The NHS is facing the biggest shake-up in its history with plans for a massive overhaul of services which could lead to hospital closures, mergers and downgrades across the country.
Sustainability and Transformation Plans (STPs) are five-year plans covering all aspects of NHS and social care spending in England.
It’s about helping people to look after themselves so they don’t come into hospital unless it is really necessaryAndrew Foster
Forty-four areas have been identified as the geographical footprints on which the plans are based.
The plans are being criticised for being drawn up in secret and for having tight deadlines and unachievable targets.
With efficiency-savings at the heart of this major re-organisation, there is a real fear the NHS as we know it will be torn apart and the radical changes will be gambling with people’s lives.
Johnston Press Investigations team has done a detailed examination of the plans as well as speaking to experts, campaigners and patients about their misgivings.
Our findings across the country include:
The proposed or likely closure of 19 hospitals including five major acute hospitals
Major re-organisations of more emergency and maternity care
A massive move to “out-of-hospital” care with patients encouraged to manage their own health needs aided by technology which may include “virtual doctors”
The closure of more than 2,000 beds in acute and community hospitals and the loss of nearly 3,000 jobs
Hundreds of millions of pounds to be saved by cutting prescription costs and in some cases rationing care or operations
The STP plans have been widely criticised for their lack of consultation, vagueness and for being filled with meaningless jargon.
A recent survey revealed that six out of seven people have never heard of the STPs prompting warnings the shake up is being pushed through without meaningful consultation.
But Greater Manchester is in a rather different position from many parts of the country, having started to draw up its blueprint under the heading Taking Charge Together as part of devolution plans as long ago as December 2015.
This has given it a longer run at making the savings - estimated at £1.978bn in Greater Manchester than other parts of the country.
But opinion is divided as to how and whether these will be achieved.
A Department of Health spokesman said: “We are committed to the NHS - that’s why we have invested £10b in its own plan to transform services and improve standards of care including almost £4bn this year.
“NHS England are introducing Sustainability and Transformation Plans to help ensure the best standards of care, with local doctors, hospitals and councils working together in conjunction with local communities for the first time.”
NHS England says the NHS needs to make major efficiencies to live within the financial budgets set by Parliament and government.
It believes the best way to do this is for local doctors, hospitals and councils to work together to identify ways that unnecessary future costs can be avoided, such as the sale of surplus land.
NHS England believes it is missing the point to suggest that STPs are all about saving money – and says they are a big opportunity to improve the care that patients receive, based on the experience of areas who are performing best and practical things that doctors and nurses have been saying for years.
The man in charge of Wigan borough hospitals believes that the plan to make local and Greater Manchester health services more efficient by 2021 is “do-able”.
Andrew Foster, chief executive of Wrightington Wigan and Leigh NHS Foundation Trust, says that many of the complaints raised over Sustainability and Transformation Plans (STPs) elsewhere in the country are not applicable locally.
He said: “The Greater Manchester plan, Taking Charge Together, is the equivalent of an STP but because there has been so much more time and resources invested in it, a lot of the criticisms about secrecy and being rushed through do not apply.
“Some of the STPs have been a bit simplistic and decided they can save money by closing hospitals but we don’t take that tack. If you do that you end up asking ‘what are you doing with all the patients who were going there then? They still need treatment.’
“We should be careful not to refer to £1.9bn in cuts. In fact spending is increasing; the problem is that demand is outstripping that increase in funds. It means we have to get £704 more efficiency per person.
“What our plan intends to do is improve the health and wealth of the population, and integrating the health and social care sides.
“It’s about helping people to look after themselves so they don’t come into hospital unless it is really necessary. It’s about identifying people coming into hospitals with particular conditions or frail elderly people and then set up care plans for them at home and in the community.
“It’s not about forcing people to stay at home, it’s helping them to stay there when possible through advanced care plans. This will dramatically tackle the growth in people coming into hospital.
“And if it continues at the current rate, the plan will have done its job.”
Lord Smith is not only Wigan Council leader but also chairman of Greater Manchester Health and Social Care Strategic Partnership Board that has been playing a key role in implementing the local version of an STP.
He said: “The plans for Greater Manchester were published as long ago as December of 2015, although we have had a refresh since then.
“While there have been criticisms of some STPs being drawn up behind closed doors, everything we have done has been in public.
“It is all about making the health service fit for the 21st century and we need people to be able to be treated more at home, keeping them out of hospitals as long as possible.
“The biggest problem for us is the lack of money for social care which has such a big impact on Greater Manchester.
“It reduces the ability of hospitals to discharge patients when treatment is complete because it is difficult to find somewhere for them to go.
“The Government knows that and it needs to come up with the money. Social care funding is important because it has such an impact on everybody else.
“It is not about reducing the number of hospitals.
“There will be a review to make sure we are doing everything in the right but we are on track to make the savings.”
Yvonne Fovargue MP said: “Despite their critical role, STPs have no statutory status and are being asked to work at rapid pace on plans with significant implications for future local NHS services with no meaningful democratic accountability or oversight.
“STPs are being asked to deliver unrealistic savings as part of the Government’s plan to deliver £22bn of efficiencies by 2020. They are working to impossible timescales.
“I fear that they will be a euphemism for cuts and closure of NHS services and that the financial crisis engulfing the health and social care sector has been the priority over clinical and patient need.”
Amy Barringer, UNISON North West Lead for Health said: “Greater Manchester is ahead of other parts of England as it has been working for over 18 months on how NHS organisations and councils can work together to better integrate health and social care.
“Greater Manchester though faces the same pressure from central government to make dramatic financial savings as other areas – some £2bn by 2020/21. This level of cut is going to make it very difficult to avoid a deterioration in services for patients.
“We believe the Government should not be attacking our public services in this way and that they are making a political choices to underfund the NHS and local councils.
“We are working with NHS and council employers to minimise the effect of cuts and protect jobs and services. Social care remains a grossly underfunded area, a sector characterised by profit-making providers and low-wages. Our wonderful care workers provide the best care they can, in difficult circumstances, and they should be given time and resources to provide high quality care. We call for dignity in social care and proper investment in this vital sector. ”