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.