The government must be prepared to back radical changes to health services to secure the future of the NHS, according to a new analysis of sustainability and transformation plans (STPs) published by The King’s Fund.
The report argues that STPs offer the best hope of delivering essential reforms to NHS services. The proposals that have been put forward now need to be developed into credible plans focused on the most important priorities in each area. Much more effort must be put into engaging NHS staff, patients and the public, local authorities and others in developing these plans.
The King’s Fund calls on the government to support reforms to services where the case for change has been made. This includes changes to the role of acute hospitals to concentrate specialist services where the evidence shows this will deliver better outcomes for patients. The report also argues that additional investment in social care and the NHS will be needed to deliver the proposals set out in STPs.
The analysis of all 44 STPs finds:
- all plans aim to deliver more services in the community, including by putting GPs at the heart of networks bringing together primary care, community services and social care
- some plans include proposals to reduce the number of hospitals, cut hospital beds and centralise some services on fewer sites
- all STPs include ambitions to give greater priority to prevention, for example by tackling unhealthy behaviours and promoting mental wellbeing
- STPs aim to improve productivity and efficiency and in so doing close the NHS funding gap
- a number of STPs highlight the impact of staff shortages, and many propose new roles such as care navigators, nurse associates and physician associates to support shifting care out of hospitals and into the community.
The report argues that STPs present an opportunity to move care closer to home and moderate demand for hospital services. However, it says that proposals to reduce the number of hospital beds are not credible unless investment is first made in services in the community. This includes making better use of existing community services through greater integration of the full range of out-of-hospital care. It warns that cuts in social care and public health budgets will make it difficult to strengthen services in the community and give greater priority to prevention.
The King’s Fund emphasises that the context in which STPs have been developed is much more challenging than when the NHS five year forward view, which set a vision for the future of the health service, was published in 2014. There is a risk that the focus on tackling financial and operational pressures will divert attention from work to transform care. There needs to be greater realism about the time needed to implement the changes that have been put forward and the leadership and governance required as STPs move to implement their proposals.
Chris Ham, Chief Executive of The King’s Fund, said:
‘It is not credible for the government to argue that it has backed the NHS’s own plan unless it is prepared to support changes to services outlined in STPs. Local plans must be considered on their merits, but where a convincing case for change has been made, ministers and local politicians should back NHS leaders in implementing essential and often long-overdue changes to services. A huge effort is needed to make up lost ground by engaging with staff, patients and the public to explain the case for change and the benefits that will be delivered.’
Responding to the report Chairman of the Local Government Association’s Community Wellbeing Board, Cllr Izzi Seccombe, said:
“We back the King’s Fund in warning over the cuts to councils’ social care and public health budgets, and share the concerns over how we can provide care in the community, improve prevention services, and keep people out of hospital.
“Councils see STPs as an important vehicle in redesigning local care and health services to improve health and wellbeing, and the quality of care.
“But we will be unable to achieve this without genuinely new money for social care. It is only by properly investing in social care that we can alleviate the pressures on the NHS.
“The report also rightly highlights the need to put more effort into engaging the public and local authorities in the plans.
“We have long warned that STPs can only be effective if councillors and communities are at the heart of the planning process. It is vital they are involved and not just consulted afterwards on pre-determined solutions. Any failure to engage councillors could lead to vociferous opposition.”