Sustainability and Transformation Plan (STP): A Brief Summary

The Conservative Government is committed to a strategy of reduced state spending in the public sector (welfare, health, education) and the marketisation (privatisation), where possible, of public services. The Health and Social Care Act (2012) forced the Clinical Commissioning Groups which purchase health services locally to do its purchasing on the open market. STPs are another top-down reorganisation of the NHS which forces it to deliver services on a reduced budget. STP means cuts. In official language they are described as efficiency savings.

Nationally the NHS has to save £22 billion between now and 2020. To deliver these savings the country has been divided into 44 footprints. Our local footprint is the BOB (Buckinghamshire, Oxfordshire, West Berkshire) and here the NHS has to save £479 million.

Cuts to services
To achieve these savings, there are planned cuts to services:
• community hospitals will be closed
• beds at the John Radcliffe will be reduced
• the Horton Hospital in Banbury will become a day hospital

Other savings will be made in the following areas:

Workforce savings
The plan is to save £34 million on workforce costs.
– a smaller workforce that can be flexibly employed across the BOB
– a reduction in skill levels: reduction of nursing grades and increased use  of healthcare assistants
– recruit staff from outside the UK
– standardise pay and conditions across the BOB area

Since they are unlikely to achieve this saving through the employment of lower grade staff, it will have to mean a significant cut in staff relative to need. Without the planned efficiency measures, the STP document estimates that workforce numbers would need to increase by 4,527 (whole time equivalent) by 2020/21 to meet increased need. The STP plan would see an increase of just 978. This would be an effective reduction relative to the greater need.

Savings from working ‘at scale’
This would mean delivering services at fewer sites covering larger areas.
GP services will be reorganised in locality ‘hubs’ serving populations of 80,000 to 200,000
one central commissioning body will purchase services for the whole BOB area
specialised acute services (cancer treatment, complex surgery, etc) will be centralised in the larger hospital trusts

Savings in ‘specialised services’
The plan is for savings of £60.2 million in commissioning of specialised services (these are services usually found in larger hospital trusts such as dialysis, special cancer treatments, genetic disorders). It is unclear from the document what this would entail.

Savings from shifting patient care from acute services to primary care and social care
The plan here is to shift health care as much as possible from the expensive hospital sector into the community, to GP services, social care, and ‘self care’.
– ‘more care provided closer to home through strengthening the availability of services available within primary care’.
– ensuring that ‘patients, their families and carers are empowered to take more control over their own care and treatment’.

The problem here is that that both GP services and social care are in crisis. And this crisis is basically a product of underfunding. Without a dramatic increase in investment in social care, it’s hard to see how the social care sector could cope with increased demand.

Savings from sale of property
The document suggests that extra funds for the NHS could be had from property sales. There is no information on which property or the amount of capital anticipated from these sales. The suspicion is that community hospital sites could be sold off. The document speaks of ”community hospital buildings which require repair and are not fit for modern needs’.

Savings from ‘lower cost of services procured’
The plan promises savings from: ‘reduced CSU, CCG & Trust management time required and lower cost of services procured.’ It’s difficult to see how reduction in ‘time required’ for existing management of CCGs and hospital trusts on fixed salaries could produce savings but what is interesting here is ‘lower cost of services procured’. This has traditionally been a signal for procurement from private providers.

STP structure
At the top of STP are Trusts and Clinical Commissioning Groups (CCGs), Health and Wellbeing Boards, Local Authorities, NHS England, NHS Improvement.

Then comes the STP Oversight Board consisting of: CEOs of CCGs, NHS Trusts, Local Authority representatives, CEO of Academic Health Science Network (AHSN), Head of Health Education England, NHS England, NHS Improvement, Healthwatch, AgeUK, Fire service, Police

Below that is the STP Delivery Board involving AHSN, STP Lead, Finance, NHS England, NHS Improvement, Local Authorities and the three local system leaders (Stuart Bell, Neil Dardis, Cathy Winfield).

CCGs: A Commissioning Executive across the 7 CCGs in the BOB area has been established to improve commissioning efficiency further and support delivery of the STP plan. The Executive will initially focus on specialised commissioning, ambulance services, 111, mental health, and cancer.

Although statutory bodies are listed as being at the top of the STP structure, it must be noted that local authorities have not really functioned at that level. For instance, members of the Oxfordshire County Council’s Health Overview and Scrutiny Committee (HOSC), whose duty it is to scrutinise ‘substantial changes’ in the health service, were completely in the dark about the actual contents of the STP.

Constitutional Powers of the Health Overview and Scrutiny Committee
‘Under Regulation 4 of The Local Authority (Overview and Scrutiny
Committees Health Scrutiny Functions) Regulations 2002 a NHS body must consult the Committee, where it has under consideration any proposal for a substantial development of the Health Service or a substantial variation in the provision of such service…

The Committee may report to the Secretary of State in writing where it is not satisfied that: consultation has been adequate in relation to content or time allowed. …

Where the Committee considers that any proposal would not be in the interests of the health service in Oxfordshire, it may report in writing to the Secretary of State who may make a final decision on the proposal….’

What we object to in STP

1. Secrecy: STP involves a massive reorganisation of healthcare which was formulated in secret with no input from local authorities, GPs, patients, or public. At the same time, bodies with a heavy bias towards ‘public-private partnerships’, such as the Academic and Health Science Network, have been very influential in the preparation of STP and are involved in the leading its implementation.

2. It means cuts in services at a time when it is recognised that there is a growing need for healthcare services. There are cuts to community hospitals, hospital beds, and specialised services.

3. Reductions in healthcare staff in the face of increasing need.

4. Reductions in the quality of care through the reduction in nursing grades and increased use of healthcare assistants.

5. Absence of meaningful consultation with patients and the public and even failure to communicate STP information to the local authority’s Health Overview and Scrutiny Committee which has the legal duty to scrutinise any ‘substantial development’ or ‘substantial variation’ in health services.

6. Shift of hospital services to GPs and social care at a time when these are in profound crisis due to underfunding.

7. Centralisation of services in big hospital trusts and community hubs which move services further away from patients.

8. Dramatic increase in the acceptable norms for home-to-hospital
ambulance time. The document claims that ‘96.1% of the population is within 60 minutes’ drive time of acute services’. Patients in Banbury would have to be taken over 25 miles to the John Radcliffe. The STP document estimates that this would take 41 minutes.

See the short video: Sustainability or Cuts? A short video on STP by Community Glue

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