In the last few days the level of chaos in the NHS created by a combination of cold weather and lack of financial resources and other factors depending on who one listens to has been capturing many headlines. It seems hard to imagine that things could get any worse. However away from the challenges in Accident and Emergency services and GP provision, those responsible for planning the way in which the NHS operates have been arranging for changes in a way that seems guaranteed to lead to problems. At the end of August 2016 I wrote about a new reorganisation in our local NHS which was being proposed to achieve a number of objectives including reducing costs. The map above indicates the area covered by the changes which are called Sustainability and Transformation Plans or STPs. I first found out about the change through this press release which is very short and ends with the paragraph “No changes to the services people currently receive will be made without local engagement and, where required, consultation. There are longstanding assurance processes in place to make sure this happens.” A couple of weeks later local MP for Lewes Maria Caulfield who was a Nurse before becoming an MP spoke in the House of Commons “because many of these 44 STPs have not shared or consulted on their plans, there is a suspicion, rightly or wrongly, that they are an excuse to bring in cuts or to bridge financial deficits. I would welcome the Minister’s thoughts on this, and a signal that consultation will happen.”
The STP was published on 25th November with a phrase overprinted on each page stating “Work In Progress”. The idea that this is a plan would be taking a liberty with the English language, however on page 15 there is a nice diagram which outlines five distinct steps: Case for change; Solution generation; Proposals for change; Public consultation on proposals; Decision making and implementation. Page 15 speaks in muted terms about the way in which engagement and consultation will take place on an ongoing basis and how Healthwatch, an advocacy charity will be a key part of this consultation. I happened to meet a leading member of a local Healthwatch organisation on 14th December and was told how the first they knew about the plan itself and that they had been mentioned in it was when they read the document and came to page 15.
It is less than six weeks since the publication of this draft document, taking into account the Christmas and New Year break and as yet the level of consultation from the STP itself or Healthwatch appears to have been non existent. However that has not prevented the STP from moving forward according to this news report which explains that NHS England wrote to the council last week about the local STP, saying that it was now moving “from a planning phase to implementation”. The letter comes hot on the heels of a motion passed by Brighton and Hove City Council in its last meeting before Christmas about the STP process. It highlighted concerns raised by the council about “the adequacy of public engagement and transparency of the process”. They wrote to the STP saying “The council will aim to ensure greater transparency of the planning process and fuller engagement with our local community.” One of the interesting elements of this is that like Healthwatch, Brighton and Hove Council is mentioned in the STP as one of the partners in the plan itself. It is unclear when the Council first saw the plan, but it is only 2-3 weeks since they promised to ensure transparency so it is hard to be too critical of the Council although clearly the clock is ticking.
If the five steps on page 15 were being taken seriously, the consultation would be a process by which change could then be introduced into the proposals as the wider community spots mistakes and failures in thinking certain matters through. We are a long way from the reassuring words from the press release back in late August which stated “No changes to the services people currently receive will be made without local engagement and, where required, consultation” it appears that we have been lied to or misled and that the change which is about to happen will not be something we can comment on or hope to shape in any way. It is actions like this which lead people to feel that Governments are prone to over promise and under deliver.