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Stevens urges critics to ‘get behind’ STPs

Sustainability and transformation plans (STPs) are vital to delivering joined-up care, the CEO of NHS England said today in his keynote address at NHS Expo.

Simon Stevens cited Amdahl’s law, a computing concept that states that an increase in a system’s speed will always be limited by the speed of the slowest part.

He said the conversation around STPs was “precisely about addressing this kind of linkage in all parts of the country” by helping the weakest part of a health system catch up with the others.

STPs have attracted controversy since their genesis, with a recent investigation by campaign group 38 Degrees finding that they could lead to hospital closures in many places, and criticising them for a lack of public involvement.

However, Stevens said: “I hope that people will then give local NHS and local government leaders the recognition that what they’re trying to do is something incredibly difficult but incredibly important.”

He pointed out that in 2013, the NHS was criticised after the Competition Commission prevented a merger of Royal Bournemouth and Christchurch Hospitals and Poole Hospital trusts.

“It’s therefore, I think, incumbent on those people who made the criticism of the impact of those competition rules on sensible planning and population improvement to get behind the STP process in places like Dorset,” Stevens said. “When they are now precisely doing the opposite of what was required a couple of years ago and are saying: ‘Yes, we are going to have a planned, integrated set of hospital services in Bournemouth and Poole’. If it was right to criticise the fragmentation and competition that kept those two apart, I hope those same people will now back a holistic approach to population planning that STPs are bringing about.”

He said that next week, every part of the NHS will receive a reminder about the need for formal, public consultation on the STPs, including input from local charities and voluntary groups.

Stevens praised the adoption of integrated care in areas such as Tameside, where the council chief executive was recently appointed as the interim accountable officer of NHS Tameside and Glossop CCG

When asked about the impact of social care cuts in Tameside, he said: “We’re not in the land of milk and honey but the best way of answering that question in Tameside is a joined-up approach rather than a beggar-my-neighbour approach.”

An investigation by NHE’s sister title Public Sector Executive then found that health devolution in Manchester seems to been more successful at delivering integrated care than the STPs.

Need to ‘get digitisation right’

Stevens also spoke about NHS digitisation, which he said must be implemented with care to avoid a “trough of disillusionment” when it fails to live up to hype.

“We have got to get digitisation right,” he said. “That doesn’t mean doing it fast.”

In addition, he said that the NHS must “get much more serious about the support we give patients directly”.

Stevens said that England will become the first country in the world to introduce a digital diabetes programme, which “could reach hundreds of thousands more people” than the newly launched Diabetes Prevention Programme.

He also said that the NHS should take advantage of the “unexploited advantage” of data sharing, which could be used to prevent deaths from problems such as sepsis and acute kidney injury.

He praised the “thoughtful and pragmatic” Caldicott report, which he said had set out a balance of data sharing and regard for patient safety, and Bob Wachter’s new review of NHS technology, also unveiled at the conference, for providing a blueprint for “clinical infrastructure at hospital level, linked with what’s happening in general practice.”

‘Not possible’ to guarantee patient safety during junior doctor strike

In response to a question about the planned five-day junior doctors’ strikes, Stevens said NHS England had asked all trusts to assess the impact of the strikes, and would ask them to do so again.

However, he added that there was now “no guarantee” that trusts would be able to mitigate the effect of the strikes without an impact on patient safety.

“We should be in no doubt that it will not be possible to ensure that there will be no harm to patients", he said.

“Even with several weeks’ notice, you really are talking about multiple weeks of up to 50,000 doctors not being available for emergency care at hospitals across this country. The vital importance of junior doctors to the NHS cannot be underestimated and so it is not just about the notice period, it is about the impact that that action would have.

“No good for patients will come out of the kind of action that is still on the table. Patients who needed their outpatient appointment or their operation are having those deferred and where it’s a day or two then hospitals have been able to cope, but when it’s repeated blocks or perhaps five days at a time, the potential impact for urgent care and knock-on for patients who have very substantially high-risk conditions is far greater.”

(Image c. Owen Humphreys from PA Wire)

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