STPs are 'vehicles for cuts' and must be scrapped, warns BMA

BMA leaders have called for sustainability and transformation plans (STPs) to be completely abandoned, as the union revealed details of a multi-million pound salary bill for managers running the process and warned millions of patients could be affected by cuts.

BMA annual conference
BMA annual conference

A motion passed by doctors at the union’s annual representative meeting (ARM) in Bournemouth on Monday overturns the BMA’s previous approach of critical engagement with the regional health and care service collaborations set up by the NHS in England to implement the Five Year Forward View.

The conference condemned the ‘woeful’ development of the 44 STPs ‘turning them into vehicles to try to legitimise further cuts to vital NHS services’ and called for them to be abandoned.

The vote came as the union published new analysis of salaries and fees paid to managers and consultants working on STPs. Information obtained by the BMA revealed an £8.5m salary bill for new health managers delivering STPs, with £1.1m spent on private consultancy firms and agency staff.

The BMA also published analysis suggesting that 1.6m patients could be affected by hospital closures or mergers because of the  plans with 23m hit by A&E closures or downgrades.

General election pledge

BMA chair Dr Mark Porter warned the ARM that while 40% of doctors are opposed to STPs 45% remain unsure. He added that none of the political parties in the general election proposed scrapping the plans, although the Labour party pledged to halt STPs, launch independent reviews and stop service closures.

Proposing the motion for London regional council Dr Anna Athow told representatives that STPs had been given massive powers to reconfigure services, change workforce contracts and impose cuts in order to privatise NHS provision.

'This outrageous fait accompli aims to end the NHS as a national health service, equitably and publicly providing care to all according to need.'

STPs, Ms Athow said, had been required to make £22bn of cuts, close beds, reduce A&E admissions, cut elective referrals, ration operations and treatments, axe specialties from district general hospitals, close emergency departments, cut staff, reduce pay bills, and sell off land and assets.

STPs would become accountable care systems, she warned - 'giant public-private partnerships for clinical and social care all ready for tender to private companies'.

NHS privatisation

'STP boards are NHS England's 44 new weapons to cut and privatise the NHS,' Dr Athow told the conference.

'We don't want American-style healthcare in England, no critical engagement. The BMA must fight for STP boards to be abandoned and STPs to be disbanded.'

Earlier, the conference passed a separate motion that made a series of demands on NHS leaders around the future of STPs, including more patient consultation, evidence-based planning, prioritisation of care quality, doctor representation and full funding of transformation plans.

Retired Yorkshire GP Dr Russell Walshaw said many doctors believe STPs 'could work'. But he added: 'Except we did not hear about them and we know it is not possible to reform and improve the NHS without the users, and in our case we mean doctors.'

STPs, he said were clearly planning for more activity for no additional resource. 'The outcome of STP plans for the NHS will not work unless they are owned by everybody, are realistic in expectations, and are fully resourced with people as well as finance.'

The motion was opposed by doctors who said the BMA should be rejecting the whole STP process rather than making demands for changes.

BMA council member Dr Jacky Davis said like the union's debate over the 2012 health and social care act, the STP process was 'another piece of acceptable government policy with a long wish list attached to it. She warned: 'Critical engagement did not work for the health and social care bill, and wish lists don't work.'

'How can a wish list work when the purpose of this is to save over £20bn. Voting for this would have about as much effect on the DH and Jeremy Hunt as a spanking with a wet lettuce leaf.'

Dr Walshaw replied that doctors should be ‘in the tent airing our views’ rather than outside the tent.

Motions passed:

41 Motion by THE AGENDA COMMITTEE (MOTION TO BE PROPOSED BY THE
SCUNTHORPE DIVISION): That this meeting believes that sustainability and
transformation plans have not produced a sustainable funding model for the NHS in
England, and the BMA calls for:-
i) the maintenance and improvement of the quality of patient care to be the absolute
priority;
ii) patients and the public to be consulted on realistic, evidence-based STPs;
iii) there to be no further reduction in inpatient beds until after a comprehensive
assessment of the clinical needs of the local population;
iv) clinical education and training to be protected and promoted;
v) any service reconfiguration to be clinician-led;
vi) at least one doctor appointed by regional councils to be engaged in a meaningful
clinical forum with each STP;
viii) STPs to be fully funded to achieve true transformation.

42 Motion by THE AGENDA COMMITTEE (MOTION TO BE PROPOSED BY THE LONDON REGIONAL COUNCIL): That this meeting condemns the woeful manner in which STPs have been progressed, turning them into vehicles to try to legitimise further cuts to vital NHS services, and proposes STPs are abandoned.

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