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Secret plans on which the fate of the NHS rests

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.