STPs: a radical shake up we should all know about

In brief:

Sustainability and Transformation plans (or partnerships), or STPs, were developed as a way to cut the massive deficits in the NHS and control the escalating costs of NHS care.

The STPs primarily target a reorganisation of services to move care away from hospitals and into the community, as well as increasing cooperation within NHS 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 STPs.

There are two major arms to all the STP plans, a) to move care out of hospital into the community, and b) to save money and eradicate the deficit.

The capital cost of all the plans has been estimated at £10bn. However, the funding from central government is far lower.

pennies

In order to contain costs many STPs are proposing:

  1. The closure or downgrading of A&Es and minor injury units;
  2. The closure of community hospitals;
  3. A reduction in staff numbers and/or a change in the type of staff employed;
  4. Mergers between hospitals.

Details of individual STPs can be found on this website.

Most of the STPs contain little detail of how money will be saved, however in June 2017 leaked information from NHS England and NHS Improvement showed the type of changes that they could well be asked to make in order to bring spending down.  This is part of a new process for saving money known as the "capped expenditure process" introduced to control the spend of the worst performing health economies (CCGs) to bring them in line with the spending limit (control total) for 2017/18. Leaders in these areas have been asked to "think the unthinkable". Changes include:

  1. Ending funding for some treatments and prescriptions;
  2. Increasing waiting times for planned care;
  3. Selling NHS property;
  4. Closing wards and theatres and reducing staffing;
  5. Delaying the use of newly approved therapies.

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.