Is our NHS at risk of cuts? NHS England’s “Sustainability and Transformation Plans” explained

What are “Sustainability and Transformation Plans”, exactly?

“Sustainability and Transformation Plans” – or STPs for short – are a series of plans being drawn up in 44 areas, officially called “footprints”, which cover the whole of England. These plans will set the stage for a major restructure of our health service.

They’re meant to detail how each local NHS will deliver NHS England’s “5 Year Forward Vision” – a national plan to link local NHS services with social care and other Council services.

So what’s the problem?

The plans sound great in theory. But in reality, these plans could mean cuts – and lots of them. This is because hidden in the STPs is a requirement to save billions of pounds. [1] Because the NHS has been starved of the money it needs for years, most NHS Trusts are in deficit. [2] These plans will need to include ways to wipe these deficits. [3] So each area is likely to have to make big cuts in order to save this money.

I’ve heard of these plans before - so why are they being called secret?

NHS England has announced that the STPs are happening. But the majority of the plans aren’t public. Since they’re being drawn up by different people in each ‘footprint’, different details are known about what each local plan entails. In some cases, no details are known at all yet, despite the final deadline being October – and cuts could happen by the end of the year. [4]

What’s more, it’s a pretty grey area as to how much public consultation local NHS leaders need to do on these plans. 38 Degrees members believe that we should have a say on plans for our local NHS, which means we all need to see our local plan and have enough time to voice our opinions.

There has also been almost no political scrutiny of these major NHS plans (a lot of MPs are in the dark about these plans, too!) and almost no media coverage, meaning that the public are mostly in the dark about potentially massive changes to NHS services near them.

How will these plans affect me?

Because a lot of the plans are being drawn up behind closed doors, we can’t say for sure how patient care in each area of England will be affected.

But we do know that everything is on the table for possible cuts. The plans could involve all sorts of proposed changes. [5] One local plan has been leaked in London, and it proposes axing 500 hospital beds and some emergency ambulances. You can read more about that plan here. [6]

What’s 38 Degrees going to do next?

Most 38 Degrees members want decisions about our NHS to be made with patients in mind – not simply to make cuts to compensate for lack of funding. These plans could be really good for our NHS, but right now, it looks like they’re being used to usher in cuts that could mean a worse health service for all of us.

So here’s what we’re going to do:

  1. First, we’re going to call for the plans to be exposed, and open to public scrutiny – so everyone across the country knows what’s in store for their local NHS services. In the meantime, we’ll commission an investigation to gather as much info as we can about what cuts are being planned in each area.
  2. And then we’re going to demand that we, as patients of the NHS, get our say on plans for our local NHS.
  3. Finally, we’re going to demand more government funding for our NHS – so the plans have the ability to actually transform our NHS for the better.
It sounds like NHS England, the public body that runs the NHS in England, is in charge of these plans. So why are you blaming Jeremy Hunt?

Yes, NHS England is in charge of drawing up and implementing the plans. But they’re doing so under the instruction of Health Secretary Jeremy Hunt and the government – they’re the ones who hold the purse strings for the NHS. [7] These plans aren’t about transforming our NHS for the better, they’re about trying to balance the books for our chronically underfunded NHS. Therefore by asking Hunt, we’ll be asking the person in government who is responsible for making sure the NHS has what it needs to give top-notch care.

How can I get more involved in the campaign to expose these plans in my local area?

38 Degrees members will be running local campaigns in each of the 44 areas across England to get the word out about the plans, and meet with decision makers like NHS bosses and local MPs about how we can have our say.

We’re creating a handy website where you can find out about the plans in your local area – and sign the petition to demand the plans in your area are revealed. If you want to be updated about the campaign, sign the petition here!

Notes

[1] As detailed in NHS England’s report on the Five Year Forward View Vision, there is an anticipated funding gap of £30 billion by 2020/2021. Because NHS funding is anticipated to stay the same, the gap will have to be closed by identifying system “efficiencies”. See points 13-16 of the Executive Summary for more information: https://www.england.nhs.uk/ourwork/futurenhs/nhs-five-year-forward-view-web-version/5yfv-exec-sum/

“Local health systems now need to develop their own system wide local financial sustainability plan as part of their STP.”
Delivering the Forward View: NHS Planning Guidance 2016/17-2020/21:
https://www.england.nhs.uk/wp-content/uploads/2015/12/planning-guid-16-17-20-21.pdf

[2] The King’s Fund: Is the NHS heading for financial crisis?http://www.kingsfund.org.uk/projects/verdict/nhs-heading-financial-crisis

BBC News: Is the NHS underdoctored, underfunded and overstretched?
http://www.bbc.co.uk/news/health-36198952

[3] The planning guidance provided by NHS England to outline how these plans will look includes a requirement to return financial balance to the NHS:
“Deficit reduction in providers will require a forensic examination of every pound spent on delivering healthcare and embedding a culture of relentless cost containment. Trusts need to focus on cost reduction not income growth” (p.12):
Delivering the Forward View: NHS Planning Guidance 2016/17-2020/21:
https://www.england.nhs.uk/wp-content/uploads/2015/12/planning-guid-16-17-20-21.pdf

Open Democracy: NHS managers are being forced to lie to the public: https://www.opendemocracy.net/ournhs/carol-ackroyd/nhs-managers-are-being-forced-to-lie-to-public

[4]  Though plan submission was planned for June with view to implementation this autumn, no plans have yet been released on the NHS England website:
https://www.england.nhs.uk/ourwork/futurenhs/deliver-forward-view/stp/

[5] Huffington Post: Another major NHS reorganisation could be about to take place behind closed doors: http://www.huffingtonpost.co.uk/justin-madders/nhs-reform-reorganisation_b_9991164.html

[6] Get West London: ‘Dangerous’ plans to axe 500 west London hospital beds slammed by council:
http://www.getwestlondon.co.uk/news/west-london-news/dangerous-plans-axe-500-west-11359024

[7] In the government’s policy paper “The government’s mandate to NHS England 2016-17” a key objective is to “balance the NHS budget and improve efficiency and productivity”. Between 2016-17 it is expected that NHS England will deliver “year one of trust deficit reduction plans and ensuring a balanced financial position across the trust sector.”

Gov.uk: NHS mandate 2016 to 2017:
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/494485/NHSE_mandate_16-17_22_Jan.pdf