Major changes to the provision of Health Services – but the public is kept in the dark

3 January 2017

What are Sustainability and Transformation Plans

They sound cuddly, don’t they: Sustainability and Transformation Plans. But are they?

Just about a year ago, in December 2015, the NHS provided planning guidance for the period 2016/17 to 2020/21. This involved a plan to develop Sustainability and Transformation Plans for 44 distinct areas (called STP footprints), which extend across local authority boundaries. Haringey is part of the North Central London (NCL) Footprint; this also includes Camden, Barnet, Islington and Enfield. The lead is the CEO of the Royal Free NHS Foundation Trust.

The planning guidance suggested a tight timetable with outline plans due in April 2016 and final submissions in June 2016. All five local authorities were asked to say whether they supported the plans by 23 December, the date on which the CCGs had to sign contracts about the STPs with NHS England.

There are some very positive things about the STPs’ approach. They bring together all the major parties who provide and commission health and social care services. But this has to be seen in the context of a climate of increasing demand, reducing resources, a health service and social care system under severe strain and swinging cuts that have already been made.

Who are the players and what is the decision-making process

A wide range of organisations are being included in the preparation of such plans including clinical commissioning groups (CCG), local authorities, and relevant NHS Trusts in the footprint area. What is rather less clear is how the development of these plans would be publicised – if at all – and how relevant local and other civil society groups would be involved in consultation.

Indeed, it is relatively clear that transparency and public consultation are sorely lacking. Stories about these plans appeared on social media in the late Spring and early Summer. Just by way of example, when I asked about them at the Patient Participation Group at my local surgery in June, I was told by the senior partner (who is on the CCG) that these were confidential but that there would be consultation once they were further developed.

And whilst the NHS website that talks about these plans says that this will be an ‘iterative process that harnesses the energies of clinicians, patients, carers, citizens, and local community partners’ there has been virtually no publicity about them and there has been only marginal consultation with local groups representing citizens and this has only happened late in November and early December 2016, with a deadline for sign-off apparently fixed for 23 December 2016.

The aspirations of the STPs

On one level the aspiration and aims of the STPs are very laudable – there is a shift towards  ‘prevention and early intervention to improve health and wellbeing outcomes for our whole population’; (p 5 of the draft North Central London STP, 21 October 2016). But there are also clear signs that this is about money. On the same page it states: ‘we currently expect that the overall financial position of NHS organisations will be a £75m deficit in 2020/21.’ Clearly one of the main drivers behind this initiative from government is to reduce the cost and so-called deficits in the NHS. Because make no mistake: since the NHS is a publicly funded service, any deficit is between the money allocated by government and the money spent (or needed). This is a deficit that is entirely a political choice.

So whilst prevention and increasing wellbeing, bringing services closer to patients and ensuring that services are available in the community are all very good objectives, they cost money. They should save money in the long run, but first they need investment. And the one thing that isn’t on the table is more money.

So what’s the problem?

The lack of money, the underfunding of the NHS, the fact that services are over-stretched and at breaking point is not the fault of the organisations working on STPs. But the STPs are not helping with this problem. Their main concern is to reduce costs. As with all public sector cuts, this is couched in terms of efficiency and cutting out waste. But the waste in the system is partly due to the artificial marketization of the NHS, to the constant drain of PFI interest charges, and to leakage of public money into private profit of the corporate sub-contractors.  In places the NCL STP recognises all of that – but fails to suggest any change to national policy

The lack of transparency however, is a real issue.

  • This is, yet again, a major change in the way the NHS will deliver services. It could lead to changes in the provision of services – with some moving from hospitals to GPs, some moving from your local GP surgery to a GP hub covering a larger area, from GPs to pharmacies (at a time when pharmacies, too, are under threat in many areas), and so on. Some areas will face hospital closures and amalgamations – although local campaigners have been assured that the A and E departments at both Whittington and the North Middlesex will stay. Maternity services could be centralised more and lead to families having much longer distances to travel to hospital.
  • There is also a significant question about the extent to which this will open the door to private interests in the NHS even more. Talk is of Private Finance Initiative style service agreement for services other than those relating to bricks and mortar. And we already know that the PFI contracts already in place are costing the NHS an arm and a leg. We need public discussion about this.
  • The proposed shift to ‘treatment in the community’ with more people using hospitals as out-patients, or very briefly, or just seeing GPs instead, throws a huge burden onto local councils who are responsible for social care in people’s homes. Likewise many preventive health programmes are now down to councils rather than the NHS itself. But councils are faced with a huge deficit in their social care budgets over the next few years – they simply cannot meet existing needs never mind extra burdens. STPs pass the buck – and many councils are saying they will not support their local STP unless they get far more extra funding than the permitted council tax increase which the government announced just before Christmas.
  • Very few people know anything about this development. There was some media coverage earlier in the year but since then, very little has been said publicly. But it is likely that these plans will have a profound impact on our health services and how we access them. Surely, public consultation is essential.
  • There have been some discussions of the NCL STP with some local groups. It is not clear who was called in to give evidence and how that choice was made. Three Haringey groups which some Greens are involved with – the local 38 Degrees group, Social Care Alliance Haringey, and  the Haringey Older People’s Reference Group did get a chance to voice their views. But which groups didn’t? 
  • It was good to see that the Joint Health Overview and Scrutiny Committee of the five boroughs, which met on December 14th, did reflect the views of the above groups in its report. Camden Council, Haringey Council and Barnet Council are known to have decided not to endorse the STP at least until more detailed financial information is available in the next few months. But we know that central government can, if it wishes, over-ride local Councils’ views.

What does Haringey Green Party think should happen

Haringey Green Party takes the view that any changes in public services that are likely to have significant impact on local communities and residents should be debated openly and publicly.

Haringey Green Party is concerned that the real driver behind these plans is cost cutting. And at a time when both health and social care budgets are under considerable strain leading to real suffering of people, we call for the restitution of lost social care funding.

We live in an aging society where increasing numbers of people have complex and long term health issues. For them, we need a model of social and health care that is integrated and that ensures an acceptable quality of life for them and their families.

Haringey Green Party considers it essential that such a plan goes hand in hand with clear mechanisms of accountability, through local Health and Wellbeing Boards or, in the case of Haringey, the Haringey and Islington Wellbeing Partnership.

Haringey Green Party takes the view that both emergency and maternity services need to be maintained at a level and in places where they are accessible. And social care need to be funded by central government at a level that meets the desperate needs of vulnerable and elderly people, without placing too much pressure on a council tax system that is itself unfair to people on low incomes.

How to find out more

The NCL STP document can be read on http://www.candi.nhs.uk/about-us/north-central-london-sustainability-and-transformation-plan

There’s lots of useful information on the web site of Health Campaigns Together…

http://www.healthcampaignstogether.com/

The London Federation of Green Parties will hold an information meeting with well-informed speakers from HCT and other campaigns on Saturday January 14th. Find out more and book your free place on https://www.eventbrite.co.uk/e/london-green-party-campaigns-political-education-tickets-29972764345






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