Lincs Sustainability and Transformation Plan is steaming ahead and has become a Sustainability and Transformation System

In response to a thread on Fight 4 Life Lincolnshire facebook group about what on earth is going on with the Lincolnshire Sustainability and Transformation Plan, STP Agony Aunt has done a bit of digging.

Lincolnshire Sustainability and Transformation Plan – renamed  Lincolnshire Health and Care Plan and referred to as a “System”in Lincs STP update May 2018 – is steaming ahead with its cuts agenda, threatening the loss of the NHS as a comprehensive health service for all.

The public is left not knowing what’s going on – much less being consulted on it. To the point that some people seem uncertain whether the Sustainability and Transformation Plan even exists.

Lincolnshire County Council rejected the STP at its December 2016 meeting, but that had no practical effect. The same happened with several other councils  , giving rise to  suspicion that Councillors were just spouting spin to appease the public.

NHS England’s Sustainability and Transformation Partnerships progress dashboard July 2017 shows Lincs STP “making progress” with “established system wide leadership”.

In July 2017 Lincs STP produced an update  to its December 2016 plan, saying:

This Plan is our final draft but is not set in stone. Many of our proposals are still at an early stage and need to be further discussed, tested and developed. Some changes will need to go through a full public consultation. Plans are now clear enough that we can talk in detail to the public to get their views and input. Over the next 6 months we will be holding a range of events where people can come and hear about the Plan and share thoughts and ideas on how we take it forward. If you are interested in finding out more or getting involved please email or call 01522 718051

To view the full Plan please go to

That webpage link doesn’t work, but this one does.

The July 2017 update promised 6 months of public engagement events. In the general scheme of NHS consultations, public engagement events are followed by public consultations. So where is the consultation document for the Sustainability and Transformation Plan/Health and Care Plan?

Is this what Cllr Martin Hill is calling for, in demanding publication of “a plan for public consultation”, according to the Lincolnshire Reporter?

Why doesn’t Lincs Health Scrutiny Committee demand that the  Sustainability and Transformation System Executive produce an STP consultation document?

And since implementation of the STP/HCP has been cracking on for the last 18 months, there is a need to identify what has already been implemented – without consultation. Is that even lawful?

John Turner is the Senior Responsible Officer for the Lincolnshire STP.

Andrew Morgan, Chief Executive of Lincolnshire Community Health Services NHS Trust, is Chair of the ST System Executive Team.

The Lincs STP news webpage is here

Lincs STP is on twitter @LincsSTP

Melissa Darcey spoke about Lincs STP at the Northern Health Campaigns Together Conference in Leeds in January 2018. Video here.

STP Agony Aunt’s next piece of digging will unearth what the Lincolnshire Sustainability and Transformation System has already carried out and what it is doing next. For now, a brief look back at the main outline of  Lincolnshire Sustainability and Transformation Plan.

A recipe for cuts, privatisation and the end of #NHS4All

Sustainability and Transformation Plans were imposed by the NHS England quango – real name NHS Commissioning Board – in order to redisorganise NHS services in a way which caps spending within a limit which is consistent with government “austerity” spending plans – against all economic reason, and which increases NHS privatisation in line with conditions that the government placed on the “extra” NHS funding it awarded in the Autumn 2015 Comprehensive Spending Review.

When Lincolnshire STP was prepared in 2016, Lincolnshire’s hospitals were underfunded by £60m /year.

In June 2016 the case for change  predicted a Lincolnshire- wide NHS funding shortfall by 2020/21 of £300m, unless cuts and changes were made.

In the July 2017 STP update, a funding shortfall of £182m by 2020/21 was predicted, unless cuts and changes were made.

It’s not clear how a predicted £300m funding shortfall became a £182m predicted funding shortfall in the space of a year.

The Lincs STP is based on NHS England instructions in the 5 Year Forward View 2015/16 -2020/1 for carrying out cuts and privatisation plans .

A key feature is cutting hospital services and transferring them into primary and community services run by Accountable Care Organisations or Systems, with a contentious form of contract used by the USA’s Medicare/Medicaid limited state-funded health insurance system.  This introduces financial considerations into the question of treating patients – abandoning the core principle that the NHS is a comprehensive service for all who have a clinical need for treatment.

Regarding similar proposals in the Birmingham Sustainability and Transformation Plan to shift many hospital services into primary and community care, Birmingham LMC chief Dr Robert Morley said:

‘The STP, and in particular the plans to massively increase the delivery of out-of-hospital care, to transform general practice and to give it far greater responsibilities across a range of areas are simply undeliverable bearing in mind the meagre additional investment, the unambitious plans to increase primary care workforce and the woefully inadequate intention to support general practice sustainability and viability.’

The Independent Reconfiguration Panel has just made a similar judgement on the Calderdale and Greater Huddersfield plans to cut hospital services and transfer them into large scale GP practices.

The 2016 Lincolnshire STP case for change said that they were considering which hospital services to move to what they call “centres of excellence”, and where this would be.

Specialist hospital services that the Lincolnshire STP identified as likely to be centralised in “centres of excellence” include mental health, cancer, stroke and

It said there will be at least one hospital for specialist emergencies like heart attacks and strokes.

The Lincolnshire STP case for change said the main hospital sites in Grantham, Boston and Lincoln would not all provide the current range of services that they do now, and:

“This may mean some patients having to travel further when they do have to visit hospital.”

The STP talked about centralising maternity services in one hospital, instead of the current two consultant-led maternity units in Lincoln and Boston. It proposed a network of urgent care centres to deal with most urgent care, with A&E limited to emergencies.


It was a condition of the extra NHS funding approved in the government’s Autumn 2015 Comprehensive Spending Review that this was used to increase opportunities for private health companies within the NHS.

The South West Lincolnshire Clinical Commissioning Group’s report to the Lincolnshire Health Scrutiny Committee meeting on 18th Nov 2015  said that for planned care, the CCG was already developing “new provider relationships” and increasing access to the independent sector. It added that

“The CCG was well placed to access alternative providers due to a lack of capacity in Grantham, Lincoln and Boston.”

Why is there a lack of NHS capacity? Because of NHS underfunding.

Optum’s £3m/year commissioning support contract

As of February 1st 2016 South Lincolnshire and South West Lincolnshire Clinical Commissioning Groups have worked with Optum Commissioning Support Services (Optum CSS) for all procurement and contracts. Optum also provides these Clinical Commissioning Groups’ marketing, communications and engagement and ‘back office functions’ ranging from payroll to IT support. The three year contract is worth £3m/year.

Optum  is part of United Health, the global American private health insurance company that NHS England Chief Executive Simon Stevens was previously a Vice President of.

Optum promotes the United Health “care models” that Simon Stevens’ NHS England 5 Year Forward plan 2015/16-20/21 aims to import into the NHS, via the Sustainability and Transformation Plans.

This Commissioning Support privatisation has taken place across England

The US federal government took out a lawsuit against Optum for packing their hospices across 13 US states with patients who were not coming to the end of their lives – so cutting the most expensive costs that come with admitting dying people, and maximising its profits from Medicare, the source of approximately 90% of its revenue.

The lawsuit said that Optum “consistently and deliberately” sought to increase the number of patients for whom it could bill for end-of-life hospice care, despite repeated warnings that a substantial portion of its patients were not terminally ill.

NHS England’s acceptance of Optum on the list of approved private companies providing commissioning support was criticised by the then-shadow health minister:

“Ministers need to explain how it can be right that companies that are being pursued for poor care standards abroad could possibly enter the NHS.”


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