New analysis of NHS plans suggests that big service changes lie ahead.
The gap between the hopeful language of the NHS Five Year Forward View and the grinding reality of the financial pressures facing health services has always been there but has never felt more gaping. Since December, Sustainability and Transformation Plans (STPs) have been tasked with bridging this divide.
These plans are intended to end an era where activity and funding has focused on institutions, and bring about place-based planning that is built around the health needs of a defined population. However, the STP process has no statutory status and the timetable gives little room for reflection of consultation. The plans themselves – which have significant implications for the future of NHS services – must be developed in a matter of months.
The 44 STP ‘footprint’ areas, comprising core health and care stakeholders – providers, commissioners and local authorities – were created, with leaders appointed in each footprint to lead the process, developing high-level plans focused on regaining financial control (sustainability) in their local health economy, and considering service decisions around priority disease areas, such as cancer, diabetes and mental health (transformation).
Some STP footprint areas built on existing relationships or boundaries, including those – such as Greater Manchester – where detailed plans were already in full development. Other new STP footprints had no history of working together on place-based health initiatives. It is therefore unsurprising that progress, as well as the way in which the task was approached, has been variable.
Incisive Health was commissioned by 38 Degrees to undertake an analysis of progress made by STPs to date. We have reviewed draft materials made available for each footprint, although the quality and detail of the information is variable and all the draft plans are subject to amendment and sign-off from NHS England.
There are, however, a number of emerging trends in the plans. Efforts to regain financial sustainability outlined in the plans included significant mention of ‘reconfiguration’ or ‘rationalisation’ of services as a required course of action to achieve financial sustainability. Specific suggestions include:
- Closure or downgrading of Accident and Emergency (A&E) and maternity units and other services;
- Reductions in the number of hospital beds;
- Cutting growth in staff costs and consolidating back office functions;
- Reducing estate costs and disposing of surplus land.
Over half (23 out of 44 plans) of STP footprints are proposing some form of service reconfiguration. Although less prominent, over a third (16 out of 44 plans) are looking to rationalise their estates by, for example, reducing their building stock or disposing (selling) of unused land.
Many of the plans also attempt to articulate a vision for transformation. Guidance to STP footprints encouraged them to be ambitious in their approach to confronting some of the big health challenges in their area. Examples of service transformation being proposed include:
- Better integrating health and social care with third sector partners to deliver more joined up service;
- Using data and modelling to better manage urgent care demand;
- Extending health and care services into people’s homes and communities to support people to manage their own health, wellbeing and care.
While there is clear interest in ‘new models of care’ as a way of ensuring efficient use of resources and improving patient care and outcomes, detail on the form these models might take is often missing.
The changes being contemplated by STPs are far-reaching, but many appear to have had little public involvement or consultation. Given the nature of the changes, consultation at some point is inevitable. Although some STPs have requested (and been promised) “air cover” for the changes it remains to be seen whether this will be forthcoming or sufficient to enable the completion of controversial service changes. This autumn is likely to see some challenging conversations between local NHS leaders and the communities they serve.