Sustainability and Transformation Plans/Partnerships

What are they?

In 2016 plans were drafted in every area around the country laying out major changes to how services will be organised over the next decade.

Called Sustainability and Transformation Plans (STPs) they attempt to find solutions to the pressures on the NHS, but controversy quickly followed their publication as in many areas they contained cuts to services and staffing.

A key public concern is that the plans are not realistic and are undermined by a lack of resources and by the government's requirement to remove all local financial deficits.

Eventually the Government wants to integrate services and create a new lead organisation in each area (Accountable or Integrated Care Organisations), a plan which has already proved controversial.  Legal action from campaign groups prompted a pause for further consultation.

In October 2018, the chief executives of NHS England and NHS Improvement wrote to all STP leaders instructing them to come up with new five year STPs by autumn 2019. The new five-year plans will replace those which were drawn up in 2016 based on the five-year funding settlement to 2020-21. The new five year STPs will be developed based on a new NHS England budget to 2023-24 and the new NHS long term plan.

Find your STP

 

What's in the plans?

Most of the plans start by discussing strategy and new solutions, but financial restrictions seriously restrict what they can propose. For instance all the plans say that they want to prevent more illness, but are very limited in what they can do due to cuts to public health budgets.

All the plans share some common ideas, such as moving more care away from hospitals and into the community and getting services to integrate with each other. Many areas propose ways for GPs, community nurses and social care to work more closely, but these ideas to expand community care cannot be funded and have been estimated to cost £10bn.

A key condition imposed upon Local planners is they cannot access further pots of  government funding unless their plan will return local finances to surplus. This is a huge task as many carry deficits. It helps to explain why so many of the plans contain closures, mergers and cuts in services.

Most areas are taking steps to reduce some hospitals services by:-

  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.
  5. Targets to close acute beds
nhs-hospital-health

Summary of views

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

What will this mean for staff and patients

The impact will vary across the country, some benefits will emerge from integrating services, but the pressure on services will grow unless capacity in both health and social be raised. The STPs do not address the huge problems with recruiting, retaining and training staff.

Details of individual STPs can be found on this website.

Patients are already experiencing the impact of steps being taken to remove financial problems.

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

 

What's the end point of the changes?

The government has stated that it wants one organisation in each area to take control of providing all care. That organisation will work under a contract and a fixed budget, creating what was called an accountable care organisations, although this name has already been changed after the idea proved highly controversial and was linked to the US insurance model.

Concerns around ACOs are that:-

  1. the new system will not be funded properly and will lead to more cuts
  2. private firms will expand their control as part of the erosion of NHS based care and lead to an insurance based system.
  3. it is all too rushed, not evidence based and staff and the public are not being properly consulted

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

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.