STP motion and background. October 2016
Motion for local political parties
(248 words)
NHS Sustainability and Transformation Plans
This Branch / constituency notes that the Government requires 44 Footprint Areas across the UK to prepare NHS Sustainability and Transformation Plans for their area which will:
NHS bodies are severely limited in how they can oppose these cuts because they risk losing access to the £2.1bn NHS Transformation Fund.
However, local authorities are in an excellent position to make clear their complete opposition to the programme, and particularly to the failure to publish detailed proposals and the completely illegal lack of consultation on the plans.
NHS Sustainability & Transformation Plans – briefing paper
Background
In December 2015, NHS England issued guidance that completely changed how the NHS in England is organized. All Clinical Commissioning Groups (CCGs) and NHS Trusts in England, and the local authorities in their area were organized (by declaration) into one of 44 area-based ‘Footprints’ covering all of England. Each Footprint was required to produce a joint 5-year Sustainability & Transformation Plan (STP) for their area that would:
The penalties for failure to achieve this: denial of access to the £2.1bn NHS Transformation Fund (vital funding to cover existing deficits and seed new models); the senior manager of the Footprint to be replaced by a manager chosen by NHSE.
The ‘new models of care’ are all intended to be far cheaper than current NHS provision. They involve, for instance: making huge cuts in numbers of hospital beds, closing A&E, reducing hospital beds and substituting with ‘care nearer home’ – digital monitoring, family carers (overwhelmingly women) looking after very sick family members; massively reducing the number of sites for healthcare provision, downgrading jobs – reducing numbers and replacing skilled professionals with unskilled, poorly trained ‘new’ roles – GPs with GP assistants (science graduates with 2 years’ clinical training). And much more. There is no valid clinical evidence for either the safety or effectiveness of these new models – the Vanguards/ pilots designed to test them out have barely started their work. The ‘new models’ have been designed by healthcare corporates; new contracts will be needed and these will attract privatisation.
Initial STPs were submitted to NHS England in June 2016. Over summer they have been revised intensively through discussion with NHSE. To date only a very few STPs have yet been published, and most give little or no detail of proposed changes to services. Those that have been published propose huge cuts in services and it’s clear that all STPs involve massive cuts in one form or another (reducing spend by over £2.5bn overall in 2016-17), and implementation of untested and potentially unsafe ‘new models of care’.
The most recent (October) NHSE letters to NHS managers say that STPs should publish only ‘a summary’ of their plans by mid-December; NHSE stress it is important that plans ‘articulate tangible benefits to patients’ in a language that is ‘clear and compelling’. STPs must explain how plans will strengthen primary and secondary care, achieve targets and prevent illness – despite also ‘achieving financial balance’ – ie implementing massive cuts in spending.
Despite expecting that only ‘a summary’ of plans will be published, STP contracts must be signed by 23 December 2016 – leaving no time for consultation on the most savage changes and cuts in the lifetime of the NHS.
Across England, the entire STP programme will implement drastic cuts in NHS services. The complete absence of any real consultation is a flagrant breach of the law requiring full consultation by any public body proposing any significant change in services.
NHS bodies are hugely limited in how they can oppose these cuts because they risk losing access to the £8bn NHS Transformation Fund.
However, local authorities are in an excellent position to make clear their complete opposition to the programme, and particularly to the failure to publish detailed proposals and the completely illegal lack of consultation on the plans.
We call on all local authorities join together to publicise widely the details of all cuts proposed to local NHS services and to make clear their outrage at lack of public consultation on details of these proposals.
As a first step, we call on local authorities to refuse to sign up to any STP, until the local proposals have been published in detail and subject to full consultation.
Further background
Is the NHS ‘inefficient’ or ‘unaffordable’?
Commonwealth Fund international comparisons of health outcomes show that our tax-funded NHS consistently outperforms the health systems of comparable economies while being nearly the cheapest.[ii] Calls for co-payments and insurance-based systems reflect a neoconservative political agenda.
Spending on healthcare is a political choice, not an economic necessity. During Labour Governments up to 2009-10 UK NHS spending rose to near the average of comparable economies. Since 2010 it has fallen sharply. The table below shows the current status after 5 years of Tory Government:
Country[iii]
Spending (% GDP)
$ Per capita spending
Austria
10.3
4,896
Belgium
10.4
4,522
France
11.1
4,367
Germany
11.0
5,119
The Netherlands
10.9
5,277
Norway
9.3
6,081
Sweden
11.2
5,065
Switzerland
11.4
6,787
United Kingdom
9.9
3,971
Average (excl. UK)
10.7
5,264
UK spending on healthcare is significantly below the average of major European economies. If the UK were to increase its spend to 10.7% of GDP, this would equate to an extra £15bn of funding.
Problems with the NHS market: – the additional cost of legal, financial expertise and procurement and contract management required to manage the NHS market, has been conservatively estimated at £4.5bn per year[iv]. This alone provides a very good case for scrapping the NHS market. Other major reasons include the need to end NHS funding syphoned into private profit; the hugely destructive fragmentation of care, and the risks to security of our personal medical information in the hands of private providers.
(With thanks to CHPI for figures cited here).
Social care
Local authority funding has been cut dramatically since the Tories came to power. But politicians of all parties have implemented a massive cut in social care with barely a murmur of protest. According to the Government Health & Social Care spending review, adult social care budgets have been reduced by 31% - some £4.6 billion from 2010–11 to 2015–16. Pressures on social care funding have been compounded by demographic changes as a result of an increasing number of older people with greater need, as well as increases to national insurance and pension fund costs[v]. By June 2015, some 400,000 fewer elderly and disabled people were receiving care compared to 2010, and those getting care have fewer hours. Local politicians are not to blame for Government spending cuts – but they are certainly at fault for not raising their collective voices to make sure the public knows about the cuts and their impact on local people. We cannot allow the same local politicians to oversee the demise of the NHS as they have done with social care.
Many local councillors seem to believe the NHS is awash with funding; they claim that integrating health and social care will save money and that NHS cash could be used to fund gaps in social care spending. The myth of NHS abundance is demonstrated above. And while better integration of health and social care is certainly very desirable, there is plenty of research demonstrating that the notion it will save cash amounts to ‘magical thinking’[vi]
[i] NHS Improvement. Performance of the NHS provider sector: year ended 31 March 2016. https://improvement.nhs.uk/uploads/documents/BM1653_Q4_sector_performance_report.pdf
(accessed 5th September 2016)
[ii] Commonwealth Fund. 2014. International Profiles of Health Care systems. http://www.commonwealthfund.org/~/media/files/publications/fundreport/2015/jan/1802_mossialos_intl_profiles_2014_v7.pdf (accessed 5th September 2016).
[iii] OECD, Health statistics. http://stats.oecd.org/index.aspx?DataSetCode=HEALTH_STAT#
(accessed 5th September 2016)
[iv] Paton C. At what cost? Paying the price for the market in the English NHS. Centre for Health and the Public Interest. https://chpi.org.uk/wp-content/uploads/2014/02/At-what-cost-paying-the-price-for-the-market-in-the-English-NHS-byCalum-Paton.pdf(accessed 5th September 2016).
[v] http://www.publications.parliament.uk/pa/cm201617/cmselect/cmhealth/139/139.pdf (para 46)
[vi] https://www.theguardian.com/society/2014/nov/19/parties-plans-nhs-future-wishful-thinking-experts
Motion for local political parties
(248 words)
NHS Sustainability and Transformation Plans
This Branch / constituency notes that the Government requires 44 Footprint Areas across the UK to prepare NHS Sustainability and Transformation Plans for their area which will:
- Contribute to cuts of at least £2.5bn nationally this year, and £22bn within the next five years, to wipe out the NHS so-called financial deficit
- achieve this by implementing 'new models of care' that are set out in NHS England's 5-year Forward View (2014)
NHS bodies are severely limited in how they can oppose these cuts because they risk losing access to the £2.1bn NHS Transformation Fund.
However, local authorities are in an excellent position to make clear their complete opposition to the programme, and particularly to the failure to publish detailed proposals and the completely illegal lack of consultation on the plans.
- We call on our local authority to join together with other to publicise widely the details of all proposed cuts and changes to local NHS services and to make clear their outrage at lack of public consultation on details of these proposals.
- As a first step, we call on local authorities to refuse to sign up to any STP, until the local proposals have been published in detail and subject to full consultation.
NHS Sustainability & Transformation Plans – briefing paper
Background
In December 2015, NHS England issued guidance that completely changed how the NHS in England is organized. All Clinical Commissioning Groups (CCGs) and NHS Trusts in England, and the local authorities in their area were organized (by declaration) into one of 44 area-based ‘Footprints’ covering all of England. Each Footprint was required to produce a joint 5-year Sustainability & Transformation Plan (STP) for their area that would:
- wipe out the NHS financial deficit in their area within a year, and for the next five years. Since the NHS ended 2015-16 with a provider deficit of £2.5bn[i], the same level of cuts (or more) will be required to break even in 2016-17 and beyond
- achieve this by implementing ‘new models of care’ that are set out in NHS England’s 5-Year Forward View (2014
The penalties for failure to achieve this: denial of access to the £2.1bn NHS Transformation Fund (vital funding to cover existing deficits and seed new models); the senior manager of the Footprint to be replaced by a manager chosen by NHSE.
The ‘new models of care’ are all intended to be far cheaper than current NHS provision. They involve, for instance: making huge cuts in numbers of hospital beds, closing A&E, reducing hospital beds and substituting with ‘care nearer home’ – digital monitoring, family carers (overwhelmingly women) looking after very sick family members; massively reducing the number of sites for healthcare provision, downgrading jobs – reducing numbers and replacing skilled professionals with unskilled, poorly trained ‘new’ roles – GPs with GP assistants (science graduates with 2 years’ clinical training). And much more. There is no valid clinical evidence for either the safety or effectiveness of these new models – the Vanguards/ pilots designed to test them out have barely started their work. The ‘new models’ have been designed by healthcare corporates; new contracts will be needed and these will attract privatisation.
Initial STPs were submitted to NHS England in June 2016. Over summer they have been revised intensively through discussion with NHSE. To date only a very few STPs have yet been published, and most give little or no detail of proposed changes to services. Those that have been published propose huge cuts in services and it’s clear that all STPs involve massive cuts in one form or another (reducing spend by over £2.5bn overall in 2016-17), and implementation of untested and potentially unsafe ‘new models of care’.
The most recent (October) NHSE letters to NHS managers say that STPs should publish only ‘a summary’ of their plans by mid-December; NHSE stress it is important that plans ‘articulate tangible benefits to patients’ in a language that is ‘clear and compelling’. STPs must explain how plans will strengthen primary and secondary care, achieve targets and prevent illness – despite also ‘achieving financial balance’ – ie implementing massive cuts in spending.
Despite expecting that only ‘a summary’ of plans will be published, STP contracts must be signed by 23 December 2016 – leaving no time for consultation on the most savage changes and cuts in the lifetime of the NHS.
Across England, the entire STP programme will implement drastic cuts in NHS services. The complete absence of any real consultation is a flagrant breach of the law requiring full consultation by any public body proposing any significant change in services.
NHS bodies are hugely limited in how they can oppose these cuts because they risk losing access to the £8bn NHS Transformation Fund.
However, local authorities are in an excellent position to make clear their complete opposition to the programme, and particularly to the failure to publish detailed proposals and the completely illegal lack of consultation on the plans.
We call on all local authorities join together to publicise widely the details of all cuts proposed to local NHS services and to make clear their outrage at lack of public consultation on details of these proposals.
As a first step, we call on local authorities to refuse to sign up to any STP, until the local proposals have been published in detail and subject to full consultation.
Further background
Is the NHS ‘inefficient’ or ‘unaffordable’?
Commonwealth Fund international comparisons of health outcomes show that our tax-funded NHS consistently outperforms the health systems of comparable economies while being nearly the cheapest.[ii] Calls for co-payments and insurance-based systems reflect a neoconservative political agenda.
Spending on healthcare is a political choice, not an economic necessity. During Labour Governments up to 2009-10 UK NHS spending rose to near the average of comparable economies. Since 2010 it has fallen sharply. The table below shows the current status after 5 years of Tory Government:
Country[iii]
Spending (% GDP)
$ Per capita spending
Austria
10.3
4,896
Belgium
10.4
4,522
France
11.1
4,367
Germany
11.0
5,119
The Netherlands
10.9
5,277
Norway
9.3
6,081
Sweden
11.2
5,065
Switzerland
11.4
6,787
United Kingdom
9.9
3,971
Average (excl. UK)
10.7
5,264
UK spending on healthcare is significantly below the average of major European economies. If the UK were to increase its spend to 10.7% of GDP, this would equate to an extra £15bn of funding.
Problems with the NHS market: – the additional cost of legal, financial expertise and procurement and contract management required to manage the NHS market, has been conservatively estimated at £4.5bn per year[iv]. This alone provides a very good case for scrapping the NHS market. Other major reasons include the need to end NHS funding syphoned into private profit; the hugely destructive fragmentation of care, and the risks to security of our personal medical information in the hands of private providers.
(With thanks to CHPI for figures cited here).
Social care
Local authority funding has been cut dramatically since the Tories came to power. But politicians of all parties have implemented a massive cut in social care with barely a murmur of protest. According to the Government Health & Social Care spending review, adult social care budgets have been reduced by 31% - some £4.6 billion from 2010–11 to 2015–16. Pressures on social care funding have been compounded by demographic changes as a result of an increasing number of older people with greater need, as well as increases to national insurance and pension fund costs[v]. By June 2015, some 400,000 fewer elderly and disabled people were receiving care compared to 2010, and those getting care have fewer hours. Local politicians are not to blame for Government spending cuts – but they are certainly at fault for not raising their collective voices to make sure the public knows about the cuts and their impact on local people. We cannot allow the same local politicians to oversee the demise of the NHS as they have done with social care.
Many local councillors seem to believe the NHS is awash with funding; they claim that integrating health and social care will save money and that NHS cash could be used to fund gaps in social care spending. The myth of NHS abundance is demonstrated above. And while better integration of health and social care is certainly very desirable, there is plenty of research demonstrating that the notion it will save cash amounts to ‘magical thinking’[vi]
[i] NHS Improvement. Performance of the NHS provider sector: year ended 31 March 2016. https://improvement.nhs.uk/uploads/documents/BM1653_Q4_sector_performance_report.pdf
(accessed 5th September 2016)
[ii] Commonwealth Fund. 2014. International Profiles of Health Care systems. http://www.commonwealthfund.org/~/media/files/publications/fundreport/2015/jan/1802_mossialos_intl_profiles_2014_v7.pdf (accessed 5th September 2016).
[iii] OECD, Health statistics. http://stats.oecd.org/index.aspx?DataSetCode=HEALTH_STAT#
(accessed 5th September 2016)
[iv] Paton C. At what cost? Paying the price for the market in the English NHS. Centre for Health and the Public Interest. https://chpi.org.uk/wp-content/uploads/2014/02/At-what-cost-paying-the-price-for-the-market-in-the-English-NHS-byCalum-Paton.pdf(accessed 5th September 2016).
[v] http://www.publications.parliament.uk/pa/cm201617/cmselect/cmhealth/139/139.pdf (para 46)
[vi] https://www.theguardian.com/society/2014/nov/19/parties-plans-nhs-future-wishful-thinking-experts
