Sustainability and Transformation Plans

Sustainability and transformation plans

What are these plans and why are so many people angered by them?

As nearly all NHS Trusts now have rising deficits something had to change.  Simon Stevens, Chair of NHS England, has come up with a five year forward view which aims to ensure the NHS is sustainable.  STPs are the government imposed implementation of this five year forward view.  It is claimed that the major aim of STPs are to integrate health and social care, creating collaboration rather than competition to streamline health and social care pathways.  All sounds good, so why the opposition?

Journalist, John Lister, has written this extremely powerful document examining the inadequacies of STPs – The-Sustainability-and-Transformation-Plans-a-critical-assessment-FINAL-WEB  it is something that is well worth a read.

In a similar vein, Prof Chris Newdick writes about the Problems of Legal Status and Accountability with STP teams – the envisaged interagency groupings who will implement the meat of the STPs.  Newdick explains the pitfalls of the fudges that come with promising to ‘do more with less’ -just when we need to be clearer than ever about rights and duties in the NHS.  He concludes that: “We need a new National Health Service Act to stabilise the NHS’

These reports resonate with concerns from others across the health world.  Have a look at them and then Tweet, Facebook or email your friends and colleagues about them now to help spread the word.

England has been divided up into 44 regions, or footprints as they call them.  Every region has their own STP board, which is a body of unelected people who are tasked with drawing up the STP for their footprint.  STPs are designed to implement massive savings, absorbing all the deficits of NHS trusts by 2021.  This would represent a £30bn cut in spending on our healthcare services, a 25% reduction from the £119bn spent in 2015-16.

These plans aim to devolve responsibility to local authorities, shifting the blame for NHS failures from Westminster to local authorities and CCGs.   Sussex and East Surrey are in footprint 33 which will need to cut a staggering £864 million by 2020/21.

Although blame will be planted on local authorities when failures in local NHS services occur due to these savage cuts the STP boards have been granted the power to over-ride the local authorities.  So we have officials who have not been elected with greater power than those who we do elect.  Hardly democratic is it?

Every region will have an Accountable Care Organisation (ACO) to run and carry out the development of STP.  Some local authorities are setting up Special Purpose Vehicles (SPV) to enable them to run ACOs.  ACOs will become prime targets for corporate takeover.

There has not been any sign of public consultation over these plans.  Sussex Defend the NHS and many of its supporters have written to the Chair of our local STP board expressing their concerns but received only a very bland reply in which he stated that: “I give you my personal assurance that no decisions have been made and will not be made without giving our patients and the public the opportunity to comment and engage.”

Despite the claims that STPs will involve public engagement it seems that in footprint 33 these plans have already been incorporated into all the CCG operating plans excluding those in West Sussex.  There is still no sign of any public engagement.

Money has been spent by employing private consultancy firms to give their input into these plans, it is likely we will see:

  • Reductions in the number of sites where healthcare is provided – so patients and visitors will have to travel further, take more time off work, arrange more childcare etc
  • Patients discharged quickly – As soon as patients no longer need medical intervention they will be discharged – post-operative monitoring and care will become the responsibility of family members of chargeable social care.
  • Reductions in NHS staff – And more pressure placed on remaining staff
  • Downgrading of professional roles – Replacing fully qualified doctors  with ‘physician assistants’ who will have just two years training, or replacing qualified nurses with health-care assistants.
  • Reliance on digital monitoring – Computerised questioning leading to diagnosis and treatment along with Skype interviews – may be good for some patients but hugely problematic for others.
  • Keep up to date with the Stop the Sustainability and Transformation Plans website

STPs stress the importance of self-care and prevention rather than treatment but there has been little or no planned investment to support this.  There may be greater integration with social care but local authorities have already cut 33% from the social care budget which is now suffering from chronic underfunding.

So are these plans something that the UK has no choice but to implement?  Is it perhaps unreasonable to demand that there be no swingeing cuts to our NHS?  After all we have a national debt of over £1,800,000 m and its rising fast! (Follow this link to see just how fast)

The UK is the 6th largest economy in the world yet we spend far less per head of the population or % GDP than comparable countries such as France or Germany.  We can afford a decent and modern NHS – after all, we set it up at a time when Britain was heavily in debt after the war.  The system of a state provider of healthcare funded through taxation in known to be the most efficient means of delivering healthcare for any nation.  It would make sense to stay with the most efficient system we can find. We also need a healthy country to grow our economy and run our businesses.

Opposition to STPs is growing with over 30 local authorities already having rejected the plans for their areas.  Although STP boards have the power to over-ride  the concerns of local councils it is hugely symbolic if we can get more councils rejecting the plans.

If these plans go through it could lead to a total destruction of our NHS.  These plans have been nick-named Slash, Trash and Privatise.  Just as Maggie did with our railways when she put British Rail through years of underfunding.  The NHS is now going through a similar phase.  As fault lines appear, the media will exaggerate them, public dissatisfaction will grow and then our government will present privatisation as a solution to the problems we have in our healthcare.

So make no mistake, our NHS is not failing, it is still doing a fantastic job, but it is being failed.

What can we do to halt this destruction? 

  • First and foremost don’t succumb to trashing the service
  • Remember we can afford the NHS –  we can’t afford to not have our NHS
  • Share and follow this website, talk to your friends and family about it
  • Write a letter to your MP and councillors, here are some template letters you can download-  Letter to Councillors etc
  • Start cross examining anyone who comes to your door canvassing for the elections we have coming up – find out their views on the NHS and make your concerns known
  • Show the NHS staff who are over-worked and suffering from years of pay restraint just how much you appreciate them
  • Sign this petition to defend our NHS
  • Remember that the NHS belongs to US

This campaign will work closely with Sussex Defend the NHS who have set up a Footprint 33 Regional Network of Opposition to STP.

 

 

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