We should not dismiss STPs. They could have potential.

NHS reorganisation


I feel passionately about the NHS. It is something we as a nation should be immensely proud of, and we are lucky we established it when we did, because I expect it would be very difficult to set up such a scheme now with all the vested interests who would oppose it. It stands as a symbol of fairness and solidarity in a society which is otherwise becoming more unequal and fractured.

I am involved with the NHS and I never cease to be amazed by how selfless and ethical most of the people who work in it are. “I think I am paid enough for what I do” a chief officer remarked recently to me when the chance of an increase was mooted. This attitude contrasts markedly with those of many who run our large banks and other corporations.

But I know I am not the only person who cares deeply about it, and when changes in the NHS are discussed people become very agitated and make a large amount of noise. The problem is we all know in our hearts that things cannot go on the way they are, and a radical solution has to be found. We are bombarded continuously with statistics describing a shortage of specialists, GPs and nurses. Last Saturday it was the Society for Acute Medicine warning us that it was becoming increasingly difficult to fill rotas for emergency care, and I expect we will continue to receive such pronouncements.

There is a need for more resources, few dispute this. Even Andrew Lansley, architect of the controversial 2012 reforms, admits this. But however much more money can be procured, the system cannot continue without fundamental reform.

I have written before about the changes we need. Fewer but better specialist hospitals, more care and support provided outside hospital, and serious efforts to promote good health and prevent illness when we can. (The North East, by the way, is good at this, having the best smoking reduction figures in the country.)

The NHS has brought forward proposals which will move in this direction, called Sustainability and Transformation Plans, or STPs. These will involve changing hospital provision and improving community support and care. Now I make it my business to talk to as many groups as I can about the challenges facing the NHS and what we can do, because there needs to be a serious debate. I consider myself as being on the left, and thought that those who thought like me would want to make sure the NHS survived.

I am really worried by the reaction by many on the left to the ideas in the STPs.It is assumed that the “progressive” position is to oppose these plans, rather than to campaign for better resources to make them work properly. I keep hearing that the STPs are there to make cuts, and to promote privatisation. Little evidence is put forward about the second proposition, but many seem to believe it as gospel. In fact many in the NHS do not like privatisation of services and there has been less of it in the North East than elsewhere.

I do not understand the logic. If changes are not made the NHS will simply not be able to continue even if there is more money. I would ask those attacking the STPs to think about the direction of the changes. If successful they would mean far more integration of services. Hospitals, local authorities and the providers of community health would need to work together. There would be a cooperative model, rather than the competitive one we have now. It would become much harder to privatise individual parts. Secondly local authorities, which are elected, would be working much more closely with the NHS which would give elected representatives more influence over what is going on.

Yes, the NHS needs more resources and I would urge all who care about it to campaign for these. But please also think about the sort of NHS you want, with more care provided locally, more control by the local community and better specialists hospitals. I am fed up with knee jerk reactions – I want a proper debate.

To summarise, I believe that the STPs have potential and as socialists we should try and develop them as part of an integrated accountable NHS. They will not be successful unless they have more resources, and we have to campaign for these. But they are not necessarily a vehicle for privatisation. If services are integrated they will be more difficult to privatise. We need to quietly get rid of the 2012 Act so ther eis no longer an obligation to put services out to tender. At present privatisation is often seen as the only way to deliver a service within a reduced financial envelope, and will eventually fail as experience such as Hinchinbrooke has shown. Please do not dismiss STPs but engage in the debate as to what they are about, which seems to me to be desirable.

This is an extended version of an article which appeared in the Newcastle Journal on 19th April 2017