Comment

Rod Thomson: STPs have alienated the people who could have made them work

The aims of sustainability and transformation plans (STPs) are reasonable, but they were developed in secrecy and are now being met with fear, says Professor Rod Thomson.
Sustainability-iStock.jpg

The aims of sustainability and transformation plans (STPs) are reasonable, but they were developed in secrecy and are now being met with fear, says Professor Rod Thomson

It is difficult to argue against the basic concepts of NHS Englands STPs. Faced with growing demand for acute health and social care, along with the evidence for concentrating treatment services in centres of excellence and the pressures on resources, the aim of developing a sustainable and effective NHS is understandable.

But the way in which NHS England has led the development of the plans has caused controversy with local authorities, professional organisations, voluntary sector bodies and the public at large. The main reason for concern was the comparative secrecy in which the 44 plans were developed, with NHS England reluctant to consult stakeholders.

Local authorities were

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The aims of sustainability and transformation plans (STPs) are reasonable, but they were developed in secrecy and are now being met with fear, says Professor Rod Thomson


The development of STPs has sparked
controversy. Picture: iStock 

It is difficult to argue against the basic concepts of NHS England’s STPs. Faced with growing demand for acute health and social care, along with the evidence for concentrating treatment services in centres of excellence and the pressures on resources, the aim of developing a sustainable and effective NHS is understandable.

But the way in which NHS England has led the development of the plans has caused controversy with local authorities, professional organisations, voluntary sector bodies and the public at large. The main reason for concern was the comparative secrecy in which the 44 plans were developed, with NHS England reluctant to consult stakeholders.

Local authorities were invited to take part in the planning process, but the pressures they face in funding adult social care appeared to be less important than NHS pressures. The NHS in England is trying to deal with waiting times and delayed transfers of care, both of which interlink with community care.

Job loss fears

At the heart of professional and public concern is the fear of closure of services, whether it is emergency departments, cancer services or community hospitals. The secrecy associated with the STP process has also fuelled a high level of mistrust and concern for jobs.

With so many NHS trusts and clinical commissioning groups reporting financial difficulties, it is easy to see why staff fear for their jobs through redundancy or redeployment. In rural areas in particular, some services are seen as too small to be clinically or financial sustainable. For rural communities with poor public transport links, closures will make services less accessible.

A further concern with STPs is that they have insufficient focus on prevention of ill health, dominated as they are with transforming hospital services. Unless there is a reduction in the number of people with long-term conditions, the demand for acute health and social care will continue to rise and swamp the NHS and local authority budgets.

At a time when the Department of Health (DH) is cutting the public health grant each year, investment in health promotion is also being undermined. As this grant funds health visiting, school nursing, smoking cessation and obesity prevention, local authorities are having to make significant cuts. 

Postcode lottery

Primary care clinicians also have concerns that STPs will seek to shift work to general practice without sufficient resources being allocated to them. The lack of engagement with these clinicians in the development of the STPs has reinforced this fear.

In November the DH announced the provisional allocations for each of the STP areas. Analysis of these allocations on a per person basis shows significant variations in the resources being made available in 2020-21. Some areas will receive more than £200 per person less than the national average allocation. For a population of 500,000 people, this equates to £100,000,000 less funding being available for local health services. 

As yet, the DH has not explained the rationale for its allocations or the apparent inequalities that it has created. Such variations will lead to a postcode lottery in healthcare if they are not addressed.

For a concept with such reasonable aims, STPs have alienated many of the stakeholders needed to transform the NHS to meet health and social care challenges. 


About the author

 

 

 

Rod Thomson is RCN deputy president

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