NHS sustainability and transformation plans – and how to understand them

Here’s an article with useful suggestions for anybody who is concerned about the latest plan to ruin the NHS in England.

The principle of the STP process is sound.

After the disastrous destruction of planning arising from the Health and Social Care Act, the notion of bringing together providers and commissioners within a recognisable geographical area is a good one.

Ignoring or actively subverting the failed market approach brings some sense at last.

But any sensible approach has been hijacked by the switch to driving savings to meet ludicrous financial control totals – which are driven from totally unrealistic levels of funding.

Despite attempts to impose secrecy we do now have some information about one third of the 44 STPs with summaries or draft plans or leaked documents of various sorts giving a chance to see some themes and trends. No STP has yet been published; they only have meaning if the accompanying schedules of workforce, estates and finances are attached.

So anyone who does read a STP might like to look for answers:-
•Does the STP read as if it has been written for general understanding or just NHS insiders?
•Does it describe clearly what would be better after the STP – for patients, for staff, for system?
•Does it read as if there has been some input from patients groups, local staff, communities, voluntary organisations?
•Does it address those local issues that are already identified (Trusts in special measures, failed commissioners, long waits etc)?
•Does it explain what will happen under realistic assumptions about funding as opposed to the unrealistic one they must all apply?
•Does it explain where the funding for the management of the changes will come from? Capital funding? Double running costs?
•Does it explain how implementing the changes proposed will be subjected to consultation, tried out first then rolled out at scale?
•Does it explain who will be responsible for what in terms of delivery; are patients, public and staff involved in the management of change?
•Does it explain how in a more integrated system decisions will be taken (and by who) about allocation of funding?
•Does it explain what is expected of regulators (like CQC) and national bodies (like NHS Improvement/Monitor) in responding to local changes?
•Does it explain how the many complicated programmes will be managed – how will enough clinical expertise be released? Will it all be run by KPMG?
•How reliable is the data on which the plan is built? What contingency scenarios have been explored where data is poor?
•What proportion of the claimed savings depends on national action like imposed pay restraint?
•How many jobs will be lost, how many new jobs created, how many jobs changed significantly? How will this be carried out
•Where is the GANTT chart? Who updates it? Who manages dependencies, risks and issues?
•And is all this to be honest, open and transparent – as required but ignored so far?

For those brave enough to dig a little deeper then maybe:-
•How many of the proposals have actually been tried successfully before locally? elsewhere? anywhere?
•How realistic are the cost savings from the usual unicorns of merging organisations, reorganising services, sharing back offices, forming chains and federations, outsourcing pathology etc, when they have all been tried before with limited success?
•Have the same improvements (such as reducing length of hospital stays) been counted two or three times or more?
•Where is the clinical leadership to ensure Right Care and other schemes to reduce variation are explored then implemented?

Source: Sustainability and Transformation Plans: What to Look For

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2 thoughts on “NHS sustainability and transformation plans – and how to understand them

  1. Barry Davies

    From what I can gather the idea will lead us back to the Area health authorities, which were abolished back in the mid 80’s because they really were ineffective,

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