Sustainability and transformation plans require robust scrutiny, but it would be a mistake for Labour not to engage with them in pursuit of greater community-based services, writes Joanne Harding
With the National Health Service in crisis and a £30bn funding gap by 2020, it is clear that we cannot go on like this.
To remedy this, NHS England created sustainability and transformation plans – not the catchiest name to engage the wider community in the future of our health service. And certainly the process by which they were launched did not bode well. NHSE instructed clinical commissioning groups and local authorities not to discuss or publish their STPs, which instantly gave rise to critics dubbing STPs ‘secret Tory plans’.
I have some sympathy, after all the ‘behind closed doors’ approach flew in the face of their ostensible objective of collaboration, public buy-in and involvement of local people and communities in their healthcare. But I was disappointed, to say the least, when Labour’s knee-jerk reaction was to describe STPs as ‘a dagger pointed at the heart of the NHS’ to be resisted and opposed.
STPs are designed to be about a real cultural shift in the way health services are planned and delivered. For too long the NHS, local authorities and primary care have worked in silos, particularly in relation to social care. Sadly my casework stands testament to some dreadful patient experiences because services are fragmented.
Better joined-up working must be the way forward and I would hope that STPs might just give us the chance to do this.
The NHS is now being told it must collaborate, not compete which is in contrast to the Health and Social Care Act 2012 which is all about competition.
Obviously, the NHS cannot stand still. If it does it will cease to provide the first class health care that the public expect and demand. Since the birth of the NHS in 1948, our society and communities have changed and with them our health needs. People are living longer with more complex long term conditions. The focus needs to be about prevention and keeping people out of hospital.
Public health has remained the poor relation, when prevention can be more important than treating and curing. Scandalous health inequalities have never been seriously addressed. The Marmot review Fair Society, Healthy Lives identified that children and young people should be the highest priority if we want to reduce health inequalities. Agencies collectively working together could prevent our young people from being the service users of the future.
It is also clear that social care is in a critical condition. The Kings Fund state that without additional investment for social care and the NHS the STP plans will fail. Cuts in social care are already having a significant impact on hospitals as delayed transfers of care run at their highest ever.
The government needs to seriously commit to addressing this funding gap or these plans cannot deliver the changes needed.
STPs will bring controversy, because they inevitably involve a reconfiguration of hospital services. Our hospitals are generally brilliant at dealing with trauma and acute care, but they are not the best places to provide social care for frail and older people.
Creating large centres of excellence save lives, especially for stroke and heart patients. The evidence is clear. Reconfiguration of stroke services in London has saved over 400 lives per year.
We should never forget that our NHS is first and foremost about improving patient outcomes.
The 44 STPs are an iterative process and should be aimed at looking at issues faced by local populations, improvements not a ‘make do’, joined-up working bringing people, patients and agencies together.
They will hopefully give us real opportunity for ‘place based’ care delivered locally. Imagine hospitals, GPs, community services and the third sector really working together to improve patient experience and health outcomes … I think ideally that is what we all want.
But it is clear that STPs need robust scrutiny and a strong patient voice. As a local councillor and health scrutiny chair, I am trying to help provide that.
All too often the bureaucratic NHS tells people what they think they need. Listening does not come naturally. The patient can bring real value. That would be a good place to start.
Joanne Harding is rep for the north-west on the National Policy Forum. She tweets @joanne13harding