not just acute hospital services which are affected by the STPs. Community services are to adopt new “integrated” ways of working. Again this sounds like a good thing, and joined up care is good for the patient. Nurses and other clinicians have cautiously welcomed the concept of “joined up care”. However, again the plans have not been discussed with local stakeholders or frontline staff. There is a likelihood that in reality, this will be a cost cutting exercise and specialist nursing services (such as the area the author works in) are likely to be axed as mixed community teams are formed. This could mean that the specialist skills which the author is trained in would be under-utilised and lost in a more generalised team, and patients needing specialist services could either be sent further or fall through ever-widening gaps in service provision. The RCN has already stated that financial constraints are making long standing health issues worse 6 (Keogh, 2016), and this will also have an impact on the NHS.
Many nurses and frontline staff are demoralised as they continue to see declining standards in the NHS, in most cases through no fault of their own. “Since Theresa May took over as prime minister last summer, patient standards in the NHS have collapsed” 7 (Ashworth, 2017). As a nurse, the author feels that declining standards are indeed accelerating in the NHS, and have been for some time, under the previous administration also. However, the level of complacency shown by this government administration is unprecedented.
Currently a questionnaire is being sent out to the author’s local area as a “consultation”. However, the questions are vague enough and misleading enough to dupe people into voting for “more care closer to home” meaning that in fact acute services in that area can be cut in favour of “community care” which is also not being invested in. In real terms this actually means more “self-care”, i.e. putting the onus of healthcare back onto the individual and not the NHS. However as more elderly people are living alone and at a distance from their families, the author argues that this cannot be the sole model of care invested in.
“In November the Department of Health announced the provisional allocations for each of the STP areas. Some areas will receive more than £200 per person less than the national average. For a population of 500,000 people this equates to £100 million less funding available for local health services” 3 (Thomson, 2017). This is at a time when clinicians are calling for adequate social care provision and adequate funding of services. The RCN calls for nursing to be put at the heart of new models of care, and yet currently they are not being consulted.
The government has repeatedly stated that they are investing in. and funding, the NHS properly. The response to a petition challenging funding and asking for STPs to be scrapped stated “The Government is investing an extra £10 billion to the NHS by 2020-21, supporting it in delivering the necessary changes needed to ensure the longer term sustainability of the health and care system.
“We know that the NHS is facing many challenges and there are increasing pressures on all parts of the health and care system due to, amongst other things, an ageing population, changing public expectations and the cost of new drugs. That is why in the Spending Review in November 2015, the Government committed to increase funding for the NHS in England, with funding to be £10 billion higher in real terms by 2020-21, compared to 2014-15. And this has been committed in spite of the continuing fiscal challenges. Alongside this, it is the case that NHS spending has increased as a proportion of total Government spending every year since 2010.” (11) This was the Government’s response to a petition “Properly fund the NHS and scrap the proposed STP programme”(24/03/17).
This response is disingenuous at best. It can be seen already from the Nursing Standard article that regional allocation of funds has reduced for each area. The Kings Fund states that although NHS funding is growing, “It is slowing considerably compared to historical trends”. In real terms the Department of Health budget will increase by less than 0.5% per year, well below the rate of inflation. “This is significantly less than the funding the government claims it has given to the NHS over this period, mainly because ministers have chosen to highlight the funding provided to NHS England only rather than the Department of Health’s total budget” 8 (Kings Fund, 2017). It is also now known that more than half of the £2 billion allocated in Autumn 2015 was spent on buying care from private and other non NHS providers, and therefore did not reach NHS providers at all 9(The Guardian, 26 March 2017). At least £17.6 million has been spent on management consultants to help draw up STPs, the very plans to cut back services 10 (Independent, 21 March 2017). This money could instead have been invested into those frontline services instead of paying “experts” to devise plans to cut them.
At least 26 councils have opposed their local “footprint” STP to date. It is not too late to make your voice heard and sign a local petition against cuts to local services in your area. Please be very careful of public “consultations” and read the questions and their implications very carefully before answering them.
Labour has pledged to secure our NHS and social care systems. “We will end health service privatisation and bring services into a secure, publicly provided NHS. We will integrate the NHS and social care for older and disabled people, funding dignity across the board and ensure parity for mental health services”. Only under a Labour government will our NHS be safe, secure and properly funded.
(1) https://www.england.nhs.uk/stps/ (2017)
(3) Thomson, R (2017) Plans made in secrecy and met with fear; Nursing Standard, 31(27) p27.
(4 )Moore, A (2017) STPs: it’s not too late to have a say; Nursing Standard, 31 (26) p.26-28.
(5) Commons Select Committee, 2016 http://www.parliament.uk/business/committees/committees-a-z/commons-select/health-committee/news-parliament-20151/accident-emergency-winter-planning-report-published-16-17/
(6) Keogh, K (2016) Funding cuts threaten the NHS public health agenda; Nursing Standard, 30 (43) p10.
(7) Ashworth, J (2017) Theresa May is overseeing a collapse in hospital standards- it’s time she sat up and took notice. Labour List. 17 March 2017.
(8) Kings Fund (2017) The NHS budget and how it has changed. www.kingsfund.org.uk
(9) The Guardian (Sunday 26 March, 2017) Half of £2 bn boost for NHS “spent outside health service”.
(10) Independent (Tuesday 21 March 2017) Government spent £17.6m on consultants hired to draw up NHS cutbacks.
(11) Properly fund the NHS and scrap the proposed STP programme Petition February 2017. https://petition.parliament.uk/petitions/165948