There’s many a slip ’twixt the cup and the lip. This proverb came to mind when I was first reading about sustainability and transformation plans (STPs). The use of sustainability and transformation in the same sentence is an oxymoron because you cannot sustain and transform without change.
The plans have been drawn up behind closed doors and are not even accessible by Freedom of Information Act requests. In some places they don’t have all the providers represented, such as GPs. They were supposed to be approved by NHS England by the middle of October.
Some of the plans involve large-scale reorganisations and the shifting of work and resources into the community. The plan is to move at least 25% of activity into the primary care sector and achieve financial balance and stability by 2020/21. This is supposed to be planning by place instead of by organisations, and there are 44 footprints across England.
In the summer edition of The Commissioning Review, Professor Colin Leys pointed out - very eloquently - that the STPs have no legal basis. Each individual organisation still has sovereign responsibility and remains legally accountable for delivery of the plans if they are adopted formally. It will be interesting to see how these organisations will come together and share their financial problems, particularly when some have huge deficits. The plans are also not co-terminus with the health and wellbeing boards and I am not sure that local government will be able to sign them off if they conflict with their own plans.
The problem is, all the plans are based on assumptions and extrapolations of previous pilots. There was a recent announcement of a reduction in A&E attendances by 26% in Greater Manchester with a saving of £768,000, as a result of the seven-day GP access scheme. What was not highlighted was that the scheme cost £3.1 million to implement. Also, it would be very difficult to disentangle set-up costs from running costs to see if the savings in A&E could be maintained.
As a society, we need to come up with a collective solution for how to care for people in their homes. It may mean a new local health and care tax, where the local government is held accountable to deliver health and wellbeing for the public they serve.
NHS England chief executive Simon Stevens said recently: “There’s arguably no more important job in modern Britain than that of the family doctor”. Sadly, the last 10 years of underinvestment, increasing demand and complexity and constant denigration in the press has left the profession on its knees. The success of the STPs relies heavily on the ability of primary care to change the delivery of care. This will require huge efforts on behalf of the whole system to change as well.
The NHS must get back to its founding principles. It must be national, not a postcode lottery because of flawed allocation formulas. It must be focused on health – with prevention and self-help, not just about curing illness. It must be a service, not a competitive business with profit and loss. The STPs can succeed if everyone agrees to work to those objectives, but the proof of the pudding is in the eating. l