Depending on which echo chamber you listen to, sustainability and transformation plans (STPs) are either ways to transform health and social services or secret proposals to slash services so the NHS reaps £22 billion in efficiency savings.
Healthcare think tank the King’s Fund today describes STPs as the “best hope” for transforming health and social care. But the think tank’s comments are hardly a ringing endorsement of the 44 STPs that are supposed to improve the nation’s well-being, NHS efficiency, and the quality of care we receive. There’s a lack of cash needed to introduce the changes and the King’s Fund says it is “no longer credible” for the Government to claim the money exists. The British Medical Association believes the infrastructure needed to implement the plans will cost £9.5 billion, at a time when all STP areas are forecast to be in deficit by £24 billion by 2020-21.
The BBC has also been analysing the plans and concludes that hospital services in nearly two-thirds of England will be reduced, which means hospital closures and cuts to specialist services, including accident and emergency departments.
The King’s Fund is also critical of the speed associated with STPs; from development of the plans, resulting in neither NHS staff nor patients being properly consulted, to expectations of implementation and delivery of ambitious plans that totally change how health and social care are delivered. The haste stems from NHS England asking the 44 areas, at the start of 2016, to share their plans by June, although the deadline was pushed out to October. Development involved more than 400 NHS organisations and more than 100 local authorities working together on ‘place-based’ planning, which itself was a new way of working for the NHS.
Much of the emphasis in the plans, as the BBC analysis suggests, is about moving care out of hospitals and closer to people’s homes. This is what place-based planning is all about: integrating care across primary, community, and secondary healthcare boundaries, as well as social care, to deliver better, more coordinated services.
But healthcare professionals in the community are concerned that the planned shift out of hospitals will be undeliverable because of capacity issues. A number of GPs have criticised STPs for being based on heroic assumptions about primary and community care, and fuelled by magical thinking.
The plans are supposed to transform and improve healthcare but for the general public have come to be perceived as proposals to close local hospitals. For the professionals who have worked to break out from professional silos and work together to deliver plans to meet the future health needs of all citizens and save the NHS, such perceptions must be dispiriting. As the NHS in England is challenged to deliver on the STPs over the coming months, perhaps the next challenge is how to communicate the changes transparently and puts patients first.
Authored by: Maya Anaokar