STPs: the final nail in the coffin of a publicly accountable, publicly run, and publicly funded health service1
January 11, 2017 by Protect Our NHS
New local NHS plan details cuts of £305 million over next five years
[Reprinted press release from Protect Our NHS Bristol, originally published in December 2016]
Health authorities in Bristol, North Somerset and South Gloucestershire (BNSSG) have published their plan for the future of local NHS services. Although the plans do not fully explain how the cuts of £305 million required by the Government are to be implemented, it is clear that they are not based on the needs of local people. These plans are being fast-tracked and are unlikely to be subject to the required scrutiny or consultation. It is not surprising that local campaigners are very worried about what is coming ahead.
The local NHS plan for the next five years has been published. It is called the Sustainability and Transformation Plan (STP) and covers Bristol, North Somerset and South Gloucestershire. It identifies local cuts of £305 million and specifies how the projected budgets of all of our hospital trusts and community services are to be slashed. For example, it aims to cut £65 million off current budgets for North Bristol Trust, £36 million from University Hospitals Bristol Trust and £4.6 million from our mental health services. Further cuts in local mental health services, which are already in a dangerous crisis situation, are shocking.
These plans come at a time when the NHS is already underfunded – it is £2.45 billion in deficit – and is increasingly unable to provide the health services we need. Patients are facing rationing and long waits and dedicated staff are at breaking point. The plans have been made by order of the government, which is set to reduce projected NHS spending by £22 billion overall. £305 million is the portion of the Bristol, North Somerset and South Gloucestershire region of the national “savings”. Interestingly, the plan does not actually specify in detail how it is going to make these cuts, and it leaves £100 million plus of them as completely ‘unidentified’. It seems that local NHS planners are finding it impossible to do the government’s bidding.
Because these plans are primarily about cutting spending, they do not identify what services local people need, they only identify what savings are to be made. This is a major step away from the basic principle and obligation of the NHS: to provide appropriate treatment based on clinical need to everyone who comes through the door. They usher in a health service like that in the USA that operates on a fixed budget and which “manages demand”.
The crisis in social care is barely mentioned. Nearly 25% of beds at North Bristol Trust are currently occupied by people who are fit to leave, but for whom there is inadequate social care in the community.
The plan, in common with the other 43 plans in England, has been produced in secret without any proper consultation with patients, the public or NHS staff. This is contrary to law and the explicit requirements for consultation in the NHS constitution. NHS England have stated that “STPs will need to be developed with, and based upon the needs of ,local patients and communities and command the support of clinicians, staff and wider partners such as local government” . Unless a thorough process of consultation begins soon, legal challenges are likely to be made. The plans are being rushed and to be implemented by April 2017 so this leaves no time for any meaningful consideration.
Protect our NHS are in no doubt that the STP agenda is the final nail in the coffin of a publicly accountable, publicly run, and publicly funded health service. We are committed to engaging with elected representatives and commissioners to account in protecting the future of the NHS and resisting the push towards an insurance-based health system as in the USA. Protect our NHS has called on Bristol City Council to reject any aspect of the local Sustainability and Transformation Plan that will result in cuts.
In typically obtuse fashion, the plans are called “Sustainability and Transformation Plans” (STP). STPs require localities to make further cuts in their health budgets, with the aim of reducing NHS spending by around £27bn over five years. This comes at a time when the UK spends only 8.5% of its total GDP on healthcare, against the EU average of 10%, and NHS funding has been flat-lined for the last 4 years despite a rising demand and an ageing population. Services are being fragmented. Hospitals like Southmead are running at a deficit. North Bristol Trust and two local CCGs are in special measures. NHS hospitals in England have overspent their 2015-16 budgets by £2.5bn.
Four years ago the Health and Social Care Act removed responsibility for the health of citizens from the Secretary of State for Health, and fully opened the door to private providers taking over health services and making a profit in the process. Protect our NHS is a local group in Bristol which opposes these changes and works to demand a comprehensive, fully integrated NHS which is financed by taxation and receives sufficient funding to provide high quality services.