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At the heart of general practice since 1960

Secret plans on which the fate of the NHS rests

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It can be very hard to keep track of all the three letter acronyms in the NHS. Most are not worth worrying about, but this is one you should remember.

The health service will live or die at the hands of the STPs

STP. These three letters signal a quiet revolution in how the health service is run and they hold the best hope of saving it.

Everyone agrees that the NHS is at breaking point. The whole system is creaking and lurching towards the ICU. Trusts are tumbling further into the red. General practice is convulsing. A&E departments are full to bursting. Hoist by its own petard of a Five Year Forward View, the whole service has at least £22bn of efficiency savings to deliver in return for the £8bn given by the Chancellor. And those figures are looking very conservative.

But radical plans – due to be submitted to NHS bosses by the end of this month – are meant to put the whole service back on the road to recovery. These ‘sustainability and transformation plans’ (STPs)* mark a massive shift in the way the NHS in England is run.

STPs will finally skin the competition-crazed, fractured cat let loose by Andrew Lansley. The NHS has ditched the Health and Social Care Act 2012 and rewound around 20 years, with the return of regional health authorities. 

The internal market is bust. The traditional separation of commissioner and provider shattered. The reliance on competition to drive up standards subtly binned.

England has been sliced into 44 new areas and CCGs, local authorities and foundation trusts told to sit around the same table within those ‘footprints’ to come up with an STP for their local NHS.

These massive cabals – some including as many as 12 CCGs – have been told to ‘return the system to aggregate financial balance’ as well as improving ‘quality and safety’, shoring up general practice and rolling out a seven-day NHS.

You may think that sounds like an impossible task, but they have no choice. NHS England has been clear that no area will get access to new funds unless they submit a convincing STP. There is no other game in town.

But you won’t see these STPs anywhere. They are not being published. Pulse has asked to see them, but have been told that we cannot until NHS England signs them off. 

And this is probably because they know that STPs will prove very controversial (indeed in North-West London they are already making headlines). They have been drawn up over six months with very little oversight or engagement with patients; the ideas in STPs are likely to be untested, probably based on flimsy ‘evidence’ and there is no sign of any independent evaluation of what they achieve.

Take the £35m savings this CCG says it is going to achieve by through GP ‘collaborative working’. This is – at best – fantasy economics, but will have drastic effects on the services patients can access on the ground.

LMCs are grumbling about the GP input into these plans; I counted that only four of the 44 areas have a GP leading the STP. They have no clear way of being enforced and are an attempt to paper over significant cracks between individual organisations that have very different concerns and no real compulsion to work together.**

You have to applaud the bravery of this move, but I wonder if they are going to be up to the job. Patients deserve much better organised planning of their healthcare, not the reorganisation by committee that is being rushed through now.

But Iet’s hope I am proved wrong. We are in last chance saloon territory for the NHS and general practice, and cannot afford yet another useless three-letter acronym.

The health service will live or die at the hands of the STPs. They had better be good. 

Nigel Praities is editor of Pulse

 

*Contrary to recent rumours, it does not stand for 'Sticky Toffee Pudding'

**Do read this recent paper from Professor Colin Leys at Goldsmiths into the STPs for a much better analysis of this issue than I could ever write.

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Readers' comments (20)

  • Well said Nigel! Our STP is Chaired by the CEO of the local trust appointed he says by NHSE CEO, so if that is not putting the rabbit in charge of the carrots... !! No conflict of interest there then? Where are the Health and Wellbeing Boards on this why are there new boards crossing over existing boundaries and who is accountable? Is this the last throws of a terminal, publicly funded, health service before being cast to global corporations to pick over the corpse and revive it as a private service??

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  • STP's are an oxymoron! How can you have sustainability and transformation in a negative sum game? There have to be losers to transform or the status quo is maintained. Costs go up but funding is flat and negative from the social care side so something must give. Clever accounting won't be able to hide the massive overspends planned. Trusts are already in debt and so are CCG's and the councils will not be keen to bail either out even though they are part of the problem and solution. Devo Manc will be the first big test of the new STP's and I predict there will be a health tax added to the council tax to help fund the shortfall as no-one will be brave enough to cut anything! Though today they are suggesting reducing from three hospitals to one!

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  • Another day,another "reorganisation".The politicos and administrators would do well to read that paper by Cleese et al on Avian Mortality .They might then acknowledge that we have an ex Health Service, it is no more, it has ceased to be.
    It does not take the brains of an archbishop to work out the end-point of Pulse's Practice vacancy study, so lets admit we chose the wrong paradigm, and see what we can adopt from other countries that have made it work.

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  • Vinci Ho

    If you read Colin Leys' analysis , STP is about mission impossible imposed through dictatorship and bullying :

    .''.....But how far these aims can be achieved by new models of service delivery that also reduce expenditure is open to serious question. The guidance makes it clear that saving money is now primary – as the King’s Fund puts it, the post-Francis era of concern for quality and safety is over. But STPs must also contain proposals for improving care; yet even the King’s Fund says that ‘It is inconceivable that the NHS will be able to achieve both financial sustainability and large-scale transformation within these financial constraints’.17 The demands made also sometimes seem absurd, given the limited powers and resources available at local level and the lack of a correspondingly serious policy at the national level (e.g. ‘What action will you take to address obesity, including childhood obesity?’). There are in all 60 such questions (including sub-questions).

    Moreover the idea that the diverse collection of local organisations and people who make up a ‘local health system’ can together produce– by the end of June – practicable plans that offer meaningful answers to even half of these questions seems so unrealistic as to almost make one wonder whether it is seriously meant. After all, ‘local health systems’ are not in fact systems. No legal or other structures link the organisations and individuals involved, there are no procedures for determining how disagreements are to be resolved, they largely lack planning expertise, and all the people who are expected to collaborate in producing STPs already have heavy workloads. And while the six organisations that have jointly issued the guidance (NHS England, NHS Improvement [Monitor and the NHS Trust Development Authority], Health Education England, NICE, Public Health England, and the CQC) presumably have the power between them to require the local NHS bodies concerned to do all the things asked of them, this does not apply to local councils, which are responsible for social care and are also included in the ‘local health systems’. Councils can no doubt be leant on by the Department for Communities and Local Government, but the whole process has a markedly extra-legal character....... ''

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  • Vinci Ho

    And love his Conclusion:

    Of course we are where we are, and perhaps sceptics will have a pleasant surprise, with the NHS emerging in 2020-21 transformed and improved, however unlikely it seems. But where we are is the result of political choices. One of these choices is to spend some two and a half percentage points less of our GDP on health than compa- rable European countries– 8.5%, compared with France’s 10.9%, Germany’s 11.0%, the Netherland’s 11.1%, and so on.18 This is a huge difference. Matching these coun- tries’ present commitment to their health services would already mean an additional £40bn a year for the NHS19. As Chris Ham points out, we are now almost back to the level of spending we were at before Tony Blair’s 2000 commitment to catch up with the European average.

    The first aim of the new planning process is ‘sustainability’, but what is truly unsus- tainable in the long run is providing a first-class health service on a third class budget. And the decision, on top of this, to be spending only £8bn a year more on the NHS in England five years from now, in the interest of shrinking the state, is another political choice, which has less and less support even among mainstream economists.

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  • Vinci Ho

    Fundamentally , it is a fragementation of mentality to go ahead with STP blindly while the Health and Social Care Bill is not abolished ,i.e. Political Schizophrenia......

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  • And where is the BMA and the medical profession in all of this? Muddling through with genial incompetence is just not good enough. If the NJS is to ne saved, it is going to take more focused and enthusiastic leadership than the BMA has shown.

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  • How bad are things going to get? It will be impossible to deliver safe care.

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  • About a year ago now I asked Channd Nagpaul what plans the BMA had made for a post-NHS world, and he looked flumuxed and embarrassed by the question. We are no clearer yet.

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  • Agree the BMA need to have a plan for the post NHS world it seems to be the elephant in the room the establishment are not acknowldgeing.

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