‘Sustainability and Transformation Plans’ have failed at the local level. Now Hunt wants them to go national
A postcode lottery of care, a lack of strategic leadership, trusts continually running at a deficit; these are the hallmarks of the National Health Service under this government.
They are the consequences the healthcare world warned about ahead of the disastrous 2012 Health and Social Care Act. There was a manifesto commitment to ‘cut the deficit, not the NHS’, but both of these promises were broken. We are now living with the consequences.
It is no surprise that in the fragmented chaos of NHS structures that exists today, new proposals are being brought forward to try and fix an increasingly damaged system.
But the so called ‘Sustainability and Transformation Plans’ (STPs) will offer little comfort to healthcare professionals, patients or the public.
It is all too familiar to North West London, as we’ve been here before. Back in 2012, the eight North West Clinical Commissioning Groups (CCGs) collectively launched ‘Shaping a Healthier Future’ (SaHF). It is clear now that this was the template for the STPs of 2016.
It promised massive investments in community based care, financial stability, and greater integration of health and social care. It also promised that the quality and performance of the NHS locally would improve. To achieve this, some reconfiguration of hospital services would be required.
Fast forward to today and the fears of the residents who campaigned alongside local councils, who fought these plans through the courts, have been realised.
Closure of acute services, like the Hammersmith and Central Middlesex hospital A&E, has placed such pressure on neighbouring hospitals that all but one failed to meet crucial waiting time targets.
Further cuts to hospital beds, closures of maternity services, and of children’s wards have been implemented while the promised investment in new facilities have been put on ice.
When the NHS’s Independent Reconfiguration Panel was asked to take a look at the plans, their assessment was clear. Health bosses behind SaHF spent far too much time, energy and money telling the public that their plans were achievable, while spending nowhere near enough time, energy or money on engaging local communities to help shape and design the services they need.
The lesson has not been learnt. Across England, 44 ‘footprints’ have been tasked with drawing up STPs at breakneck speed. Instructed by national NHS bodies to keep their plans secret for fear of the public’s reaction – even the very healthcare professionals tasked by the government to take ownership of the NHS are in the dark.
A recent survey by the BMA of London’s GPs revealed that 53 per cent hadn’t even heard of STPs, while 87 per cent hadn’t been consulted on their content.
Local councils are not happy. They are grappling with year on year budget cuts from central government, while attempting to address the growing crisis in adult social care.
With money on the table for integrated health and social care through STPs, many are nervous that they are being asked to be complicit in hospital cuts and closures in order to plug that funding gap.
With Ealing and Charing Cross hospitals earmarked for cuts, both Hammersmith & Fulham and Ealing Council are not giving in easily: they have refused to sign their local STP.
Despite the dangerous situation of growing demand but reduced resources, the government are yet again trying to squeeze even more out of an already overstretched and underfunded NHS.
STPs are a solution to a problem the government created, and are doomed to failure. But there are alternatives.
Through serious action on tackling often avoidable conditions like diabetes, cancers and lung disease, the NHS could reinvest the billions saved into treating the most complex of conditions.
If the government reversed its continuous cuts to local authorities, councils could provide more community based services meaning fewer people would need to spend time in hospital.
By funding for new medical technology, the NHS could shift toward more cost effective alternatives, without making waiting times and treatments worse before they get better.
These solutions may be a little harder to achieve, and cost a little more in the short term. But there are no longer any easy options, and sensible funding decisions now will save us billions in the future.
We need long term investment and a significant shift to preventative measures if the NHS is to meet the modern, changing, health and care needs of our country. Sustainability and Transformation Plans will achieve anything but.
Dr Onkar Sahota is Labour’s London Assembly Health spokesperson and a practicing GP in West London.