Sustainability and Transformation Plans are a massive vehicle for NHS privatisation


STP Agony Aunt writes:

Far from the Sustainability and Transformation Plans (STPs) marking the government’s shift away from NHS marketisation and privatisation – as some are mistakenly claiming – the opposite is true!

The Sustainability and Transformation funding that the government announced in its 2015 Comprehensive Spending Review comes with the condition that it is used to increase opportunities for the private sector in the NHS:

“The government will encourage long term partnerships between the NHS and the private sector to modernise buildings, equipment and services, and deliver efficiencies, especially where these partnerships support the upgrade of diagnostics capabilities and the development of new models of care, such as Accountable Care Organisations and hospital groups.” (para 2.48, p 94).

This was made clear in NHS England’s initial STP Planning Guidance in December 2015, which said that the independent sector should play a key role in helping individual footprints to meet the stated requirements for STPs and in ensuring the plans are effectively delivered.

A report on the 2015 Comprehensive Spending Review (CSR) from the Marwood Group (a firm that advises private health companies on business opportunities and investment decisions) confirmed  that,

“Today’s CSR explicitly…encourages private-public partnerships.”

By 2017, the Marwood Group had followed this up with a White Paper on ‘the opportunity for international players in the UK healthcare market’, concluding that:

“…areas of…opportunity includ[e]

  1. Supporting the NHS to achieve its efficiency objectives

2. Supporting the NHS to transform services–such as the development of population-based healthcare models

3. Providing a healthcare offering for individual consumers”

You will not find the government’s “encouragement” of public/private NHS partnerships mentioned in any STPs. Nor will Clinical Commissioning Groups acknowledge it, if Calderdale Clinical Commissioning Group’s Chief Officer is anything to go by.  Questioned at the Calderdale Health and Wellbeing Board’s 25th August meeting, he said he didn’t “recognise” the requirement for STPs to encourage NHS privatisation.

The Sustainability and Transformation Plans aim to conclude the 30+ years of stealth privatization of the NHS

STPs are intended as the final stage of successive governments’ privatization of our nationalized industries. The process started with the Tories’ Nationalized Industry Policy Group, set up in 1976 as part of the Economic Reconstruction Group.

The Nationalized Industry Policy Group masterminded the 1984 attack on the miners, as well as planning and overseeing Thatcher’s early privatization sell offs of nationalised industries.

The NHS Drs and Nurses are to Cameron – and now May – what the miners were to Thatcher.

We HAVE to defend them and stop the demolition of our proudest social achievement, the NHS, that has been there for all of us when we need it since 1948.

Here is the plan in the July 1977 Final Report of the Nationalized Industry Policy Group:

  • “Denationalisation should not be attempted by frontal attack but by a policy of preparation of return to the private sector by stealth” (exactly what the STPs do)
  • “We should first pass legislation to destroy the public sector monopolies” (already done – definitively – through the Health and Social Care Act 2012)
  • “We should fragment the industries as far as possible” and establish units which will constitute “separate profit centres” (already done through various Acts and regulations, starting with Thatcher’s creation of an internal NHS “market” and carrying on through the creation of NHS Trusts, Foundation Trusts and Clinical Commissioning Groups etc)
  • Some nationalized industries could be divided into separate companies which could then, individually, be sold to the private sector – “There are some industries… where we should seek to sell off, or form workers’ cooperatives…” (Locala, anyone? – the community health care social enterprise spun out of Kirklees Primary Care Trust that now has a massive 5 year contract for the Kirklees Care Closer to Home scheme.  And the drive in the STPs to hand over huge chunks of care closer to home to voluntary organisations and social enterprises?)

A study of the work of the Nationalized Industry Policy Group in preparing Thatcher’s attack on the miners (doi:10.3828/hsir.2013.34.7) points out that

“…the creation of individual cost centres, either through a separation of functions within an industry, or by regionalizing it…offered the added advantage of potentially weakening solidarity…”

All the many local Save the NHS campaigns need to stand together to stop the STPs and refuse to allow our solidarity to be weakened.

“Sustainability” is code for “cuts”, “Transformation” is code for “privatisation”

The NHS Partners Network and the NHS Confederation – the trade association for private health companies that provide NHS services, quickly seized on NHS England’s initial STP Planning Guidance in December 2015 that the independent sector should play a key role in helping individual footprints to meet the stated requirements for STPs and in ensuring the plans are effectively delivered.

They announced in their report Capital, Capacity, Capability:  Independent  sector providers helping to develop a strong Sustainability and Transformation Plan:

The 2015 Spending Review settlement for the NHS committed the government to encouraging long-term partnerships with the private sector in a number of key areas including:

•development of new models of care including Accountable Care Organisations

•the upgrade of diagnostic capabilities

•hospital groups and acute care collaborations.

These are key to the STPs.

Sustainability and Transformation Plans’ “partnerships” for public health and “health champions” are going to be a massive source of privatisation

The NHS Partners Network/NHS Confederation Report also says that private/voluntary and community sector companies are “well placed” to provide public health services through “health champions to advise on exercise, diet, fitness and sexual health”.

This is after huge public spending cuts have wiped out NHS-run services in these and other vital areas of public health, as cash-strapped Local Authorities re-procure the services through competitive tender and outsource them to private companies.

The privatisation “opportunities” that the NHS Confederation identifies in Sustainability and Transformation Plans’ “partnerships” for public health and health champions are going to be a massive source of privatisation.

For example, in the October 21st 2016 Devon STP I have started unpicking a thread that shows Optum has the Devon Healthy Lifestyles contract, that is identified as key to the STP “prevention” plans to improve health and cut costs of NHS treatment.

Devon County Council put this contract out to competitive tender earlier in 2016.

In August 2016, Unison was in a row with Optum about Optum’s refusal to TUPE over the staff from NHS N Devon Trust that previously had the Devon Healthy Lifestyles contract. (TUPE is Transfer of Undertakings -Protection of Employment regulations. It is supposed to do what it says on the tin – protect employees’ rights if the organisation where they work transfers to a new employer.)

Optum also had a similar “Live Well” contract for Dorset    (That link no longer works, but this one does .)

(Update: When Optum’s 3 year contract expired in March 2018, Live Well Dorset was taken back in house by Dorset Council’s Public Health Dorset. An email from the Council with this information claimed that Live Well Dorset “no longer has links to Optum.”

But in fact, the links to Optum are embedded in Live Well Dorset, as the Optum staff were transferred into Public Health Dorset to work in the Council team. The digital platform for the service was created by Optum. More info here.)

Optum has a £12.5m contract for 5 and a half years with the option to extend for 2 more years in Gloucestershire and probably others that I haven’t yet unearthed.

Optum is a subsidiary of United Health, the global American private health insurance company that NHS England Chief Exec Simon Stevens used to work for. Optum has a criminal record in the USA for fraud. They also have their fingers firmly in the pie of the recently privatised Commissioning Support Units, which means they are in the decidedly dodgy position of advising Clinical Commissioning Groups about commissioning services that they themselves provide.

Optum’s Healthy Lifestyles contracts with the NHS all reproduce its American programme such as the contract it holds with Salt Lake County  – more evidence that the “transformation” bit of the STPs is code for “impose the American system of private health care on the NHS.”

The Sustainability and Transformation Plans’ cuts to acute and planned care are meant to fund the behaviour change/social control programmes, which are to be run by Optum and other companies.

Privatisation – along with cuts  – is the very essence of the STPs.

Other key aspects of STPs’ mandatory “encouragement” of long term NHS “partnerships” with the private sector include:

  • Strategic partnerships with the NHS and the 39 Local Economic Partnerships.
  • The abandonment of  “old-style contracting” and the  imposition of Cerner and United Health-friendly contracting.
  • Embedding digital technology in STPs.

You can find out about them here.

Updated 2 Jan 2018 with info about the Marwood Group’s white paper on ‘the opportunity for international players in the UK healthcare market’.


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