Early thoughts on STP

From Gilda of Leeds KONP:

still trying to plough through all this. As expected it is fairly detailed on what they want to change but incredibly light on any detail re where the savings/ cuts  are coming from. It acknowledges that the plan is based on accepting totally inadequate funding in the face of rising demand and predicts that if they continue business as usual there will be a £1.07bn funding gap in West Yorks and Harrogate  by 2021.
As I understand it the STP proposes closing this gap by

  • getting people to look after themselves and each other better  to reduce demand on the health service  (People will be supported to self care, with peer support and technology supporting people in their communities) which means that the most vulnerable people in our community will find it harder to access health care, particularly from a doctor they know and trust.
  • making  some improvements to primary and community care services ,( with  Locala  in Wakefield  quoted as an example) ,  called developing “ a different relationship and new approach to the way we deliver services across both health and social care”  , focusing on “early help and support  which means shrinking hospital care/ beds, fewer and larger GP practices, more consortia and opportunities for private companies to profit from our ill health.    
  •  closing  and centralising  services across the region eg cutting  the number of hyper acute stroke units ,cut A and Es,   called “reducing duplication and difference in service delivery” and making services “safe sized” , meaning fewer  services, further apart , requiring people to travel much further for treatment with knock on effects on visitors if you are an in patient   
  • Collectivising processes: sharing  back office/ support functions, selling off estates, joint commissioning and joint decisions about which  treatments and  medicines to support ,   called “acting once across West Yorkshire  and Harrogate , meaning job losses, more privatisation, ( the STP office is run by Attain funded collectively by the CCGs)  more rationing.  

In return for the above plans to save £0.9bn  West Yorks hopes to receive  0.2bn from the Government’s Sustainability and Transformation Fund but  acknowledges that at least part of the £0.2bn will get eaten up “supporting business as usual, underpinning basic services not developing new ways of doing things” . 

Instead of trying to dance on a pin head the Footprints, CCGs and Local Authorities should be joining the increasing chorus of people, including Chris Hopson for the providers, The Royal College of Physicians and the Royal College of Emergency Medicine  who are saying the NHS must have significantly more funding to be able to provide safe, sustainable care. 4% increase per year would be a start.  The NHS  has already been obliged to make £22bn cuts, annual increases have been driven down from 4% to under 1% and what little extra, highly conditional, funding has been made available this year  is going to disappear entirely in the next few years , falling to 1.3% next year and 0.4% in 2018/19, while demand is increasing at around 3% for many services.
Of course there is room for innovation within the NHS. It is happening all the time but  without  proper funding , without any commitment to maintaining  a publicly funded and provided national  health service and without  full patient engagement in designing services and a solid evidence base, these plans are just taking us further over the cliff to a less safe, more fragmented and increasingly privatised health service. Nowhere did the public ever vote for this!


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