NHS sustainability plans
unlikely to work without greater government commitment
LOCAL sustainability and transformation
plans (STPs); designed to transform the way health and social care services are
organised, delivered, and used across England; are unlikely to work without a
much greater commitment from government, warns an expert in The BMJ.
Kieran Walshe, Professor of health policy and management at the University of
Manchester, argues that while STPs aim to keep people well and help them to care
for themselves, and use health and care services more appropriately, there are
four main problems, which if not resolved make it unlikely that these plans will
1st, he warns that they are being launched at a time of huge, unprecedented
levels of financial constraint and challenge in the NHS, which will require
2nd, he argues that the plans have been written in a rush, and professional and
public consultation and engagement have been largely neglected, resulting in
and opposition" from the medical profession, the public, and the media.
3rd, he says these plans have no statutory force or authority, adding that the
Health and Social Care Act 2012 "contains a host of provisions on
competition and market access that make these changes open to legal challenge
and difficult to implement."
Finally, these plans are founded on the sound idea that we should bring health
and social care services together, but he points out that:- "social care
services are funded separately by local authorities, whose funding has been cut
by 37% in real terms over the last 6 years."
Fixing these problems and giving STPs a real chance to succeed requires action
from government, writes Walshe..
He therefore calls for government action to provide realistic transitional
funding for the changes and to give political backing to the changes and allow
for proper consultation at a national and a local level.
He also calls for legislation to remove the competition and market access
provisions of the Health and Social Care Act and to allow for statutory bodies
to be created to lead STPs.
Finally, he suggests the government tackle the health and social care divide by
implementing the recommendations of the Barker commission for a single system of
funding to commission health and social care.
"The NHS and its leaders have done what they can to map out a sustainable
future health and social care system for England. But without a much greater
commitment from government, it seems very unlikely that these plans will work,"