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Plans a critical assessment

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The Sustainability and Transformation Plans: a critical assessment care they deliver (‘payment by results’), a reduction in caseload in one service can trigger the collapse of viability of related services and pull the financial rug from already indebted trusts. Conclusion At the end of the day, when the innovations in STPs don’t deliver savings for the NHS, NHS England will again resort to cuts and rationing. Indeed many knowledgeable people see the STPs as a smokescreen to divert attention from cuts at trust level, whittling away staffing levels, imposing smaller-scale service reorganisations, and preparing to push through controversial closures on ‘safety’ grounds (as has happened in Grantham and Chorley and is increasingly on the cards in Ealing). Up to half of most STPs’ planned savings are in any case to be squeezed out of the hospital sector, through ever more relentless ‘efficiency savings’ and reductions in staffing levels, along with closures of beds, services and even whole hospitals. With no alternative services in place, and no capital available to build new or extend existing hospitals, 19 and with even community hospital beds and staff facing cuts, it is a recipe for a chronically under-resourced, chaotic and scandal-prone NHS. Promoting STPs may seem an easier course of action for NHS England than to warn Mrs May that if the cash freeze begun in 2010 is extended to 2020/21, many services will collapse. We know that Simon Stevens’ effort to do this after she became Prime Minister was met with a frosty reception 20 . But STPs cannot solve the problem of inadequate funding. Ministers will have to fund the NHS properly or take political responsibility for its collapse. 14

The Sustainability and Transformation Plans: a critical assessment References 1 https://www.england.nhs.uk/wp-content/uploads/2016/09/NHSoperational-planning-guidance-201617-201819.pdf 2 http://www.healthcampaignstogether.com/STPplans.php 3 Brennan, S. Leaked STP reveals region cannot meet control totals Health Service Journal 9 Decemberhttps://www.hsj.co.uk/7014062.article?utm_source=newsletter&utm_ medium=email&utm_campaign=Newsletter307&mkt_tok=eyJpIjoiTURkbU9UR TNZakJoTXpBeCIsInQi- OiJVKzZZR1BBRnRNV08zRlhJNDF0VW5jVDFsVUg1WWpEa2Rwd1ptd29s THFqZWJ5YjZyMCs4NjBFNUZPOTdFQ0RmY0drWk8ydEk2Ynp0cXU0aThI QjNrSVM2SEZOZmRFVUp1QWFwMXppVXBISHlqY01iWFBac2U5RVdBU1 ZNNzdHSSJ9 4 http://www.healthcampaignstogether.com/pdf/Herts%20&%20West%2 0Essex.pdf pages 12-13 5 http://www.liverpoolecho.co.uk/news/liverpool-news/mayoranderson-comes-out-fighting-12264453 6 Gainsbury S (2016) Feeling the crunch: NHS finances to 2020. Nuffield Trust, http://www.nuffieldtrust.org.uk/publications/feeling-crunch-nhsfinances-2020 7 Gainsbury, S (2016) Behind the numbers: NHS finances, a Nuffield Trust blog October 18, http://www.nuffieldtrust.org.uk/blog/behind-numbersnhs-finances 8 https://www.england.nhs.uk/wp-content/uploads/2016/12/item-7-15- 12-16.pdf 9 Robertson R. (2016) NHS rationing under the radar, Kings Fund blog, August 17, available https://www.kingsfund.org.uk/blog/2016/08/nhsrationing-under-radar 10 https://www.theguardian.com/society/2017/jan/09/nhshumanitarian-crisis-conservatives-british-red-cross 11 https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfvweb.pdf 12 Kaffash J., Matthews-King, A. (2016) Why Hunt's pre-election promise of 5,000 new GPs is a long way off. Pulse, 28 March, available http://www.pulsetoday.co.uk/your-practice/practicetopics/employment/why-hunts-pre-election-promise-of-5000-new-gpsis-a-long-way-off/20031461.fullarticle 13 Barnes, S. (2014) Integration will not save money, HSJ commission concludes, Health Service Journal, 19 November, 2014 available http://www.hsj.co.uk/news/acute-care/integration-will-not-save-moneyhsj-commissioncon- 15

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