Reassurance over STPs needed or NHS risks entering era of permafrost

The recent intervention by Simon Stevens to ensure that mass bed closures will not happen in STP areas unless alternative arrangements are put in place first is a very welcome and much-needed move, according to the president of the Royal College of Physicians (RCP), because without that level of reassurance the NHS will enter an “era of permafrost”.

Speaking at the RCP’s annual conference in Manchester, Professor Jane Dacre said that she believes one of the reasons for concern about the NHS’s future is linked to the “uncertainty facing us due to STPs”.

“There are 44 proposals across the country with the laudable aim of addressing health and wellbeing, care and quality, and finance and efficiency,” she explained.

“But from those we have seen so far, many are planning to cut beds – up to 30% of beds in their area. In the past two decades the numbers of NHS beds has already been reduced by 25%, and the only way we have been able to cope with increasing numbers of patients is by reducing the length of stay.

“We cannot do that forever. We cannot reduce the number of beds by 30% unless they are provided elsewhere. We have seen that even a mild winter, with no major epidemics, has not stemmed the constant flow of patients.

“I’m extremely pleased Simon Stevens intervened two weeks ago to make it clear that mass bed closures will not be permitted unless alternative arrangements for patients are put in place first. We need that reassurance, otherwise we will enter the era of NHS permafrost, where winter doesn’t go away.”

The NHS England boss recently stated that he didn’t foresee any new funding for the NHS in near future, and that was the case in last week’s Spring Budget. However, the chancellor did release some capital funding for advanced STPs and A&E triage pilots.

Reflecting on this, Dacre said: “It is clear from the lack of government action during the winter NHS pressures that no one is now going to help. No one is coming to the rescue, and no one is going to provide more funding.

“Last week, the chancellor chose not to give the NHS a penny more in the budget. I’m grateful for the increase in social care provision, which I hope will also go towards supporting people in the hospital – but it has been referred to as a sticking plaster. As with our patients, we are leaning towards self-management. The more I think about it, the more I fear that we are going to have to come up with the answers ourselves.”

Despite painting a bleak picture of the current state of the NHS, the RCP president acknowledged: “Most of the truly innovative transformations in care over the past decade have been developed by doctors. We need to harness the experience and intellect of physicians and patients working together, backed by the independence of the RCP as a royal college.

“As physicians, our voice can be powerful, but we all need to lift our heads above the parapet. I know we are struggling to maintain morale, but that will improve if we take more control of our situation.”

She also issued this rallying cry to the profession: “be those decision-makers, push your trusts into finding time for consultants and trainees to take part in decision-making, STPs, and ask the uncomfortable questions for your patients. Sort out your ward or clinic if it isn’t working well – get stuck in, you can do it. Don’t look back in five years’ time and regret that you hadn’t been more involved”.

(Image: c. RCP)

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