STPs – What are they all about? Why are we being kept in the dark?

The public haven’t been given any information about the STPs – the new area plans for changing NHS services. We have a legal right to be involved in, and able to influence, any major plans for the future of Our NHS services. Why are we kept in the dark?


National NHS Public Voice campaign is challenging the decision by NHS England and other NHS organisations to keep the wider public out of discussions and decisions about the future of Our NHS.

There are NO leaflets to explain what the Sustainable & Transformation Plans are all about.

There IS a page on the NHS England website that tells us a bit about why they are happening.  Here’s what they say:

  • “We are now able to treat people with new drugs and clinical care that wasn’t available in the past.”
  • “As life expectancy increases, so do the ailments of old age and there are now more people with chronic conditions like heart failure and arthritis.”
  • “There are also big opportunities to improve care by making common-sense changes to how the NHS works.”
  • “Improvements that matter, like making it easier to see a GP, speeding up cancer diagnosis and offering help faster to people with mental ill health.”
  • “With services feeling the strain, collaboration between organisations will give nurses, doctors and care staff the best chance of success.”

BUT they don’t mention that the money is the problem.  It’s all because the Treasury has refused to increase the money needed by the NHS to help meet the increasing need and the new technology for diagnosis and treatments.

Nor do they mention that the Plans require all services to find ‘efficiency savings’ out of their smaller budgets.

They also leave out the fact that the average annual increase of NHS funding of 4% over 60 years since the 1950s was reduced after 2010 to an average annual increase of less than 1%.

The crisis in the NHS has been a political choice.

SO in the absence of clear information for the public from NHS sources about the STPs we, the National NHS Public Voice campaign, N-NHS-PV, have written a basic STP information sheet.  stps-what-are-they-all-about


And here it is (with some links at the end):


Sustainability & Transformation Plans (STPs) – What Are They All About?

STPs are the NHS establishment’s answer to the Treasury’s refusal to increase the money for the health, and social care, services we need – with more people, and more needing care, in 2017 than ever before.  But it’s all being done on the quiet, in a rush, with no details and no democratic accountability – no legal back up so that we know who is responsible if things go wrong!


Why are STPs happening?

The last two Governments since 2010 reduced/cut the annual increase in NHS funding to less than 1%, after inflation, from an average of 4% over the lifetime of the NHS[1].

  • At the same time  training places for doctors & nurses have been reduced
  • And Bursaries for nurses have been turned into loans
  • All staff have had changes to their working conditions, including added workloads

BUT managers responsible for NHS services have to cope with:

  • Meeting the same quality and safety targets
  • With more people to treat & more treatments available to them
  • BUT with not enough money & not enough staff

They have asked for more money so services can still run – but the Treasury has refused


What have NHS leaders done to fix this?

In July 2013 Sir David Nicholson, the NHS boss, made a ‘Call for Action’ asking the public, professionals and politicians to say how could the NHS change to do the NHS cheaper

  • As the NHS had ‘increasing demand’ with ‘new technology’ but ‘flat funding’ (no more £s)
  • & if it doesn’t change, it’ll get a £30 billion ‘funding gap’ from 2013/14 to 2020/21 (7 years)

In October 2014, the new boss, Simon Stevens published his Five Year Forward View[2]

  • He said the same – but the £30 billion ‘funding gap’ was from 2015/16 to 2020/21 (5 years)
  • He suggested new ways of delivering services called ‘New Models of Care’

In January 2015 groups of NHS service providers were selected to start trying out some New Models of Care[3] – e.g. emergency services, community services, etc.

In December 2015 a new Planning Guidance[4] introduced the idea of the STPs

In 2016 local NHS planners, CCGs[5], had to work together in 44 areas across England to plan services for the next 5 years (till 2021) across bigger populations, extra work

BUT all NHS services have to make large ‘efficiency savings’ to help fill the ‘funding gap’


What is an STP?  (Sustainability & Transformation Plan)

  • It’s a PLAN to TRANSFORM health & care to be SUSTAINABLE for the next 5 years
  • England has been split into 44 areas, of up to 3 million people, for NHS & care decisions.
  • Each area has to SAVE money by making ‘efficiency savings’ with target sums to save
  • Local NHS planners, CCGs, joined up to PLAN health & care for a bigger area = the STP
  • A ‘Local Place Based Plan’ describes how services will look in each CCG’s local borough

BUT the joined up CCGs ‘committees’ have NO legal status to decide all our services & are NOT accountable, NO-ONE knows yet who WILL BE accountable if things go wrong!


What services will be in this STP?

  • Each STP covers NHS services, Social Care and Public Health
  • Each STP includes services provided by many organisations in the area it covers
  • NHS – GPs, Hospitals, Community nurses, Mental Health, Dentists, Opticians, Chemists..
  • Others – Councils ( Social Care & Public Health), Charities, AND the Private sector

Such as a South Yorkshire & Bassetlaw STP (of 5 CCGS working across 5 boroughs) it has a target sum to find, £571million savings before 2021


What will they mean for hospital services?

  • There won’t be enough money to keep things as they are – so things will have to change
  • To meet quality & safety targets services are being centralised – local services will close
  • This will put pressure on the centralised services – more people to treat – who are more ill
  • This will mean their mortality rates are likely to go up = more people will die
  • Nationally the plan is to reduce staffing and reduce hospital beds – to save money
  • So more hospitals will have to close to new patients – they will become full more quickly
  • This will ‘clog’ the system as the space & staffing will be overstretched – more often
  • Many medical staff are retiring early or leaving because their workload is impossible


What will they mean for community services?

  • There isn’t enough money to keep things as they are – so they won’t set up more services
  • As hospitals take fewer patients there will be more people needing community services
  • Services will have to see more people & still meet quality & safety targets – no extra cash
  • Rather than increase waiting lists, it’s likely they’ll change who can use the services
  • There is no more money for more services so existing services will be overstretched
  • Many smaller services that help keep people well may not continue to be funded
  • Many smaller services that help people when they are unwell may not be funded
  • Mental health service support will only offer time limited services, open access will go
  • People may not have the mental services they trust available when they are reaching crisis
  • Many medical staff are retiring early or leaving because their workload is impossible


What will they mean for patients & the public?

  • We will lose many of our local services that we trust, we rely on and we know the staff
  • We will have to travel further for treatment, even in an emergency – with greater risks
  • Our families will have to travel further to visit us or be with us in an emergency
  • This is at a time when public transport is less subsidised, less available & more expensive
  • Centralised hospital services will be very busy, we’ll wait longer and we may not get a bed
  • Evidence finds that centralised emergency services admit more patients who are more ill
  • Evidence finds a need for more beds in trauma centres – but bed numbers are being cut
  • Evidence finds more inpatients die in centralised hospitals near A&Es that have closed



NOTES – to explain some of the information 

[1] See the Kings Fund’s article on historical increases & analysis of figures on NHS budgets for last two decades

[2] See the Five Year Forward View which includes information about the New Models of Care

[3] See the New Care Models pages of the NHS England website

[4] See the Planning Guidance that introduced the STPs (Sustainability & Transformation Plans)

[5] CCGs=Clinical Commissioning Groups – they receive NHS funds to pay for services needed in their Local Authority area



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