Sustainability & Transformation Plans in London

NHS reorganisation

A seminar on Sustainability &Transformation Partnerships in London, held at the King’s Fund on September 12th, voiced the most serious concerns yet from within the political elite about the viability of STPs. As I understood it the King’s Fund’s report contained seven warnings (as well as a job description for a London Mayor with an interest in the NHS). The warnings were:

  1. Providing more community-based care is right but the NHS needed to be realistic about what could be achieved in a short time with limited resources. The expected impact of new models of care on hospital use should not be overstated.
  1. Reductions in the number of hospital beds in London proposed by some STPs are not credible, given the city’s growing population. Around 1,600 extra acute hospital beds will be needed by 2021 to keep up with population changes, but there is no evident funding source for this or for the staff recruitment that would be needed.
  1. The case for concentrating some services in fewer hospitals to improve the quality of care is weak.
  1. Plans to increase preventive activity and reduce health inequalities need to be concrete and detailed, not vague and undefined, and they are not aided by reductions in Public Health funding.
  1. London’s health services face a £4.1 billion overspend by 2020/21, and plans to reduce this sometimes overstate the savings that can be made. Proposed efficiency savings of 3-4% per year are unrealistic.
  1. Capital investment is needed in London’s health services, and the budget needed is estimated to reach £5.7 billion by 2020/21. This is unlikely to be made available by the NHS, so Trusts will need to sell under- or unused land.
  1. NHS staff, and the public, need to be “meaningfully involved” in developing their local STP, implying that they are not being at present.

The analysis on which these warnings are based was dated, the King’s Fund’s investigation having started in October 2016. It is possible that the current picture is less alarming, although no-one in the discussion suggested this. As usual the debate included special pleading, like children’s services being overshadowed by older people’s services, or GPs being unable to recruit and retain staff. A final comment about having plenty of specialists in London raised a laugh; it is still hard to grow much in the shadow of a teaching hospital, an insight that the King’s Fund finds difficult, I think.

The Mayor’s spokesman outlined the six assurances that London government wanted to have. They included evidence of strong public involvement in STPs, clear support from front-line NHS staff (not just the grandees), attention to health inequalities, calculation of the impact of STPs on social care, detailed modelling of hospital capacity, and an investment flow from the NHS centrally. This is a good enough basis for political work at local government level, within the NHS and at policy level.