Are Chorley & Grantham required STP changes being pushed through on 'safety grounds' ?
"STPs cannot solve the problem of inadequate funding. Ministers will have to fund the NHS properly or take political responsibility for its collapse".
following excerpt from The Sustainability and Transformation Plans: a critical assessment John Lister, Centre for Health & the Public Interest
At the end of the day, when the innovations in STPs don’t deliver savings for the NHS, NHS England will again resort to cuts and rationing. Indeed many knowledgeable people see the STPs as a smokescreen to divert attention from cuts at trust level, whittling away staffing levels, imposing smaller-scale service reorganisations, and preparing to push through controversial closures on ‘safety’ grounds (as has happened in Grantham and Chorley and is increasingly on the cards in Ealing).
Currenty, Lancashire Teaching Hospitals NHS foundation Trust are £43m in deficit.
How did the trust providers get into such a mess?
The answer is pretty simple. Every year between 2010-11 and 2015-16 the amount hospitals were paid for each treatment they provided was cut, year after year. That meant that by 2015-16, a hospital was paid the equivalent of £820 to treat a patient they would have been paid £1,000 to care for in 2010-11.
Hospitals tried to balance their books by cutting their costs by around 13 per cent over the same period. But the amount they were paid was cut even faster – by around 18 per cent, resulting in the expenditure-over-income deficit we see today.’
Under-funded hospitals are indeed failing to meet their targets.
More than 10% of elective patients (364,000) are waiting over 18 weeks to start treatment, missing the time limit supposedly guaranteed under the NHS Constitution.
....abstractions like ‘integration’ and ‘self care’, to be found in every STP, distract attention from unpopular changes, and ignore facts on the ground. Public health programmes are actually being cut back across the country as a result of cuts in local government funding, so there is no money for the new prevention schemes that would be required to reduce the need for care, or for projects to tackle seriously the social determinants of health – which in any case would take years to show any measurable reduction in pressure on the NHS. Yet many if not all STPs rely on public health action to significantly reduce the ‘demand’ for services.
- Primary care is already floundering: with more and more practices unable to cope with ever-increasing pressure, many GPs are leaving and are increasingly hard to replace, while Jeremy Hunt’s promise to recruit 5,000 more GPs plainly lacks credibility.
Many STPs seek to paper over the cracks, proposing that other, less qualified – and yet to be recruited –staff will take over a lot of the work now done by GPs.
As for community health services, some rural STPs involve closing community hospitals, with Cumbria and Devon expecting patients to travel up to 50 miles on sometimes hazardous roads when they need hospital care. None of the STPs addresses travel issues for elderly, less mobile patients, or single parents.
Even where community and home-based health or care services have been shown to be effective in enhancing patient care,
they don’t save money, but cost more.
Yet STPs are required to save money, to enable the NHS to deliver more services to more people and absorb more cost inflation and cost pressures over the next four years, and wipe out existing deficits.
Many questions also hang over the proposals, more developed in some STPs than others, for the development of new forms of organisation of health care through US-style
Accountable Care Organisations (now called Integrated Care Partnerships), as outlined by Simon Stevens in the Five Year Forward View. Many of these schemes are for the medium or longer term, and none of the proposals explain how they are supposed to improve services while at the same time saving money.
Indeed far from being cheaper to run,
ACOs in the USA receive and require far higher spending per head than any British equivalent could even dream of, with allocations between 3 and 5 times higher than the average £2057 spent per patient per year in England’s NHS – a figure which many STPs explicitly seek to further reduce.
Nor do STPs address the consequences for existing NHS and Foundation Trusts of establishing new contracts and provider organisations, or the proposed reductions in caseload and funding for existing providers which are central to the expected cost ‘savings’.
Since acute trusts are largely paid only for the patient care they deliver (‘payment by results’), a reduction in caseload in one service can trigger the collapse of viability of related services and pull the financial rug from already indebted trusts.
Conclusion
At the end of the day, when the innovations in STPs don’t deliver savings for the NHS, NHS England will again resort to cuts and rationing. Indeed many knowledgeable people see the STPs as a smokescreen to divert attention from cuts at trust level, whittling away staffing levels, imposing smaller-scale service
reorganisations, and preparing to push through controversial closures on ‘safety’ grounds (as has happened in Grantham and Chorley and is increasingly on the cards in Ealing).
Up to half of most STPs’ planned savings are in any case to be squeezed out of the hospital sector, through ever more relentless ‘efficiency savings’ and reductions in staffing levels, along with closures of beds, services and even whole hospitals.
With no alternative services in place, and no capital available to build new or extend existing hospitals, and with even community hospital beds and staff facing cuts, it is a recipe for a chronically under-resourced, chaotic and scandal-prone NHS.
Promoting STPs may seem an easier course of action for NHS England than to warn Mrs May that if the cash freeze begun in 2010 is extended to 2020/21, many services will collapse. We know that Simon Stevens’ effort to do this after she became Prime Minister was met with a frosty reception.
But STPs cannot solve the problem of inadequate funding. Ministers will have to fund the NHS properly or take political responsibility for its collapse.
