STPs – The future of the NHS?

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2017 National Delegate Conference
22 February 2017

Conference notes that despite their often bland phrasing and heavy cosmetic decoration with proposals for improved integration of services, collaboration between providers and with commissioners, and public health measures which we could all endorse, the 44 Sustainability and Transformation Plans (STPs) in England represent proposals for over £24 billion of cuts, “efficiencies” and “savings” by 2020-21, which can only be at the expense of health workers and patients.

While some STPs pull up short of spelling out explicit plans for rationalisation, reconfiguration, back office consolidation, bed cuts and staffing reductions, most of them set course in that direction and seek to enlist local authorities in support of plans that will reduce access to services for many of the local communities they are elected to represent.

UNISON notes that while many STPs contain plans for new hospitals, expansion of existing hospitals, new community facilities and new ‘digital’ services, there is little or no NHS capital available to fund these developments, leaving many of them an empty promise, alongside a real plan for cuts in existing services.

UNISON opposes austerity-driven cutbacks in hospital, community and mental health services, whether these be presented in the form of STPs or less overt moves towards reconfiguration, cost-cutting and consolidation by trusts. We agree to support national campaigns on this and campaigns to defend local access to hospital services until new, superior, alternative evidence-based services are developed, properly staffed and funded, that ensure safe and improved services for patients.

Conference also supports the TUC campaign for an end to the seven years of real terms funding freeze that is squeezing the life out of our NHS, reducing performance on key services, and undermining public confidence in the NHS – with the threat of four more years to come. Conference calls for funding to be increased immediately from the current disastrous level with further increases year by year towards the levels of comparable European and Organisation for Economic Co-operation and Development (OECD) countries, and for an end to the waste of billions on a competitive market system.

While endorsing the aspiration to greater integration of health and social care for the benefit of patients, UNISON notes that the application of means-tested charges for social care, the extent of the enforced cutbacks in budgets and raised eligibility thresholds, coupled with the fragmentation and privatisation of most domiciliary care and the private ownership of nursing homes prevents integration with an NHS that is still funded through general taxation and free at point of use.

Although in principle we welcome NHS England’s moves to reverse, or in some cases override the Lansley Health and Social Care Act, restore strategic planning and develop a fresh collaboration between competing trusts, UNISON notes that the Act remains in place. As a result many irresponsible Clinical Commissioning Groups (CCGs), not least in Staffordshire, are continuing to contract out services, some awarding fresh contracts to Virgin and other private sector providers even as other contracts end in failure. STPs do not reverse the Act, and cannot eradicate the divisive market system deepened in 2012.

UNISON therefore will work and campaign for new legislation, such as the NHS Reinstatement Bill, that is promoted in the Commons by Margaret Greenwood MP, to reverse the 2012 Act, dismantle the costly and wasteful NHS market system, and restore the NHS as a service publicly financed, publicly owned and publicly provided.