Significant changes to health care services are no longer hidden

The public debate about what NHS services need to look like in order for the country’s most cherished institution to survive is now under way, and not before time.

There is, however, only a very short time window for any public consultation.

The GPs who have been involved in drawing up these five-year plans have roles on clinical commissioning groups (CCGs) and do not necessarily represent the views of their peers.

This has generated criticism as there appears to have been little input from grassroots GPs.

Like other STPs, its key priorities are prevention, early intervention, self-care and reducing health inequalities as well as primary, community and acute care collaboration.

All worthy goals, so why keep the plan secret for so long?

Reconfiguration of hospital services – NHS-speak for shutting things such as A&E and maternity units – is a key part of their plans.

NHS Improvement last month told the leaders of the 44 STP footprints to plan for “the consolidation of unsustainable services”.

The growing fear among NHS campaigners is that the definition of “unsustainable” has already been agreed behind closed doors, and that it will lead to a huge reorganisation of NHS services.

But care still has to be provided somewhere and that still costs money.

The greatest danger of STPs is that they become the focus not of improvement or innovation, but of cost-cutting: moving bottle-necks of demand from one setting to another and leading to poorer health services.

The plan talks of discharging patients as soon as they stop needing hospital care (but lacks detail on how our social care crisis and financial pressures would pose obstacles) and shifting care to community settings. 

Crucially, for services to be delivered outside rather than inside hospitals there has to be enough capacity in GP and other community-based forms of care.

There isn’t, especially with family doctors already struggling to meet demand. They have no spare capacity. There are also too few staff across the NHS to make this bright new dawn a reality.

All these practical considerations may prove even more significant obstacles to the implementation of this covert reorganisation of the NHS than public and political concern.

The STP groups are not organisations. They are footprints – lines on maps. T – there’s no building with a name on the door. There are too many silos of influence, especially when adult social care, which desperately needs to be integrated into the NHS, remains parked firmly with local councils. They could make more sense if we move to a unitary management like Manchester, but that is a long way away.

It is unusual to find what are in effect high-level talking-shops expected to tackle the biggest problems in the NHS and then internally agree push through changes that no one pretends will be popular.

The fact that they are non-statutory bodies and have no formal power – and, crucially, their reliance on reaching agreement among bodies with sometimes different agendas – could yet prove a flaw.

What happens if a hospital which is set to lose a much-loved A&E or maternity unit as a result of an STP decides to go to court to thwart it, or a council rejects the need for adult care integration? The cooperation vital to the whole programme would disappear.

We need much more practical detail on the Hampshire STP before we should move to support it, especially on the savings to be made, and new staffing plans the sooner the better, and the public need to be intimately involved, which at the moment they are not.

John Chandler, Southampton.