In a Commons debate initiated by Labour on Wednesday, shadow health secretary Diane Abbott said the plans being developed by 44 local footprint collaborations of NHS and local authority organisations would be used to force through funding cuts, close hospitals and GP practices, and make it more difficult for patients to see their GP face-to-face.
‘In some cases, even local GPs have not been fully involved in decision making,' Ms Abbott told MPs. GPonline first reported LMC concerns about being ignored by STP leaders in May.
The shadow health secretary told MPs about concerns raised by LMC leaders in Birmingham - also first reported by GPonline - who discovered secret plans to shift massive amounts of hospital care into general practice.
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Ms Abbott said that while there was ‘undoubtedly a case for bringing health and social care stakeholders together to improve planning and co-ordination’, it was ‘absolutely wrong’ for STPs to be ‘hatched in secret and used as a cover for cuts and hospital closures’. She added that it ‘is increasingly clear that STPs may be a stalking horse for more privatisation’.
Health minister Philip Dunne defended the plans as a ‘unique opportunity’ for local health and care leaders to think strategically.
‘For the first time, the NHS is planning across multiple organisations—both commissioners and providers—with local authorities to address the whole health needs of an area and the people it serves,’ the minister said.
Local leaders were for the first time producing multi-year plans to develop services over five years which was leading some areas to ‘face up to tough choices about the future of some services’, he added.
But Mr Dunne said there were no STP proposals as yet, just ‘a number of draft ideas’.
And the minister rejected accusations of secrecy, denying there was a lack of transparency. ‘Local STPs’ leads have been engaging locally, as they deem appropriate—there has been no secret,' he told MPs.
‘The NHS will scrutinise these plans and make recommendations over which to take forward and prioritise for discussions with ministers and for formal public consultation.
NHS transformation plans
‘We have made it clear to local leaders that they are responsible for ensuring that plans engage with all local stakeholders,' he added. ‘Many have already engaged with groups of clinicians.’
But the Conservative health select committee chairwoman, former GP Dr Sarah Wollaston, also raised concerns over transparency and accountability.
While the process was an opportunity for the NHS to integrate the fragmented service, she said, ‘we should not see genuine local consultation and engagement as an inconvenience but as something that improves the eventual plans’.
‘NHS England now has to … take a step back, and ask how it could have been better at engaging local communities. It is a great shame that members across this house were unable to see the draft plans until they were leaked to the press.’
Dr Wollaston also warned that with many STPs proposing to shift care into the community, it was important to ensure proper funding and workforce in out-of-hospital services.
Former Liberal Democrat health minister Norman Lamb said the STP process was ‘destined to fail and simply will not work’ if local communities are not fully engaged.
Mr Lamb agreed with other MPs that STPs ought to be an opportunity to bring health and care bodies together, but, he said ‘I fear that the opportunity will be fatally undermined’ by the services’ ability to deliver transformation given their financial situation.
The former coalition minister warned the government: ‘If they really think that a formal consultation process after full draft plans have been produced in a secret process will in any way convince the public that they are being properly involved, it will fail. It is inevitable that it will fail. People are so suspicious of consultation processes that they simply do not believe that they are being properly engaged in them.’
SNP health spokeswoman and health committee member Dr Philippa Whitford welcomed the STPs’ move to placed-based commissioning and integration of services but warned: ‘If it is not done properly - if it is just a fig leaf whereby we pretend that something is being done - the NHS will suffer and we will be the generation of politicians who moved the deckchairs on the Titanic.’
Former Labour shadow health secretary Heidi Alexander said the public understood there that the NHS could not be preserved in aspic, but there was ‘deep public mistrust of the government’s intentions’.
‘If you do not fund the NHS adequately and if you do not staff it properly, do not be surprised when the public do not trust your so-called improvement plans,’ she said.