STPs: a radical shake up we should all know about

In brief:

STPs or Sustainability and Transformation plans were developed to reorganise health and social care and cut local deficits.

The idea is that this can be achieved by moving more care into the community, increasing cooperation within the NHS and by cutting or rationing services.

There are 44 STPs nationwide, each one covers a geographical ‘footprint’ and sets out the NHS plans for that area over the next five years.

As of July 2017, most STPs are in the public information stage with consultations to be held later in the year.

Across England all parts of the NHS need to make £22 billion in savings by 2021. (Why?)

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Find your STP

What do the STPs mean?

We have analysed all 44 plans STPs.

All the STPs attempt to produce ideas and initiatives to improve care, yet many of these are fundamentally undermined by underfunding. All STPs have projected deficits and have been told to end them, which explains why cost-cutting is a major feature within most of the plans.

They all plan to treat far less people in hospitals and more in the community. The capital cost of this across all the plans has been estimated at £10bn. However funding from central government is far lower.

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Underfunding is leading STPs to propose major cuts

  1. Close wards and theatres (33 A&Es are slated for possible closure whilst there has been a 39% increase in A&E attendances since 2003/4)
  2. Reduce staffing numbers and underfund recruitment
  3. Ending funding for some treatments and prescriptions.
  4. Delay or avoid funding newly approved treatments.
  5. Force patients to wait longer and travel further for treatment.

Read more: HSJ, The Independent

New Models of care

Aside from cost cutting the other major feature of STPs are plans to reorganise care to make services work together more closely. After pilots in a few areas around the country, The government is offering a number of options. in some areas GPs, community staff, social care and hospital specialists are combining in new hubs (MCPs), other groups involve GPs and hospitals (PACS), but how these new bodies will run and how they fit with the existing structures is still unclear.

So far there has been low involvement of staff and the public. Positive views about the potential of the new models have been expressed but there are also substantial concerns.

Concerns:

  1. Serious lack of funding to make these plans work
  2. New models won't solve lack of capacity just shift problems
  3. Very low involvement of staff and the public
  4. Concerns over further privatisation
  5. No governance and weak accountability

Positive views:

  1. Will create cooperation and pool budgets
  2. Will design care around the patient
  3. Could improve the focus on prevention

Claims Vs Reality

Claim 1

The STPs will pay particular attention to healthcare prevention. Helping keep people healthy and out of hospital. This will improve quality of life and save money.

What is the reality?

Severe cost cutting to public health and social care have fundamentally undermined these ambitions. Cuts to stop smoking services for instance, is detrimental to public health and will ultimately place more pressure on NHS services.

Claim 2

The STPs will reduce hospital capacity through cuts and mergers whilst moving more care into the community.

This will improve quality of care, save money and relieve the pressure on hospitals.

What is the reality?

NHS hospitals are under severe pressure and community services will continue to receive limited funding.

A&E admissions are rising, bed occupancy rates are above the ‘safe level’ of 85 per cent and delayed transfers of care are at record levels.

Resources made available in the 2015 Spending Review are currently going towards cutting the deficit, not investing in community services.

GPs, district nurses, mental health services and adult social care are all struggling to meet current demand. Placing more pressure on these services without allocating adequate funding would push them to the brink.