STP Watch

Stephen Hawking on STPs

‘Further evidence that the direction is towards a US-style system
is that the NHS in England is undergoing a complete
reorganisation into 44 regions with the aim of each being run as
an “accountable care organisation” (ACO). An ACO is a variant of
a type of US system called a health maintenance organisation (HMO) in
which all services are provided in a network of hospitals and
clinics all run by the HMO company. It is reasonable to expect the
powerful US HMO companies such as Kaiser Permanente and
UnitedHealth will be bidding for the huge contracts to run these
ACOs when they go out to international tender.’
Stephen Hawking Challenges Jeremy Hunt: The Complete Dossier

Over 200 People in Oxford signed this petition to the County Council’s Health Overview and Scrutiny Committee on Saturday 19 August.

Petition to the Oxfordshire Joint Health Overview and Scrutiny

We entreat you to reject phase 1 of the Oxfordshire Transformation Programme because:
 It entails closing hospitals and health facilities that belong to us
 It will give the people of Oxfordshire a poorer, cheaper service than they had
 It will lead to overcrowding and longer waits at the JR and Churchill
 It will make things even more difficult for those without transport, and those
living alone
 It is based on the false idea that the government must cut funding to the NHS
(funding can be found and taxes for the rich raised).
Please demand that Phases 1 and 2 be consulted together, and agreed with West
Berkshire and Buckinghamshire across the whole STP population.

The following letter was sent by Oxfordshire KONP to Party Leaders on the County Council in August:

Dear County Council party group leader,

Oxfordshire Transformation Plan Phase 1: A failure in the County Council’s accountability?

In a letter of 3 April to the chair and chief executive of OCCG, Cllr Michael Waine, County Council chair, wrote:

As you know, Cabinet were not supportive of the proposals. Full Council went further and indicated their strong opposition to the proposals and rejected the consultation.


Full minutes of County Council 21 March 2017]

However, on 7 August the county’s Health Overview and Scrutiny Committee decided, as we understand it from notes taken at the meeting (there are no minutes yet available):

  1. To support the proposals on critical care subject to assurances that there will be no knock-on effect at Horton General Hospital
  2. To support the permanent closure of 110 beds already but not to support any further closures until they see the impact of these on phase two proposals and impact on all of our community hospitals
  3. Not to support the proposals on planned care services at the Horton at present

because there is no detailed plan, there is a vision. The proposals needed to be fully thought out and fully costed. The CCG was invited to come back when they had a fully developed proposal and detailed plan.

  1. On maternity services, if the CCG was minded to approve the downgrade recommendation on Thursday, the HSC would refer the matter to the Secretary of State.

Acceptance of permanent bed closures

Referral of the Horton maternity services is in hand. The news of the HOSC’s vote to accept permanent bed closures has not gone down well with the public. One health worker in accident and emergency at the John Radcliffe, said:

This is just awful. Working in A&E is particularly difficult, and has been all year. We often have significant nursing and medical rota gaps, and long waiting times. Despite it being August, every shift has patients on trolleys in the corridor, with the time waiting for a bed over 12 hours. Resus [ward], built for 4 patients regularly has 6-7. For patients requiring level 3 care, mothers and babies requiring obstetric care and stroke patients to have to travel from the Horton will definitely put lives at risk.

‘We are not coping, and when I ask managers about winter planning I get a shrug of the shoulders…’

At the full Council meeting in March, councillors

discussed the Oxfordshire transformation proposals in the wider national context of significant financial challenge for the NHS and social care. They wanted to emphasise that they understood that the situation the CCG is facing is a result of national policy. The rising demand for health services and lack of funding to address this was a huge national issue which was being played out locally to the detriment of services for local people.

Members felt that the consultation did not make clear the impact on social care and there was a lack of modelling to accurately assess this. It was felt that the proposals would benefit from a workforce plan setting out how the impact on carers would be managed. It should not be assumed that county council services would be able to absorb the impact of the changes on social care. It was also noted that the care sector is financially very fragile as recent examples of agencies becoming insolvent shows.

Members expressed frustration that no options for alternative delivery options were presented in the consultation. Some members felt this implied a ‘fait accompli’ as no alternative future arrangements were presented for consideration. It was also unacceptable to expect proposals for substantial bed closures to be agreed without any detail about proposals for the future of services in the community. These would be vital to support changes in the acute system.

The concerns expressed by the full Council were ignored by the CCG representatives in their contributions at the 7 August HOSC meeting. The national funding context has not improved. The suggestions made by the Council were not taken up by the CCG. We are concerned that the Committee has failed in its duty to defend the interests of the public in the county.

Given the stance adopted by HOSC and the go ahead decided by the CCG board, where does that leave the County Council, given its stance to date on the OTP phase 1?

Yours sincerely,

Gus Fagan, acting chair, Oxon Keep Our NHS Public

KONP Address to the County Council’s Health Overview and Scrutiny Committee on 7 August 2017

Address to HOSC 7 August meeting on Oxfordshire Transformation Programme

 I’d like to present a petition signed by members of the public opposed to these plans to your committee for consideration and action.

 In addition, I‘d also like to draw your attention to firstly the derisory amount of time allowed by OCCG for the scrutiny of critical papers for Thursday’s Board meeting, and for the submission of written questions. A sure sign of an organisation intent on steamrollering its way through to Phase 2.

 However, it is evident that the decision-making business case is deeply flawed and illconsidered. Although appearing to offer much, closer examination reveals false assumptions, unrealistic provisos, glittering but hollow inducements, and flimsy mitigations. It starkly fails to provide solutions to address serious funding issues, chronic and enduring workforce pressures, valid travel, journey times and parking concerns, or the problems of providing a safe, reliable and well-resourced ambulance service. All essential components of a business case setting out to justify substantial change. But notably absent here.

 On the issue of funding, the business case does nothing to reassure us that the Hospitals Trust (already in deficit) would have the necessary finances to implement much trumpeted service improvements. It would have to raise multi-millions in additional capital for the promised ‘enhancements’ to planned care at the Horton- adding to an already massive PFI debt of nearly two and half billion pounds. It’s also likely to lose the million pounds or so it’s been paid for providing obstetric services at the Horton. And counting on some funding from the meagre Sustainability and Transformation Fund to solve its difficulties, may not be

 But there’s more. One of OCCG’s key proposals – and cost-cutting devices –to shift care from acute hospitals to the community – is now in jeopardy. Significant reductions to DTOC numbers have failed to materialise, with the Trust currently being investigated by the regulator. Alternative services, part of the justification for closing beds and predicted to create huge savings, have actually added to the costs – to the tune of an extra 1.6 million pounds! Not surprisingly given that quality care requires secure, long-term investment, and is not likely to deliver ‘savings’ – points made repeatedly by the independent King’s Fund and the Nuffield Trust.

 The continuation of the Discharge Liaison Hub, Hospital at Home service, HART, and ambulatory care provision is now in doubt. Shamefully, OCCG is using this to pressurise the Board to approve the permanent closure of 110 acute beds.
 On the issue of workforce, although the business case acknowledges local difficulties and insufficient numbers of domiciliary staff to carry out its plans, it makes an unwarranted assumption that adequate numbers, including medical staff, will somehow materialise – prepared for additional training, cross-site travel, and greater role flexibility.

 Other assumptions in the business plan rest on the capacity of the ambulance service to deal with increased journey times and 999 calls, an assumption which should have been closely questioned, given the resource difficulties already faced by the service.

 In conclusion, it is all too apparent that the business case and supporting papers fail to counter previous grave misgivings expressed by this committee, and others. The OTP is undeliverable within current funding and workforce constraints, and is not in the best interests of the people of Oxfordshire, especially the most deprived and vulnerable. We urge you:
1) To recommend to the OCCG Board that it rejects the recommendations for Phase 1 of the OTP;
2) To refer Phase 1 of the OTP to the Secretary of State for Health

Interview with Dr Bob Gill – harsh truths about the NHS

Final Address to Health Overview and Scrutiny Committee on Clinical Commissioning Group’s Resoponse to HOSC Concerns, by Joan Stewart, Oxfordshire KONP, 6 April 2017
Report on the Sustainability and Transformation Plan for Leicester, Leicestershire, and Rutland, Footprint 15, by Dr Sally Ruane, Health Policy Research Unit, De Montfort University, 6 March 2017
Letter to Members of Health Overview and Scrutiny Committee from Oxfordshire KONP, 6 December 2016
 Sustainability or Cuts? A short video on STP by Community Glue
Sustainability and Transformation Plan: A Brief Summary, 6 Dec 2016
The Sustainability and Transformation Plan (STP) for Buckinghamshire, Oxfordshire and Berkshire West (BOB) has been published and may be read or downloaded here. 17 Nov 2016
NHS transformation Plans May be Used as Cover for Cuts, Says BMA, 21 Nov 2016
Government quietly privatises the NHS’s in-house agency staff provider, 20 Nov 2016


A Brief Summary of the STP document, 17 Nov 2016
Explanation of Sustainability and Transformation Plans (STPs)
October 2016
Email to Oxfordshire County Council about STPs, 19 October 2016

Dear Councillor

We are attaching a briefing on Sustainability and Transformation Plans (STPs), which you may find useful.

As you will no doubt be aware, these plans have been hastily produced behind closed doors, and remain secret, with access denied to MPs, councillors and the public. The STP produced for the Bucks, Oxfordshire and Berks West (BOB) footprint, or grouping of 7 CCGs, 6 foundation and NHS trusts, and 14 local authorities, is no exception.

This means that you, as one of our elected representatives, will not be able to raise any concerns you may have about the massive restructuring that will impact health and social care services in the county, until the full plan is published, rumoured to be by the end of November. By which time, the detailed plan will have been evaluated by NHS England to test compliance with rigorous directives, and will have demonstrated where it will make the required ‘efficiency savings’ – or cuts.

Cuts that will have a drastic and permanent effect on our health and care services, hospitals and workforce. Oxfordshire Clinical Commissioning Group will also have set its operational plans and agreed provider contracts by 23 December, leaving insufficient time to scrutinise the full plan adequately.

We call on you as our elected representatives to demand a full debate in council; make clear your opposition to the STP programme and the failure to publish detailed proposals before the plans are irreversible; organise public meetings to express your concerns about the undemocratic process being forced on the public in Oxfordshire; and widely publicise the details of the proposed cuts and changes to local healthcare services.

With best wishes
Oxfordshire Keep Our NHS Public

Protest Email to Oxfordshire County Council

Join the campaign to get Oxfordshire County Council to publish the Sustainability and Transformation Plan that will have a huge impact on healthcare services in Oxfordshire, and pave the way for further privatisation of the NHS.

Join the lobby of the County Council Health Overview and Scrutiny Committee to call on councillors to publish the secret Sustainability and Transformation Plan in full and for full public consultation before contracts are signed with healthcare providers.

9.15 outside County Hall, New Road, Oxford on Thursday, 17 November

Please write or email the letter below to your local county councillor (councillor details here:

Dear Councillor
I am writing to ask you to stop the Council from rubber stamping both the
Oxfordshire Transformation Plan and the wider ‘Footprint’ Sustainability and
Transformation Plan (STP). STPs are being drawn up in conditions of secrecy
imposed by the government’s quango, NHS England, and will accelerate NHS
cuts and privatisation.

Sustainability and Transformation Plans were submitted to NHS England on
21 October, and contracts for NHS services to be delivered through the STPs
in the next two financial years have to be signed on 23rd December.

Julia Simon, who recently quit as head of NHS England’s commissioning
policy unit and programme director for co-commissioning of primary care, has
warned that forcing health and care organisations to come together so quickly
to draw up these complex plans is likely to backfire. She said that, up against
tight deadlines, organisations were likely to make unrealistic financial
forecasts and claims about benefits to patient care, “and then you have a lot
of lies in the system about the financial position, benefits that will be

At the very least, these plans should be subject to proper scrutiny in our
Council and Joint Health and Overview Scrutiny Committee. But by allowing
these STPs to be developed without public, parliamentary or councillor
scrutiny, and simply rubber stamping them in OCC, without proper knowledge
or understanding of what they contain, I fear the Council will fail to carry out
due diligence in protecting the NHS on behalf of the public.

Years of de-funding the NHS means hospitals, GPs and community health
services are struggling to provide safe and effective services; chronic
government under-investment in training has resulted in staff shortages that
provide a major threat to the future of a publicly-funded NHS.

With the imposition of Sustainability and Transformation Plans, NHS
Improvement – the NHS regulator – has instructed NHS organisations to list
services which could be axed or centralised, and to make ‘rapid progress’ and
‘quick fixes’ during the current financial year. This will have a massive impact
on services in Oxfordshire.

Statements from NHS England and the NHS Confederation – the organisation
that represents the interests of private health companies working in the NHS –
show how STPs are the vehicle for accelerating the privatisation of the NHS.
The secrecy shrouding the STPs is an abuse of our democratic rights. It is
being met throughout England with protests at Health Overview and Scrutiny
Committees, Health & Wellbeing Board meetings, Clinical Commissioning
Group meetings and the offices of NHS England – all which have a role in
developing the Sustainability and Transformation Plans.

Sutton Council has published the STP for SW London, claiming that
prevention has ‘provoked concerns about their content and the process
around development’. Every day, more and more councils acknowledge their
responsibility to their constituents by publishing their area’s STP.

Will you as my elected representative urge OCC to publish the full BOB STP
immediately, to allow the public to assess the effects of the proposed plans on
our healthcare?

Kind regards


STP: Healthwatch Oxfordshire Appeal against refusal of Freedom of Information request,  18 October 2016

Healthwatch Oxfordshire has lodged an appeal, following the refusal of
its request to Oxfordshire Clinical Commissioning Group under the
Freedom of Information Act for details of the Buckinghamshire,
Oxfordshire and Berkshire West Sustainability (BOB-STP) plan.

Healthwatch Oxfordshire requested copies of both the initial and current plans
submitted to NHS England.

Healthwatch Oxfordshire made these requests after concerns that too little
information is being made on possible changes in the way health and social
care if provided in the future. We are particularly concerned that NHS
England has asked for the submission of plans on a confidential basis and
has set a timescale that does not allow sufficient time for public involvement.

However, the response from Oxfordshire CCG said that it “was not in the
public interest” to release the information. The response added that “releasing
this information into the public domain at this time would be likely to, inhibit the
ability of public authority staff and others involved to express themselves
openly, honestly and completely, when providing advice or giving their views
as part of the process of deliberation in the future planning and decision
making as part of the agreed STPs. The inhibiting of the provision of advice or
the exchange of views may therefore impair the quality of decision making by
the public authority.”

Oxfordshire Clinical Commissioning Group will have 20 days to respond to the

KONP Press release: 6 October 2016
Oxfordshire health consultation a sham

Campaigners from Oxfordshire Keep Our NHS Public today criticised the decision of the body responsible for buying health services on our behalf for completing contracts before consulting the public and patients on a controversial plan that will mean service cuts, and department and hospital closures across the county.
By the time the formal consultation process on the Sustainability and Transformation Plans (STPs) begins in January 2017, the Oxfordshire Clinical Commissioning Group (OCCG) will have already had its currently secret plans passed by its controllers – NHS England (NHSE). If the plans are not approved, then it will be deprived of Transformation money allocated by NHSE to fund the service improvements it hopes to deliver. By January 2017 OCCG will also have completed its two-year operational plans and agreed contracts with service providers.

A necessary process undoubtedly, but one that cannot be said to support proper
consultation, which to be meaningful must allow the possibility of the public having the opportunity to make changes. Chair of the House of Commons health select committee, Dr Sarah Wollaston, has stated that: ‘The lesson we learn from every major reorganisation has been that if we take local people with us on the journey, and on the thinking behind it, it is much more likely to be successful. We should not see genuine local consultation and engagement as an inconvenience but as something that improves the eventual plans.’

Julia Simon, until earlier this month the head of NHS England’s commissioning policy unit and its co-commissioning of primary care programme director, warned ‘forcing health and care organisations to come together so quickly to draw up the complex plans was likely to backfire. Up against tight deadlines, organisations were likely to make unrealistic financial forecasts and claims about benefits to patient care.’ Ms Simon added: ‘Everyone will submit a plan, because they have to. But it means there is a lot of blue sky thinking and then you have a lot of lies in the system about the financial position, benefits that will be delivered – it’s just a construct, not a reality.’

Chair of Oxfordshire Keep Our NHS Public, Dr Ken Williamson, said: ‘When even a former member of NHSE speaks out against the secrecy and pace of the Sustainability and Transformation Plans, we are right to be suspicious and to question whether these plans are less about improvements to patient services and more about continuing to severely defund the NHS, secreted within the Trojan horse of ‘cost-efficiencies’.

Contacts: Dr Ken Williamson, Chair of Oxfordshire Keep Our NHS Public, Mobile: 07831570936
Bill MacKeith, Secretary of Oxfordshire Keep Our NHS Public 01865 558145;;

KONP press release: 27 September 2016 
Secret Plans for Oxfordshire Still Under Wraps

The body that has agreed to cut £9.7 million from local health services, but has yet to admit where the axe will fall, now refuses to reveal its involvement in secret government plans that could see further threats to patient care in Oxfordshire.

Oxfordshire Clinical Commissioning Group (OCCG) continues to stall by not answering direct questions put by campaigners Oxfordshire Keep Our NHS Public, and by its repeated delays in responding to an information request from our local Healthwatch, challenging the secrecy of the plans.

And the local Health Scrutiny Committee, which has a public duty to ask searching questions about significant changes to local health services, has once again failed to see this blueprint, officially known as a Sustainability and Transformation Plan (STP), which will impose further drastic cuts on local health and social care. Leaks of STPs from other parts of the country reveal planned cuts that will see more GP practices closed, community services reduced or removed altogether, hospital wards and whole departments downgraded or axed, beds permanently lost, A&E threatened, and staff terms and conditions weakened. The tell-tale signs are already visible throughout Oxfordshire, with the downgrading of maternity services at the Horton, GP practice closures in Witney and Bicester, and hospital and community beds no longer available.

Chair of Oxfordshire Keep Our NHS Public, Dr Ken Williamson, said today: ‘That the public is being prevented from seeing these secret plans until the end of the year is shocking. It isn’t good enough to say that the plans have to have government approval before the public can comment on them. By Christmas, these plans will be a done deal, and any consultation will be a cynical PR exercise, and totally meaningless. These plans (STPs) are being imposed by central government as part of a massive de-funding of our National Health Service, deliberately starving it of much-needed investment. Chomsky said that the standard technique of privatisation was: “defund, make sure things don’t work, people get angry, hand it over to private capital”. They want the NHS to fail. They want people to get angry. All the easier to introduce co-payments and private health insurance.’

Contact: Dr Ken Williamson, Chair of Oxfordshire Keep Our NHS Public, Mobile: 07831 570936  Bill MacKeith, Secretary of Oxfordshire Keep Our NHS Public 01865 558145; ttps://; @keepNHS_oxon

Editors’ Notes
Keep Our NHS Public was formed in 2005 and has a broad-based, public membership. There are 65 local groups, plus a national association. It has the explicit aim of countering marketisation and privatisation of the NHS by campaigning for a publicly funded, publicly provided and publicly accountable NHS, available to all on the basis of clinical need. It is opposed to cuts in service which run counter to these principles. Further details of national organisation:

Statement on STPs from the Birmingham Conference of Health Campaigns Together on 17 September 2016 
NHS Cuts Planned Across England, BBC, 26 August 2016
Colin Leys, Can Simon Stevens’ Sustainability and Transformation Plans save the NHS?  28 July 2016
Birmingham Conference on STPs, 17 September
 Sustainability and Transformation Plans (STPs): A new threat to local NHS care, 28 July 2016
 Andrew Smith MP, Parliamentary Questions on STPs, with Response from Department of Health, June 2016
 Sustainability and Transformation Plan (STP): A formula for cuts and privatisation, by John Lister, 2 April 2016