NHS reform: Why sustainability and transformation plans could be dangerous

Across England, 44 'footprint' areas are drawing up sustainability and transformation plans (STPs) for the NHS in their region. But east London GP and Socialist Health Association honorary vice president Dr Brian Fisher says the lack of transparency around the process suggests the plans may contain nasty surprises.

Another month, another redesign.

Integration is good, support in the community is good, making best use of hospital land is good – all for patient benefit, of course. The rhetoric is persuasive.

But STPs are likely to be dangerous. There are 44 of them across England, pulling together local authorities and CCGs in defining and developing a 'place-based budget', exploring areas of co-operation and synergy, trying to find ways of maximising capacity. It sounds great. And maybe it will be.

NHS funding

But STPs are driven by the Treasury. They are focused on reducing NHS spend. In south-east London, for instance, the STP has to bridge a £1.015bn gap in NHS funding over five years to 2020/21. Across the capital, councils face a £900m gap in social care funding to 2019/20.

Many places in the country are in worse shape, but unless STPs meet the funding demands of the Treasury, the plans will not be approved and areas will not receive any transformation money.

Examination of the plans so far suggests many areas where plans and the savings linked to them have heroic underlying assumptions. It appears that some figures are double-counted. The evidence underpinning the claims for benefit and savings are uncertain. Efficiency savings required from NHS trusts are punishing. It is only recently that, in south-east London, plans have actually acknowledged that social care is underfunded.

The contradictions are seen in comments reported in GPonline from a GP leading the STP process in Somerset. Dr Matthew Dolman said earlier this year: ‘We want to change a whole system. And we are constrained by workforce, recruitment, the money we haven't got, overspending. And a whole community of health and care wants to do things differently.'

The STPs are being planned with almost no public nor professional involvement. Driven by the Treasury, rules may be different. These plans could be draconian. We have heard of a demand to a local authority to sign off an STP without having seen it. After they refused and insisted on seeing the final document, they were given 90 minutes to read and sign. I understand that they still have not signed.

Read more: what is an STP?

I understand that CCGs and local authorities have been told that they cannot consult or release information until NHS England has agreed the plans. So, in essence, the plans will be finalised, agreed by CCGs and local authorities and, only then, will they be shown to the public. Any concerns or challenge is likely to be far too late. Indeed, some plans, even though they have myriad impacts on local services, are not deemed worthy of consultation at all.

This cannot be right.

Quite apart from the lack of transparency, the incredible figures, the probably drastic outcomes, the changes are likely to ramp up privatisation across the English NHS. The service redesigns will be procured by the rules for tendering which remain in place.

Indeed, there appears to be a new drive towards privatisation - the HSJ reported last month that: 'NHS Improvement is to explore new partnerships between the health service and the private sector, including the potential for further outsourcing of clinical services and the use of "independent sector management models".' Very timely.

Plans are likely to appear in September or October. STPs promise much but are likely to be sinister in intent and in outcome. Beware.

  • Dr Brian Fisher is a GP in Lewisham, east London, and honorary vice president of the Socialist Health Association.

Photo: Dan Wootton

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