Sustainability and Transformation Plans (STPs) are the big thing in the health sector at the moment. They are detailed plans outlining how the health and social care organisations in local areas will work together to meet the needs of the people living in those areas while at the same time achieving financial balance by 2020.
England has been divided into 44 STP geographic ‘footprints’ made up of NHS hospitals and community providers, clinical commissioning groups, local authorities and other health and care services. These organisations will work together to create a plan based on local health needs. STPs are important because they will be the main route to both funding and service change from 2017/18.
Over the last month a number of STPs have been published ahead of the recommended timescales from NHS England. As the plans and their contents become known, people are getting angry, particularly around how little public engagement there has been so far and how health professionals have been kept out of the planning process. The BMA released figures this week which showed that over two-thirds of doctors say they have not been consulted on the plans. They also showed that a third of doctors have never heard of STPs, with more not knowing what to think because they haven’t been consulted.
In Leeds, the local medical committee organised a meeting last week at which local GPs, consultants and senior health care managers all came together to talk about the Leeds plan and the wider STP for West Yorkshire. Such meetings are rare and it is extremely concerning that the majority of doctors across England have not been consulted on this issue, particularly as Ministers have been so keen to insist that all stakeholders would be involved.
New BMA analysis also show that STPs will have to deliver £21.6bn in annual savings by 2020/2021 in order to balance health and social care spending across all 44 ‘footprint’ areas, raising serious concerns about likely cuts to services and the impact on patient care. In West Yorkshire and Harrogate alone, if nothing was done, the projected deficit in health and social care spending is £1.07bn. In South Yorkshire and Bassetlaw it’s £579m. This is clear evidence of the crisis facing health and social care as a result of years of underinvestment at a time of rapidly rising patient needs.
STPs could help develop health policies more suited to local needs and help integrate services across health and social care. With an ageing population with more complex health and social care needs, demand on services is only set to rise, so it is right that we look at how best to deliver care in a sustainable way. However, we have serious concerns about the ways in which some of these STPs plans have been put together and what they can realistically achieve. Simply making cuts to services and trying to stretch an already overstretched service more thinly will only reduce the quality of care, not improve it.
The BMA is calling for all the plans to be made public immediately. For STPs to be successful it is crucial that there is sufficient public awareness and that they are drawn up in an open and transparent way.
All of the proposals within the plans need to be realistic and evidence based. Beyond West Yorkshire, some published plans include proposals to close hospitals, reduce the number of practices and even the number of GPs. Many patients will be horrified about this prospect. Any changes like this need to be based on evidence that they will maintain or improve the quality of care patients receive.
There needs to be a commitment to full consultation with clinicians, patients and the public on any proposed changes as early as possible. This is particularly important as there is no legal or clinical accountability within the STP process – ‘footprints’ are not a statutory part of NHS structure.
Crucially the plans need to be funded properly. NHS England has been explicit that there will be little capital or transformation funding over the coming years, which gives the plans a very limited chance of success.
Most importantly, the priority of each and every plan has to be on improving care, not cutting it to save on the budget. The plans must not become an inadequate response to the crisis of the long-term underfunding of health and social care. The last thing we want to see is the Government using these transformation plans as a cover for further starving services of resource and patients of care.
Dr Richard Vautrey, deputy chair of the BMA’s General Practice Committee