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STP proposals to cut beds not credible without community investment

Process ‘rushed and behind closed doors’; funding to carry out plans simply not available

Louise Prime

Tuesday, 21 February 2017

Sustainability and transformation plans (STPs) offer the best hope for delivering essential NHS reforms but proposals to reduce the number of hospital beds are not credible without prior investment in community services, The King’s Fund insisted this morning. The BMA warned that vital funding to carry out the plans “simply isn’t available” and argued that from the beginning, the process has been rushed and carried out largely behind closed doors.

The King’s Fund, an independent health policy charity, said in Delivering sustainability and transformation plans that the government must be prepared to back radical reforms to health services to secure the future of the NHS – including changes to the role of acute hospitals, concentrating specialist services where the evidence shows this will deliver better outcomes for patients.

The report’s authors said STPs present an opportunity to move care closer to home and to moderate demand for hospital services, but they said that “proposals to reduce the number of hospital beds are not credible unless investment is first made in services in the community”, for example making better use of existing community services through greater integration of the full range of out-of-hospital care.

They warned that cuts in social care and public health budgets will make it difficult to strengthen services in the community and give greater priority to prevention, and that additional investment in social care and the NHS will be needed to deliver the proposals set out in STPs. And they called for much more effort to be put into engaging NHS staff, patients and the public, local authorities and others in developing the plans.

Their analysis of all 44 STPs found that:

  • All plans aim to deliver more services in the community, including by putting GPs at the heart of networks bringing together primary care, community services and social care.
  • Some plans include proposals to reduce the number of hospitals, cut hospital beds and centralise some services on fewer sites.
  • All include ambitions to give greater priority to prevention, for example by tackling unhealthy behaviours and promoting mental wellbeing.
  • A number highlight the impact of staff shortages; many propose new roles such as care navigators, nurse associates and physician associates to support shifting care out of hospitals and into the community.

The King’s Fund chief executive Chris Ham said: “It is not credible for the government to argue that it has backed the NHS’s own plan unless it is prepared to support changes to services outlined in STPs. Local plans must be considered on their merits, but where a convincing case for change has been made, ministers and local politicians should back NHS leaders in implementing essential and often long-overdue changes to services. A huge effort is needed to make up lost ground by engaging with staff, patients and the public to explain the case for change and the benefits that will be delivered.”

The BMA said the STP process could have offered a chance to deal with the NHS’ increasing problems such as needless competition, expensive fragmentation, and unfit buildings and equipment – but, as The King’s Fund report shows, efforts to transform care will be crowded out by  the work to sustain services.

BMA Council chair, Dr Mark Porter, said: “We already know that the vital funding needed to carry out these plans simply isn’t available. From the beginning, this process was rushed and carried out largely behind closed doors, by health and social care leaders trying to develop impossible plans for the future while struggling to keep the NHS from the brink of collapse.”

He went on: “Given the scale of the savings required in each area, there is a real risk that these transformation plans will be used as a cover for delivering cuts, starving services of resource and patients of vital care.”

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