The wider public started to hear about STPs (Sustainability & Transformation Plans) in the late spring of 2016. These are now required by the newly formed ‘footprints‘ which are made up of large groups of health and social care organisations in order to plan services on a larger scale, for a much larger area and population than the statutory CCGs (Clinical Commissiong Groups) that plan and contract NHS services at borough level.
This new public awareness of previously secret changes in the NHS was combined with the growing publicity about the Junior Doctors’ dispute over unsafe contract changes, the lack of funding for the NHS and the growing hospital debts.
Hospital Trust Finances (Green = surplus & Red = deficit)
It was also becoming increasingly clear that the department of health was not willing to fund the increased demand for NHS services. This predictable demand is due to an ageing population, where people live long enough to suffer from more long term conditions, and to more people surviving life-threatening conditions as there are more successful diagnostics and treatments resulting from medical research.
The work on the ‘Vanguard sites‘ was also becoming more visible to the public. These ‘Vanguards’ were set up across England in 2015 as a number of NHS providers worked together to test out the ‘new models of care’ proposed in the 2014 NHS England Five Year Forward View. People were becoming aware of this work mainly due to the fact that many Vanguard proposals were to centralise their area’s Urgent and Emergency Care services resulting in plans to close many local A&Es around the country.
All the documents, and guidance letters from NHSE England said that ‘engagement’ with the public was crucial to the success of the STPs and the New Models of Care, particularly in the early stages. Such as the guidance letter dated 16th February 2016 which says:
“If we get this right, then together we will:
engage patients, staff and communities from the start, developing priorities through the eyes of those who use and pay for the NHS;”
However there was no public, or patient information about any of these changes, nor any involvement in the decisions to restructure local services either at an early, or at any, stage.
Informed campaigners worked hard to enlighten the public and the 38 Degrees pressure group worked with the Guardian newspaper leading to the headline on 26th August 2016:
“The NHS secret is out. And local communities won’t like it.”
This started a public outcry which grew as the message was repeated across the media. Campaigners, including those from N-NHS-PV (the National NHS Public Voice campaign), continued to challenge NHS England, about their local ‘footprints’ and their CCGs about the lack of public information on the proposed changes, together with a lack of patient and public involvement in the planning of them.
In Manchester, on the 7th and 8th of September, the NHS EXPO was held. This was a showcase for providers in the so called ‘health economy’. Campaigners, including from N-NHS-PV, challenged NHS England at various EXPO sessions, in public, about the secrecy of the Five Year Forward View plans through the Vanguards, New Models of Care and STPs. NHS England senior executives were very defensive, tight lipped and gave no answers or reasons.
However one week later, on 15th September 2016, a document was published by NHS England that required the STP collaboratives to ‘engage’ with patients and the public. This document, Engaging Local People – a guide for local areas developing Sustainability & Transformation Plans was given a very high profile on the NHS England website, and inserted at the bottom of the webpage about support for STP footprints. This document, however had not been mentioned the week before at the NHS EXPO – or even appeared to exist.
This document claims that it outlines how the:
“public bodies with responsibility for the STPs have a variety of legal duties including to involve the public in the exercise of their statutory functions”.
It goes on to say that:
“Not doing so effectively is likely to cause legal challenge and lengthy delay.”
It then repeats this message throughout the document, and on P13 it says that:
“failure to appropriately involve patients and the public in plans may lead to judicial review and criticism, regardless of any resource constraints.”
This focus on legal challenge may be linked to a Freedom of Information request sent by N-NHS-PV campaigners to NHS England in July 2016 regarding involvement of the public in the Five Year Forward View implementation, and the STPs. This Freedom of Information request has still not been answered.
It is clear that, during the summer of 2016, the voice of the public, supported by N-NHS-PV, held NHS England to account for not making sure that the public are involved in the implementation of the Five Year Forward View proposals.
NHS England had funded an NHS Citizen website since 2013 which included a public discussion forum called ‘Gather’. However this forum was closed overnight at the end of May 2016 – and with it went the only national public space within the NHS in England where open discussion about current NHS issues was possible for patients and the wider public.