Sustainability and Transformation Plans in England and the Funding Crisis in Our NHS

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2017 Health Care Service Group Conference
13 December 2016

Health Conference notes with alarm the growing crisis of underfunding in our NHS. The King’s Fund has reported that the share of Gross Domestic Product (GDP) spent on health has dropped from 8.8% in 2009, to 7.3% in 2014/15, and is projected to be just 6.6 percent in 2020.

Conference condemns these cuts that do not match the public’s spending priorities and are the root cause of the increasing work pressures on our members.

Health Conference notes that the crisis is such that public calls for more funding have been made by NHS Providers’ Chief Executive Chris Hopson, Chair of the House of Commons Health Select Committee Sarah Wollaston, and even former Health Secretary Andrew (now Lord) Lansley.

It is in this context of underfunding that NHS England has set up 44 newly-defined sub-regional areas to develop ‘Sustainability and Transformation Plans’ (STPs). NHS providers, NHS commissioners and local authorities have been set the task of formulating plans to integrate health and social care services for their ‘footprint’ area.

Health Conference believes that sub-regional planning of this type is an important and useful method of organising services – where it relies on collaboration rather than competition.

However, Health Conference condemns this STP process because:

1) Decision-making is being done without public scrutiny and without clear lines of democratic accountability.

2) The funding environment and the requirement for STPs to make a combined saving of some £22bn in England means that this is a process of planning for cost reductions rather than for service improvements.

3)Some STP plans include proposals to privatise clinical support services and “back office” admin; and to establish Accountable Care Organisations (ACOs), the model preferred by US private healthcare, to manage all care in a locality, ACOs could themselves be privatised.

4)The hospital reconfigurations, A&E downgrades, and transfers of care from the acute to the community sector, are not based on rigourous evidence from peer-reviewed evaluations of pilot studies; they are a massive gamble driven by the Treasury.

Health Conference is particularly concerned that inadequate funding will result in the STPs leading to local controversies about where the deepest cuts to services should take place. Conference believes that there is a danger that public attention could be distracted from the true cause of the cuts – decisions taken by central government to underfund and privatise the NHS.

Health Conference calls on the Health Service Group Executive to:

a)Campaign to highlight the Government’s underfunding of the NHS.

b)Work with branches and regions in efforts to keep the focus of public anger at service reductions and privatisation on central government decisions.

c)Condemn the lack of openness and transparency in the formation of the STPs

d)Support branches and regions in strongly opposing proposals which lead to the erosion of health and social care services, reduction of jobs and/or the erosion of terms and conditions, and further privatisation.