News

Concern as STP investigation reveals potential hospital closures

The initiative intended to solve the financial and services problems besetting the NHS has come under fire after it emerged that it could lead to major services being closed.

Campaign group 38 Degrees published the results of a crowd-funded investigation into the sustainability and transformation plans (STPs) currently being drawn up by local health and social care organisations.

The uncovered proposals include merging two hospitals in the Black Country, closing a hospital in Leicester, Leicestershire and Rutland and closing an A&E at Shrewsbury or Telford.

Chris Ham, chief executive of the King’s Fund, said evidence shows that “major reconfigurations of hospital services rarely save money and do not necessarily improve care”.

“It would be a huge shame if a vital opportunity to improve services for patients is derailed by bruising rows about ill-conceived hospital closures,” he added.

‘Hard to see’ how bed cuts can be achieved

A number of STPs also proposed reducing acute bed capacity, with 500 beds to be lost in North West London and 240 in Dorset.

Ham said: “It is hard to see how this can be done with demand for hospital care rising inexorably, bed occupancy already at eye-wateringly high levels and services outside hospital not in a position to provide an alternative after years of under-investment.”

He added that the STPs “will not be credible” unless they show how they will provide money and funding for services outside acute hospitals.

Lara Carmona, associate director – policy, international and parliamentary at the Royal College of Nursing, said: “Where changes are made, they must be fully scrutinised to ensure that care is shifted to meet demand rather than simply reduced to save money. This includes listening to the patients, nurses and other clinicians who can directly match local need and local decisions.

“Staff, patients and their loved ones can see the cracks widening in the NHS, and the complex changes in demand. Until NHS finances can be placed on a better long-term footing, there is a danger that poor long-term decisions could be made in order to plug financial gaps in the short term.”

The report comes after growing concerns that STPs are being diverted from their original purpose into cost-cutting measures.

Former life sciences minister George Freeman admitted recently that STPs have no legal basis and that the original June deadline was not binding.

Health secretary Jeremy Hunt then said their purpose was “very simply” to reduce hospital bed days, appearing to water down their purpose.

The BMA warned this week that STPs risk being used to “starve services”. And a recent survey of NHS financial directors found that just 16% thought their organisation could deliver a sustainable STP by 2021.

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

In a blog post this week, Nigel Edwards of the Nuffield Trust said that STPs are failing to meet their financial targets and could simply lead to patients being “shifted into community settings”.

‘Limited’ public involvement

In addition, the 38 Degrees report criticised STPs for being implemented with a lack of input from local communities.

“Although the STP process requires local NHS leaders to come together develop plans, the extent of ‘coproduction’ with patients and the public appears to have been limited, perhaps necessarily by the punishing timetable for the development of these plans,” it said.

Andrew McCracken, head of communication at campaign group National Voices, said: “Health and care services need to change, but those changes must be made with local communities, not behind closed doors.

 “The current system is struggling to meet people’s needs. Changes to services should not simply be about finances, they must be about developing services that are safe, effective and support people to live well.

“Properly embraced from the start, the insight, experience and expertise of citizens can make services better tailored, more sustainable, and ensure that service changes command legitimacy.”

An NHS England spokesperson said: “This is a unique exercise in collaboration. It is hardly a secret that the NHS is looking to make major efficiencies and the best way of doing so is for local doctors, hospitals and councils to work together to decide the way forward in consultation with local communities.

“Proposals are at a draft stage but we expect all local leaders to be talking to the public and stakeholders regularly –it is vital that people are able to shape the future of their local services.

“No changes to the services people currently receive will be made without local engagement and, where required, consultation.”

Have you got a story to tell? Would you like to become an NHE columnist? If so, click here.