Tuesday, 7 February 2017

NHS Sustainability and Transformation Plans and Walthamstow - a briefing

This briefing has been produced by the Political Education co-ordinator for 
Walthamstow Labour Party to whom we are very grateful. 
STPs are currently under intense discussion locally.

Sustainability and Transformation Plans (STPs) are currently being drawn up all around the country to make major changes to the NHS. Understanding this mechanism is really important if you want to help shape our local NHS in a positive way.

Some background
In 2014, NHS England laid out their plans for the NHS until 2020/21 (the ‘Five Year Forward View). They estimated that if current funding and health care provision remain the same, by 2020/21 there will be a £30bn shortfall in NHS funding. NHS England proposed a number of ways to help address this funding gap through the transformation of services:
·         More prevention and public health.
·         More integrated care (physical and mental health; social care and health care; acute and primary care).
·         More community based services.
At the same time, the Government promised to invest £8bn in the NHS in the last Parliament. This still leaves 22bn still missing from the NHS budget by 2020/21.

What are the Sustainability and Transformation Plans (STPs)?
England has been divided up into 44 ‘footprints’, consisting of the health and care authorities in that area. Each of these has to submit an STP, which will outline how these changes will be made in that particular area. Of the overall forecast gap, 15bn of the savings have to be made through these local footprints. This equates to each area spending an average of £341 million less by 2020/21.
What about Walthamstow?
Walthamstow is in the North East London footprint. It is estimated that the shortfall in the North East London area will be £578 million by 2020/21, or 14% of the overall spend on health.

You can have a look at our STP here: http://www.nelstp.org.uk/. Like the national strategy, it focusses on moving care out of hospital and into the community. The proposals include:
·         Over a quarter of A&E treatments to be shifted out of hospital into the community.
·      One third reduction in GPs. Compensated for by 200+ lower paid staff: physician assistants (science graduates with 2 year diploma); nurses; pharmacists.
·         Only 240 extra hospital beds by 2025 (projected need: 500).
·         More self care (people looking after themselves).
·         90% of people to access urgent care online or by phone.
·         More home births and mid-wife led units.
The Centre for Public Health have analysed these plans and point out a number of problems. There is little evidence that self-care or prevention will be able to take up the burden of the reduced services, especially as public health budgets have been cut. It is unclear if the new, less qualified workers will be able to cope with increasingly complex cases in the community. The average commute for key workers to Waltham Forest is 15 miles, throwing doubt on our ability to recruit 200+ lower paid public sector workers. We already have problems with turnover and recruitment to nursing roles. Expecting 90% of patients to book appointments for urgent care online or by phone is also testing in an area with high levels of English as a second language, a population turnover of 28% a year, and where only 42% of over-60s have internet access. They recommend three key questions we should be asking:
·         Will this workforce be able to provide care that is equal in coverage and quality to what is provided now - or better, or worse?
·         Is it realistic to expect that this workforce will be available?
·         If it is not realistic, what are the implications for patients in East London?

What can I do?
There are two key concerns about the STP process:
·         Accountability          
The only democratically accountable party in delivering STP plans are local councils, who have limited power in the process. There has been almost no role for patients and users of services.
o   Action! Help to raise the visibility of patients’ voices within this process. As part of the Healthy E17 campaign join your Patient Participation Group at your GP, or create one. Ask about how the STP plans will affect your GP.

·         Can the plans work?
Another concern is how realistic these plans are. They are based on the assumption that people’s health will improve, and people will become better at looking after themselves, and that community services can take over from hospital care. We also have the additional problem of the £58m Whipps’ Cross PFI debt
o   Action! Help out in the ongoing research Healthy E17 campaign are doing to investigate the Whipps Cross PFI debt.
o   Action! Please get in touch with any ideas you have for how we can help shape and improve this process. How can we improve public health in Walthamstow? How can we help to communicate these plans and changes to the local population? How can we help to keep the positive parts of these plans without jeopardising the future quality of our local healthcare? To respond email: 

More information here:

‘Transforming Services Together’: what does East London’s plan for health services imply for East Londoners? – Vivek Kotecha, Colin Leys, CHPI. https://tinyurl.com/jrxhkog
Can Simon Stevens’ Sustainability and Transformation Plans save the NHS? – Colin Leys, CHPI.https://tinyurl.com/hotdmga
North East London’s STP site - http://www.nelstp.org.uk/

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