Sustainability and transformation (rationing) plans – surely STPs deserve a better acronym…

Surely STPs deserve a better acronym… Stupid Terrifying Policies which bring back fear?.. NHSreality has already explained that patients in rural areas still prefer convenience to better outcomes, and distant “high tech” specialisation.. There is a real need to explain the centralisation that is planned, and a real risk that, after “making difficult decisions”, the most benefit will go to those nearest  tertiary centres. Without the transport infrastructure there will be differential outcomes.. If Local Government runs the health service in your Region, Post Code rationing will be more obvious, and the universal cover will disappear. LA local taxation mandate risks spending too much on high volume low cost treatments, and on residential care. The perverse incentive for families (esp. those with Power of Attorney) to dispose of assets 7 years before relatives die, especially when they are living so long with dementia, could put an intolerable burden on the state.

Image result for fearful cartoon

Chris Smyth in the Times 14th November 2016 reports: Fears that secretive NHS reforms will put savings before patients

A “secretive” plan to reorganise the NHS risks failing patients, a report warns.

Widespread bed cuts, closures of accident and emergency units and even shutting hospitals have been proposed by NHS bosses who are often more focused on saving money than improving care, the King’s Fund think tank says.

Simon Stevens, head of NHS England, has conceded that managers in many areas are not up to the job of implementing his vision for the health service and is warned today that it risks failure in most of the country…..

Most patients would agree that it makes more sense to keep elderly patients well at home rather than letting them tip into crisis and have to go to hospital (Chris Smyth writes).

In essence, this is what Simon Stevens’s “sustainability and transformation plans” are trying to achieve: getting the local NHS to pay more attention to preventing illness, improving mental health and working with social care.

Of course, it is not quite that simple. Nothing brings patients out on to the streets faster than plans for hospital closures. When Theresa May met Mr Stevens for the first time, she warned him not to use the threat of closures as a weapon to try to prise extra cash out of the government.

Often, there are good clinical reasons for shutting poorly performing units. But when so much emphasis is put on saving money, many in the NHS understandably fear this will mean cost-cutting masquerading as better care.

Hugh Alderwick, Phoebe Dunn, Helen McKenna, Nicola Walsh, Chris Ham write for the Kings Fund in Sustainability and transformation plans in the NHS- How are they being developed in practice?

Sustainability and transformation plans (STPs) have been developed by NHS and local government leaders in 44 parts of England. The plans offer a chance for health and social care leaders to work together to improve care and manage limited resources. But will they succeed where other initiatives have failed?

Despite the importance of STPs for the NHS and the public, little is known about the process of developing the plans and how the initiative has worked in practice. Based on a series of interviews with senior NHS and local government leaders which took place throughout 2016, this report looks at how STPs have been developed in four parts of the country……….

  • Local context and the history of collaboration within STP footprints have played a major role in determining the progress of the plans.
  • Despite the focus on local ownership, key elements of the process have been ‘top-down’.
  • National requirements and deadlines for the plans have changed over time, and guidance for STP leaders has sometimes been inconsistent and often arrived late.
  • The approaches of national NHS bodies and their regional teams have not always been aligned.
  • Tight deadlines have made it difficult to secure meaningful involvement in the plans from key stakeholders, including patients and the public, local authorities, clinicians and other frontline staff.
  • Organisations face fundamental policy barriers to working together on STPs; existing accountability arrangements focus on individual rather than collective performance.

Policy implications

Based on these findings, the report makes a number of recommendations for the future of the STP process. There is a need to:

In Place of Fear A Free Health Service 1952 Chapter 5 In Place of Fear


This entry was posted in A Personal View, NHS managers, Perverse Incentives, Post Code Lottery, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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