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STP realities

Medicine Balls

Phil Hammond

Wednesday, 20 September 2017

NHS cuts_AdobeStock_27919040.jpgWhere do you stand on STPs? If you’re on the ball, you have spotted that the name of these 44 roadmaps for the future of the NHS has changed from Sustainability and Transformation Plans to Partnerships, suggesting a degree of collaboration and transparency that may not exist in reality. We know the NHS is seven years into a decade of austerity funding, the tightest fiscal squeeze in its history. We know social care is on its knees, with massive cuts and unmet needs. We know the NHS is committed to making another £22 billion savings (the Stevens challenge) on top of the previous, never to be repeated £20 billion savings (the Nicholson challenge). And STPs are apparently the answer.

It was Andrew Lansley (remember him?), who promised us “no decision about me without me” before foisting the biggest ever market reforms on an unwitting NHS (we were promised no major reorganisation in the 2010 manifesto). STPs too have largely been developed in secret and have not felt the full force of public scrutiny, and we know why. There will be multiple closures and downgrades ahead, and that never goes down well with the press, politicians or the public.

We know, for example, that Derbyshire STP plans 530 fewer beds by 2020, Devon 590 fewer beds, Kent and Medway 296 fewer beds, Lincolnshire 118 fewer beds, Dorset 360 fewer beds and Leicester, Leicestershire and Rutland 281 fewer beds. West, North and East Cumbria plans to reduce beds in cottage hospitals from 133 to 104, with beds at Cumberland Infirmary and West Cumberland Hospital going from 600 to 500. All this lead Jeremy Corbyn to proclaim that NHS beds will be slashed by a third under STPs. Twitter is full of STP = Slash, Trash and Plunder or Switch to Private.

We won’t know the true extend of cuts until every STP comes clean, and there’s a big difference between a cottage hospital bed and an acute bed. But we also know that winter pressures are a round the year phenomenon in the NHS, and winter itself could be very testing given the H3 flu strain outbreaks in the antipodes that are heading our way. We also know that the UK, at 2.8 beds per 1,000 people, has amongst the lowest for the number of hospital beds relative to population size, with England pretty much at the bottom (ref 2014 OECD league tables). In the last decade, more than one quarter of hospital beds have been closed, with 37,000 fewer general and acute beds now than in 2006/7. Long stay NHS beds fell off the NHS under Margaret Thatcher, and with care homes closing every week due to debt and poor care, there simply isn’t the capacity in hospital or the community to cope with the demands of an ageing population. The UK’s hospitals are already among the fullest in the OECD, with occupancy above 90% and knock on effects for the safety of staff and patients.

Whoever’s job it is to explain their STP in public, my suggestion is to simplify it and be honest. Some changes are essential to provide high quality care (the amazing response of our emergency and trauma services to terrorist atrocities is not just down to the amazing staff, but because trauma care has been centralised to major centres rather than taking patients to the nearest A&E). Some changes are essential because services can no longer be safely staffed (the staffing crisis in the NHS has worsened post the Brexit vote and the junior doctor dispute, forcing emergency and maternity services to close or downscale due to safety). And some changes, to be blunt, are just about saving money to hit the £22 billion target (these are the ones that could make the service worse). Once STPs are explained in this way, we can have a debate about funding the NHS. If you want this type of service, it will cost you this much. If you want that type of service, it will cost you that much. Now how would you like to pay for it?

Author's Image

Phil Hammond

Phil Hammond is an NHS doctor, journalist, author, broadcaster, speaker and comedian. He qualified in 1987 and worked part time in general practice for over 20 years. For the past seven years he has worked in a specialist NHS team for young people with chronic fatigue. He presented five series of Trust Me, I’m a Doctor on BBC2, encouraging patients to be more involved, assertive and questioning. Phil is Private Eye’s medical correspondent; in 2012, he was shortlisted with Andrew Bousfield for the Martha Gellhorn Prize for Journalism for ‘Shoot the Messenger’, an investigation into the shocking treatment of NHS whistleblowers. In 2013 and 2014, he was judged to be one of the top 100 clinical leaders in the NHS by the Health Service Journal. As a comedian, Phil was half of the award-winning double-act Struck Off and Die, with Tony Gardner. He has done five solo UK tours, appeared on several TV shows, and has written five books.
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