News / King’s Fund: government needs to back sustainability plan proposals

27 February 2017 Seamus Ward

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Although sustainability and transformation
plan (STP) areas must step up their engagement with staff, the public and patients, the government should back evidence-based proposals, even if this means substantially changing the role of a hospital, the King’s Fund said.

News - Kings Fund report

In its report on STPs, Delivering sustainability and transformation plans, the fund said the 44 plans offered the best hope of delivering essential reforms of the NHS. They are an opportunity to move care out of hospital and closer to patients’ homes and also to stem demand for hospital care.

Its analysis of the 44 STPs found that all areas proposed delivering more services in the community and aimed to boost their preventative work by, for example, addressing unhealthy lifestyles and promoting better mental wellbeing. As a consequence, some planned reductions in hospital numbers and cuts in the number of beds. Others looked to centralise services such as stroke and maternity on one site. 

Some centralisation of care has been prompted by workforce shortages, which means all existing services cannot be staffed adequately, and a need to become more efficient. Other STPs wish to reorganise services to improve quality. In stroke care, for example, an overhaul of London’s services in 2010 moved care to eight hyper acute units and the capital’s stroke services are now regarded as world class.

Chris Ham, King’s Fund chief executive, 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 fund said plans to reduce hospital capacity would not work unless steps were taken to boost community and primary care services. Cuts in social care and public health budgets will make it difficult to strengthen services in the community and give greater priority to prevention, it warned.

The report called for greater realism about the time it will take to deliver changes. NHS Confederation chief executive Niall Dickson agreed that patience would be needed but that health and social care were working together to change the delivery of care. However, the report provided more evidence that social care needed more funding urgently. 

‘The government and NHS England deserve credit for putting in place a process and a large number of important schemes to transform services – but there is a need for patience for these and other initiatives to bring about the necessary change. What is being asked of local organisations is unprecedented and the STPs are having to drive this forward in extremely difficult circumstances,’ he said.

Service change

 A BBC analysis of STPs said the plans could lead to cuts or reductions in hospital services in nearly two-thirds of the areas. It highlighted 28 proposed changes to hospital services, ranging from full closure to centralisation of services, including A&E, on fewer sites. These included an option of a single site for maternity in Lincolnshire and a proposal to reduce the number of acute hospitals in Leicestershire, Rutland and Leicester from three to two. 

It said a third of the 44 plans proposed reductions in the number of hospitals providing emergency care, while another third planned to consolidate elective care to fewer sites.