NHS reform: Why sustainability transformation plans could be dangerous

Across England, 44 ‘footprint’ areas are drawing up sustainability and transformation plans (STPs) for the NHS in their region. But east London GP and Socialist Health Association honorary vice president Dr Brian Fisher says the lack of transparency around the process suggests the plans may contain nasty surprises.

Another month, another redesign.

Integration is good, support in the community is good, making best use of hospital land is good – all for patient benefit, of course. The rhetoric is persuasive.

But STPs are likely to be dangerous. There are 44 of them across England, pulling together local authorities and CCGs in defining and developing a ‘place-based budget’, exploring areas of co-operation and synergy, trying to find ways of maximising capacity. It sounds great. And maybe it will be.

NHS funding

But STPs are driven by the Treasury. They are focused on reducing NHS spend. In south-east London, for instance, the STP has to bridge a £1.015bn gap in NHS funding over five years to 2020/21. Across the capital, councils face a £900m gap in social care funding to 2019/20.

Many places in the country are in worse shape, but unless STPs meet the funding demands of the Treasury, the plans will not be approved and areas will not receive any transformation money.

Examination of the plans so far suggests many areas where plans and the savings linked to them have heroic underlying assumptions. It appears that some figures are double-counted. The evidence underpinning the claims for benefit and savings are uncertain. Efficiency savings required from NHS trusts are punishing. It is only recently that, in south-east London, plans have actually acknowledged that social care is underfunded.

GP online 2 Aug 2016