NHS England has told local health leaders to keep sustainability and transformation plans (STPs) secret from the public until they are finalised, analysis by the King’s Fund has discovered.
STPs have been devised in 44 areas of England as strategies to reduce costs, change services and improve care in the face of the £2.45bn NHS deficit.
Some of the plans have been published or leaked, revealing that some hospitals, A&E units and maternity units could face closure, with other services being forced to merge.
The plans, which could lead to hospital and A&E closures, have not been announced to the public and frontline staff has not been involved in the decisions.
The report claims that NHS staff have been only “weakly engaged” with the implementation process despite costly management consultants have been brought in to help.
The report said that NHS England went as far as “asking leaders to keep details of draft STPs out of the public domain. This included instructions to actively reject Freedom of Information Act requests to see draft plans.”
Some councils have objected so strongly to the lack of public involvement that they have ignored NHS England’s demand to keep the documents private until a later stage and have published them on their websites.
The review’s findings are based on a series of interviews with senior NHS and local government leaders, which took place throughout 2016.
“Despite the importance of STPs for the NHS and the public, little is known about the process of developing the plans and how the initiative has worked in practice”, the review said.
“Tight deadlines have made it difficult to secure meaningful involvement in the plans from key stakeholders, including patients and the public, local authorities, clinicians and other frontline staff.”
NHS England has been criticised for ‘managing the narrative’ about the plans and deciding them in a ‘top-down’ process.
The plans have been put in place to improve patient care and are necessary to fulfil Jeremy Hunt’s goal for a for full seven-day NHS. However, critics claim that the plans are being rushed through in order to implement further cuts with minimum public opposition.
Chris Ham chief executive of the King’s Fund said: “The introduction of STPs has been beset by problems and has been frustrating for many of those involved, but it is vital that we stick with them.
“For all the difficulties over the last few months, their focus on organisations in each area working together is the right approach for improving care and meeting the needs of an ageing population.
“It is also clear that our health and care system is under unprecedented pressure and if STPs do not work then there is no plan B.”
The NHS medical director, Prof Sir Bruce Keogh said: “Advances in medicine mean it is now possible to treat people at home who would previously have needed a trip to hospital. It also means those with the most serious illness need to be treated in centres where specialist help is available around the clock,” he said.
“So this is not a moment to sit on our hands. There are straightforward and frankly overdue things we can do to improve care. We are talking about steady incremental improvement, not a big bang. If we don’t, the problems will only get worse.”
