Ahead of the general election on 8 June, we examine the big issues around health and care.
What’s the issue?
Sustainability and transformation plans (STPs) are place-based plans for improving health and care services in 44 areas of England. They set out how the NHS five year forward view will be delivered locally and mark a decisive shift away from the focus on competition as a means of improving health services by requiring NHS organisations to collaborate with each other and with local partners. STPs have had a difficult beginning, attracting criticism for the lack of involvement of patients, the public and staff; insufficient engagement with local authorities; and in some case for proposing controversial changes to hospital services.
What’s behind this?
The NHS needs to develop new ways of delivering care in response to the changing needs of patients. It must also improve productivity in order to bridge a financial gap estimated to be £22 billion by 2020/21. Delivering these objectives requires NHS organisations to work together and with local partners to break down barriers between services and to tackle waste and variations in care.
STPs were produced to a tight deadline that made it difficult to engage meaningfully with stakeholders. Guidance from NHS England and other national bodies emphasised the need for plans to show how they would achieve financial balance as well as how they would improve services. The plans submitted in October 2016 describe what providers need to do to deliver efficiency improvements and what changes in service delivery are being proposed in each area.
STPs cover a very wide range of issues from prevention through to the provision of specialised services. They contain proposals to strengthen services in the community, improve the provision of hospital services, develop the workforce and invest in IT. Many of the plans also outline ambitions to improve specific services such as cancer care, mental health and children’s services.
The King’s Fund view
STPs are a workaround of the complex and fragmented organisational arrangements that resulted from the Health and Social Care Act 2012. Despite criticisms about the process so far, they represent the best opportunity for the NHS and its partners to plan together for the future. The priority now should be to turn ambitious proposals into credible plans and to achieve wider and deeper engagement in taking forward what STPs are proposing in collaboration with local authorities, staff and patients.
During this process, it is essential that the clinical and financial assumptions on which the plans are based are tested and challenged to ensure that improvements in care will result. Proposals to cut the use of hospital beds are unlikely to be credible without a prior investment in community services. Similarly, ambitious proposals for improving productivity to bridge the financial gap in the NHS may not be achievable unless there is detail on how providers expect to deliver them.
To realise their potential, STPs need to strengthen their leadership and governance and ensure they have the capacity and capability to implement their proposals. NHS England and NHS Improvement need to work together to oversee STPs and be consistent in their dealings with commissioners and providers. The wide scope of STPs needs to be narrowed to focus on the most important priorities in each area of England.
Proposals for changes to the role of hospitals and specialist services are likely to encounter opposition in some areas, and the clinical case for these changes must be credible. Growing shortages of doctors, nurses, midwives and other staff will require certain specialist services, and in some cases A&E and maternity services, to be concentrated in fewer hospitals to provide acceptable standards of care. Where the clinical case for change has been made, politicians should not stand in the way of changes that will improve the quality of care.