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.



Sustainability and Transformation Plans

Update on threats to our hospitals

Our hospitals are the next in line for severe cuts in funding from this Tory government hell-bent on destroying our healthcare service. Sustainability and transformation plans (STP) for primary care have already been incorporated into the operating plans of our CCGs.  But we are now waiting for the publication of plans for our hospitals.  These plans are being drawn up in secret with no public engagement.  There seems to be a media blackout being applied so most people are left unaware of just how far the intention to finally put the nail in the coffin of our NHS goes.  Here is an update of what we know is going on in this footprint (region).

Continue reading “Update on threats to our hospitals”

Naylor Report

NHS up for a quick sale! The Naylor Report

NHS- not for sale sign

You may like me be starting to struggle to keep up with rotten government policies that seriously threaten our quality of life.  They are after all bombarding us with news of proposals for changes to how our country is run and it would be impossible to fight every proposal even if we wanted to.  But the NHS is something that matters to most of us, it is there to keep the country healthy.  The Naylor Report is something that we all should know about.  And, we need to understand why it is such a worrying proposal. Continue reading “NHS up for a quick sale! The Naylor Report”

NHS birthday card campaign

NHS birthday campaign

NNHS birthday card campaign

The NHS was created on the 5th July 1948, an appropriate time to set off with this campaign’s first street action.  We were out in the town centre of Eastbourne on three days in the run up to the 5th July.  The campaign had a simple message –  The NHS is not failing it is being failed, the only reason it is not failing is due to the hard work and dedication of NHS staff.  We asked the public to sign a birthday card for the NHS and say thank you to it staff. All the birthday cards were delivered to the DGH on the NHS birthday. Continue reading “NHS birthday campaign”


Psychaitry – the Cinderella service of the NHS

Silhouette of woman sitting in a dim room

I speak from bitter experience of mental illness.  I have experienced the best and worst of psychiatry.  The best came just a few years ago when I finally was diagnosed correctly and the doctors admitted they didn’t know how to help me. It was a groundbreaking moment to be told by one psychiatrist that he had no idea how to help me because nobody had ever admitted that before, although I had known it was true.  My story reflects how little understanding there is of mental illness.  I was successfully treated eventually but the unit I was treated in closed four years later.  My story also reflects how psychiatry is now going backwards. Continue reading “Psychaitry – the Cinderella service of the NHS”

General Practice

A changing climate for GPs

GP surgery

Many of us will have heard GPs talking about their almost unmanageable workload.  Even more of us will have noticed just how hard it can be to get a GP appointment when we need one.  The importance of primary care should not be underestimated, it is primary care that keeps us from needing hospital admissions.  It may also keep vulnerable patients safe and out of crisis.  To start damaging primary care is very unwise as it may simply translate into patient harm, increased pressure on hospitals and increased costs for the state. So what is happening now with primary care? Continue reading “A changing climate for GPs”

regional Opposition to STP

Update on the first meeting of the Regional Opposition to STP Campaign

Despite this meeting being held on a Sunday of bank holiday weekend, and at a time when many people would be involved in canvassing for forthcoming elections we had a surprisingly good turnout.  Representatives from groups in Brighton, Eastbourne, Hastings, Lewes, Lancing and Chichester met to try and make sense of what we are up against in the fight to preserve healthcare across the Footprint 33 region (East Surrey and Sussex).

The first half of the meeting was focussed on sharing information about what we know so far.  One major problem seems to be the language used in these plans.  As we start off with the region being named a Footprint instead of simply a region it is not hard to see that the whole plan is full of language that would make little sense to most people.

We discussed this impenetrable jargon and tried to make sense of some of the terms used.  Should we ask for a complete translation or perhaps a glossary of terms?  Surely any public body has a duty to make documents such as this understandable for the public?

Place-based plans are the part of the Sustainability and Transformation Plan relating to primary and social care.  Despite assurances that there will be public consultation on these plans we know that place-based plans are already incorporated into CCG operating plans for the whole of East Sussex and East Surrey.  Yet, there is still no sign of any public engagement happening.

Accountable Care Organisations (ACO) are the bodies that would be responsible for implementing STP.  This is an idea copied over from America, giving an indication that the intention is to move Britain towards an American style insurance based system of healthcare.

There is already a draft ACO in West Sussex but it has no local support.

There is much talk in place-based plans of ‘hubs’ in relation to primary and social care and we really need to start understanding what this will mean in our localities.  The place-based plans tend to be easier to read than the parts of STP relating to hospitals.  We can start to get an idea of what these plans may mean by looking at the plan for Central Sussex and East Surrey.  It is really important for everyone to find out what the operating plan for their CCG is.

Social Care is already in crisis through lack of funding and highlights the tragic farce of STP.  Regional STP proposes a cut of £112m and there are many proposals to prevent over-75s from going into hospital.  These cuts hinge on the idea of community care and social care preventing people needing hospital.

The main regional STP is supposedly a ‘work in progress’ with an abundance of meaningless headings such as Provider Productivity which we are sure relates to staffing cuts of £270m.  There is still an estimated £200m of cuts to be made to balance the STP budget for 2020-21.  Unsurprisingly hospital-related changes are yet to be announced.  There is nothing like closures of hospital services to trigger public outcry.  The fear is that cuts, closures and redundancies will happen slowly using a drip-drip approach in an attempt to avoid mass public protest.

NHS improvement officers are involved in three NHS trusts in the region (BSUHT, East Sussex Healthcare trust and Secamb).  A report on BSUHT (in special measures for Quality and Finance) has supposedly been completed but nothing has been released.  There are key questions to be asked around A&E and Maternity Services.

Coastal West Sussex have taken over the Board of Brighton and Sussex University Hospital Trust.  this is supposedly a temporary buddying arrangement but is obviously a prelude to other major decisions. The position relative to Eastbourne DGH and Conquest Hospitals needs to be checked out.

Propco, a NHS England quango, is in charge of all NHS buildings.  Potentially they could be making £billions through the sale of NHS buildings and land.  In our region our STP board may well hope to clear much of the £864m ‘do nothing’ deficit through the sale of buildings and land or by putting up rents on properties such as GP surgeries.  It was decided that further research into this must be done as a matter of urgency.

By looking at other regions around the country  where STPs have been published we have seen hospital and service closures and mergers with increased catchment areas for many hospitals.  In areas where they know what is happening there have been big public demonstrations, particularly in Devon and Cornwall. The Keogh report of 2013 recommended cutting back to just one A&E service per footprint.

We all need to keep a very close eye on our hospitals.  The danger of news about hospital and service changes being drip-fed under the radar to avoid a  massive public reaction is one we must be on guard for.

Thankfully there was then some Good News! – There are two judicial reviews which are both quite far advanced which may generate hope for some.  Here is a link to a Crowd Justice campaign which is aiming to raise funds for one of those judicial reviews.  This is an excellent opportunity to get a legal ruling that would prevent our NHS being destroyed so please donate whatever you can afford. The Socialist Health Association which has the ear of the Labour Party is now under excellent leadership and everyone is encouraged to join.

The next half of the meeting focused on actions that the group could take.

  • There is a Wiggio group, which is an online platform where information can be shared.  It was decided that this would be trialed for three months and then re-evaluated.  Membership of the Wiggio group is through invitation only but do get in touch if you would be interested.
  • There was a discussion about the setting up of a Facebook page with the feeling that this may offer instant possibilities for organising.  However some people are not keen on Facebook.
  • It was agreed that co-ordinating press releases on hospital bed review figures across the region may help to get a message out to the public.  A press release to local papers needs to be adapted according to area but a draft press release will be shared on Wiggio for anyone to use.  If you do send a press release to your local paper try and include a high-resolution  image, preferably with somebody’s face on it, with the text.
  • There is a possibility of trying to get a region-wide pledge to oppose STP.  Health Campaigns Together are doing a national oppose STP petition which will go on Wiggio shortly.
  • July 1st-5th – Health Campaigns Together have suggested these dates for nationally coordinated actions around the birthday of the NHS on the 5th.  It would be good to coordinate something regionally on these dates.  One idea was to collect signatures on a birthday card for the NHS in town centres that could then be delivered to the local hospital.  Another idea was to target action around Virgin Healthcare with coordinated placards and publicity.
  • The idea of a regional march was also discussed, with coordinated marches organised in different town converging on Redhill, the base of Michael Wilson, Chair of our STP Board.



Privatisation in the NHS

There is a major sticking point in the NHS which routinely divides opinion.  For many people their only concern is that their healthcare remains free at the point of need.  So why worry who delivers healthcare?

There is a very good piece on the website weownit which is quite brief but gives a good summary of why we need to campaign against privatisation in the NHS.  Obviously privatisation has always existed in the NHS.  Non-public bodies have always been involved in our healthcare service.  Pharmacies, charities, drug manufacturers, care workers to name but a few.  There is no need to say that every aspect of our healthcare must be delivered by a publicly owned National Health Service – but there is every reason to say that privatisation has gone too far.

Although hospital services such as cleaning and portering began to be outsourced some time ago in recent years privatisation of NHS services has been drastically increased as this Guardian article highlights.  Another great source of information regarding NHS privatisation is the website for the Keep Our NHS Public campaign.

So what harm is resulting from the amount of DoH money that ends up in the hands of private companies?  Here we have another great piece from the Guardian that is not for the faint-hearted reader who cares about our NHS.

To call simply for an end to privatisation, or for more money to be spent on healthcare or for any other single issue regarding the NHS is simply not enough.  We need to focus our attention on putting right every aspect of policy that harms the health of our nation.

On March 4th a massive demonstration took place in London for our NHS.  Estimates of attendance ranged from between 250,000 and 350,000 protestors.  We don’t all need to be experts in health policy to fight for our NHS.  But we need to come together and demand that our government protects the NHS.  We know what is wrong, we see it and hear about it all the time.  And we know what we as a nation need in terms of healthcare.  If you can’t get your head around all the complex issues of health policy but feel that as the 5th richest nation in the world we should have access to better healthcare, then make your voice heard.


regional Opposition to STP

Regional opposition to STP campaign

Sussex Defend the NHS Campaign is organising a regional campaign against the Sustainability and Transformation Plans that are the most immediate and devastating plans that threaten our NHS.

The first meeting of this regional campaign to oppose STP is set to take place on Sunday 30th April at the Brighthelm Centre in Brighton between 1pm and 4pm.  They are hoping to get representatives of local organisations, political parties and trade unions at that meeting in an attempt to organise a campaign across the whole of the East Surrey and Sussex area that would be covered by the Footprint 33 plans.

They have shared the following documents with this campaign group that explain very well exactly why this regional campaign against STP is of so much importance and what the meeting will be covering.  I would urge anyone reading this who belongs to any organisation that has an interest in the safeguarding of the NHS to read through these documents and consider sending a representative  along on Sunday.

The first document gives an outline for Sunday’s meeting OUTLINE FOR FIRST MEETING OF REGIONAL OPPOSE STP CAMPAIGN

The next document gives a summary of the main issues of concern regarding the STP for our region Summary of issues of concern with STP

The next document describes how we can go about fighting against the STP in our region STP and HOW TO FIGHT IT IN FOOTPRINT 33

Finally, for anyone still yet unsure about whether they oppose the STP here is an excellent document that details why many people feel STPs would signal the death of our NHS STP takes over the NHS


It would be great to see as many people as possible from organisations right across our region there on Sunday