What are Sustainability and Transformation Plans?

Here is a summary of some key features of Sustainability and Transformation Plans, as promised at the Leeds Keep Our NHS Public Conference in October. It was meant to be 1 side of A4 but has turned out to be 2 sides of A4. You can download it if you want to print it and share. If you have questions or comments please email the STP Agony Aunt at stpagony@gmail.com or put them in the comments box at the end of this post.

44 Sustainability and Transformation Plans – each covering an area of England that NHS England has defined as “footprints” – outline how the NHS and social care in each area  are to:

  • obey harsh new financial controls and sanctions that will eliminate the current huge hospital and commissioner “deficits”, that are the result of government underfunding of the NHS since 2010
  • redisorganise the entire NHS so it is cheaper to run and sticks within the limits of a funding shortfall of around £25.5bn by 2020/21- without any possibility of running further “deficits”
  • radically increase opportunities for private and third sector companies in the NHS, by operating it as a set of public/private partnerships like PFI, but for services as well as buildings.

All STPs have to follow NHS England and NHS Improvement financial controls and planning guidance, so will all be more or less the same, apart from local details.

Withdrawal and restriction of treatments

Already the STPs mean withdrawal and restriction of treatments – particularly so-called “over the counter” products like special feeding for the frail and elderly, and treatments like hip replacements and cataract removal, that are not life saving but if not provided, leave people in pain and with disabilities.

Closing/downgrading A&E and other acute hospital services

STPs are not just about closing or downgrading a full accident and emergency unit or other acute hospital cuts and closures – although a Health Service Journal survey of clinical commissioning groups shows that a “substantial minority” of STPs will do this.

Destroying the patient-doctor relationship

There will be far fewer hospital beds, and more care at home via interactive digital technology, etc.

The whole patient – doctor relationship will be undone – GP and community services that include many services formerly provided in hospitals will be delivered by huge “ GP Federations” in a number of “hubs” that cover very big populations and provide standardised “care pathways” or “managed care” for various illnesses.

Copying American private health  insurance companies’ schemes, “care pathways” tell doctors what treatments they must give – undermining their vocational skills in identifying the best course of action based on an understanding of and empathy for their patients’ situation.

This enables care to be delivered by new grades of less skilled, cheaper staff. The Footprint 3 STP says workforce spending is to be cut by £42.9m compared to the amount that would be spent if there weren’t the funding shortage.

The STPs place a big reliance on unskilled voluntary sector people, family and friends, as well as on patients themselves managing their own care.  The cost savings from this will be big.

Patient self management

STPs segment patients into groups according to their risk of hospital admission. The lowest risk groups will be subject to “preventive” care aimed at changing their behaviour to become more healthy and teaching them to “self manage” their illness. This ignores all the social, environmental and economic determinants of ill health and the fact that these are structural aspects of society that are outside individuals’ control.

Already GPs are “inviting” their patients to register for self-management courses run by companies like Self Management UK.

This is about taking the “care” out of health care, to cut costs. But we are the sixth richest country in the world and the government funds corporate welfare to the tune of about £93bn/year. We can perfectly well afford a proper NHS.

About the only good thing about being ill is that someone kind & knowledgeable looks after you. Take that away and what have you got left? Someone telling you to look after yourself. How unkind is that?

Incentive to cherry pick most “cost effective” patients

The “care closer to home” schemes in the big GP/community hubs that replace many hospital services will be funded on a per capita basis for a given population. This is copied from US private health insurance companies that are notorious for offering “managed care” to only the most “cost effective” patients.

This will allow the organisations that hold the contracts for the care closer to home schemes and primary/community care hubs to make a profit.  It also undermines the principle of a comprehensive health service.

And are GPs on board with all this?

A twitter survey of GPs and Practice managers found that 84% didn’t know what is in their area’s STP about General Practice/Primary care. At the end of October, a BMA survey of London consultants and GPs found that 50% are unaware of STPs.

No one else knows either – if we are to believe replies from Council Leaders to members of the public who have asked them to publish the STP for their area.

Of course, NHS England  and almost all the NHS and Local Authority organisations involved in the STPs are spinning them as being about improvement to the quality of NHS and social care services and reduction of health inequalities through preventive care. Don’t believe the spin.

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