July 20, 2017

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Will STPs finally wreck the NHS? -

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Will STPs finally wreck the NHS?

NHS Leaflet

Sustainability and Transformation Plans (STPs) are the latest attempt, claim the Tory government, to improve the NHS.  But a more likely outcome is that they will finally wreck what remains of the publically owned NHS.

A new report commissioned by London South Bank University1 doesn’t pull its punches in answering the question on whether STPs will improve the NHS and the health service offered to us, the public at large.

The background to the report is that in late 2016 the 44 STPs, based on newly defined geographic areas of England, published their STPs setting out how health and care will be delivered within their local areas in the period from now to 2020/21. These plans are intended to bring about a radical transformation of the health care system in England and the report offers a critical review of all 44 STPs.

To deliver a better future for the NHS, the report’s authors argue that the 44 existing STPs for the NHS in England would need to be given the legislative powers and support necessary to achieve effective collaboration, plus some much-needed clarification on their role.

The report also recommends that STP leaders need to plan ahead based on the reality of their current situation, identify changes that are evidence-based, develop workforce plans that match their ambitions, and focus on reducing demand before removing resources from the acute sector. At present some elements of these recommendations are missing in all of the 44 published STPs.

Overall, this critical review reveals a distinct lack of comprehensive planning and evidence-based policy making by all of the 44 STPs. The plans are also not of sufficient quality to deliver the level, pace and scale of change said to be required for the future transformation of the NHS.

The report finds that none of the STPs are ready for implementation due to:

  • The funding shortfalls,
  • The lack of legislative framework to support collaboration across health and care,
  • The lack of clarity on the role of the STP and its leadership,
  • The challenge of collaborating across multiple organisations in the midst of coping with existing financial challenges,
  • The speed of planning that was required,
  • The failure to ensure engagement with local government,
  • The lack of clarity about accountability to citizens,
  • The failure to produce adequate business plans,
  • The lack of workforce plans (two thirds without any detail),
  • The lack of focus on reducing demand before switching resources away from the acute sector.

The authors propose that a viable business case must first be established in order to take full account of the proposed changes to the health and care system. This must ensure that sufficient staffing and adequate capital are made available to establish new services and prove their effectiveness, before existing services are reduced. The STPs need clarity on their accountability and authority, and legislative change to enable collaboration.

Co-author of the report, health economist, Seán Boyle said: “The health and care system needs time to develop partnerships, and a legislative and accountability framework that fosters collaboration.

That is why this report recommends a constructive overhaul in each of the 44 STPs looking at the appropriate framework for that work in terms of geographic area and what parts of the health and care system should be involved including the stakeholders for that area of work, the partnership agreements required and the accountability to the population of the proposed changes.”

Professor Rebecca Malby at LSBU’s School of Health and Social Care, who commissioned the report said, “There is an acute need for the evidence base supporting the case for change in each of the 44 STPs within the NHS to be substantiated further before the service commits to launching plans for widespread ‘transformation’. STPs also need time to clarify and develop their leadership function – moving from a top down command and control approach to a planning and enabling approach.”

Professor Warren Turner, Dean of LSBU’s School of Health and Social Care said: “Faced with tightening financial pressures on the NHS and social care the weakness or absence of serious workforce plans means there is little reason to believe that these ambitious reductions in demand and pressure on acute services will be achieved in the timescale proposed.”

The message from the professionals can be more impolitely said to be that this is yet another ill thought out and underfunded Government attempt to reduce expenditure on the NHS and when it all goes wrong blame the 44 STPs.

The NHS is shell shocked from the continuous government reorganisations of the NHS. All are allegedly meant to make the NHS more efficient, all involve the private sector, all end up over budget and all deliver a worse service than previously.

http://www.lsbu.ac.uk/__data/assets/pdf_file/0019/114409/sustainability-and-transformation-plans-critical-review.pdf

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