By Kam Sandhu @KamBass

As part of the ‘Five Year Forward Plan’ being implemented by Simon Stevens, Head of NHS England, the health service is being split into 44 regions. Sustainability and Transformation Plans (STPs) are bringing in covert and controversial cuts through it’s framework according to researchers and campaigners. How are they being implemented? What changes are taking place at a local level?

We spoke to Madeleine Dickens, Sussex Defends the NHS, about unaccountable boards, secrecy and the coming effects of the plans in Part One of our interview.

Who makes the decisions? Who is pushing through these plans in the NHS?

The government in the first instance. They’ve been driving this policy on the NHS generally and Sustainability and Transformation Plans (STPs), from the moment the coalition was elected and then they passed the Health & Social Care Act which laid the blueprint for what was going to happen.  

It was the appointment of Simon Stevens to head of NHS England which really set things in motion. Simon Stevens was a senior manager at United Health in the states, and his appointment clearly indicated the direction of travel that they wanted to go. NHS England has been driving the whole thing on the instruction of the government.  

What about STP Boards? Who are they?

STP Boards are very interesting. They appeared out of nowhere. England is the only country in the UK that is undergoing this. England was divided into 44 footprints, regions, which would eventually manage their health and social care, and manage their own budgets.  The whole thing was premised on dividing the NHS up.

A year and a half ago, we received a list of appointed heads to STP boards. It emerged they hadn’t undergone any formal recruitment process. These heads had obviously been specially selected.

We’ve put on a lot of pressure to find out what they were, what their terms of reference are – they operated completely in secret, no minutes published, no parliamentary mandates. Most health campaigners knew more than MPs about what was going on with STP boards. Until Sarah Wallaston MP on the Healthcare Select Committee decided to institute an investigation last Summer.

But they appeared out of nowhere. From various parliamentary questions it turned out they had no legal mandate, they were described as a discussion forum. This was to get them out of any Freedom Of Information (FOI) provisions, and keep them as much in the background as possible.

The chair of our STP board is going, and they’re going to get someone with a much harder line in. We’ve been hearing that they’re going to attempt to legitimise the STP boards retrospectively, if the government gets back. This hasn’t been confirmed yet – this is very, very, new.


Are you able to get in touch with the representatives on these boards? Do you know their names?

We know who they are and we write to them at regular intervals. There’s no direct Local Authority involvement. They’re mainly Clinical Commissioning Groups (CCG), some heads of NHS Trusts, token public representation in the form of health watch, which is an almost meaningless contribution. So no public representation. No Local Authority representation.

Our Local Authority have been broadly going along with what’s happening, their one grievance is their exclusion in the new governance structure proposed for these STPs in our area. It’s amazing as STPs are meant to be about integration of health and social care. And it’s gives the lie to the whole thing.

Have your local authority responded to you?

They have responded. We’ve got technically a Labour minority council.

The Greens tried to get a motion passed calling a halt to any consideration to STPs – a good motion, we didn’t feel it went far enough. They got quashed by an alternative Labour motion to proceed with STPs alongside a working group as part of the Health Overview and Scrutiny Committee (HOSC) – they can call witnesses from the STP board, CCGs and so on. It wasn’t ideal. They weren’t saying we oppose STPs but were acknowledging it needed investigation. That group has met twice – the second time they interviewed the chief accountable officer of the CCG and it was a complete waste of time – he avoided every question. We know the deficit which the STP is supposed to clear is £864m and rising. He was allowed to make a statement that it would go up and no one challenges that or what that meant.

The deficit will go up – it’s heading for a billion. We were shouting things but we weren’t allowed to participate. The person delegated to lead the HOSC had the best intentions but they weren’t geared up for the degree of avoidance and duplicity on show. There hasn’t been a meeting since. There’s been no response. We’ve been pushing and pushing for the next meeting and then the General Election was called so they’re now in purdah.

The chair of our Health and Wellbeing board said there were red lines that cannot be crossed and if they are he will advise the council not to support the STP. We had a public meeting in February, well over 300 people there, he made the statement – ‘my red lines have been crossed and I am not going to collaborate with the main STP.’ On the other hand he said I am going to carry on working with the CCG locally, and alarm bells rang there. Lo and behold, a few weeks later the CCG introduced part of the STP into their operational plan.

We tried to find out from the council if they signed off on this, how come the CCG was allowed to do this? There’s been a deafening silence. The council on some level, is going along with it and its been caught up in purdah.

It’s still early, but what are the effects of STPs locally, and what are you expecting?

It’s only just come into the operational plan of the CCG – I should say that there are two tiers of the STP. There’s the regional STP – the general plan has been released but it’s got work in progress stamped all over it and broad, terrifying headlines of cuts. We’ve tried to find out what those mean; there’s no explanation, no detail of what those cuts will be.

The second tier is what they call Place Based Plans – there are three across the region and ours have been published. There are more details in there, and more terrifying cuts, but amazing inconsistencies.

We are asking them what is going to happen to the acute sector/hospitals? We think the STP has been deemed a work in progress because two hospital trusts are in special measures. So NHS Improvement have been all over them with private consultants making recommendations about what happens within those hospital trusts. We think the STP can’t be released until the NHS Improvement decisions have been finalised. We know it won’t be good but we have to wait for the NHSI report. Our local hospital trust is in £54m deficit for various reasons and at the same time there is a lot of refurbishment going on, a lot of which we know will be for private patients.

We can’t get solid information on any of it. They say it’s not finished, it’s work in progress. Having said that in the Place Based Plan I referred to there are specific details about what’s happening, and we know they’re going to start running with them. For instance the 6 GP Hubs across the region as opposed to GP surgeries. Some of these are being based on what they call Multi Speciality Providers (MSPs) – we know that there is private involvement already and we know those are going to be prime pickings for the private sector.

We’ve heard of Care UK doing triage in some of these centres and they already run a walk in centre. Care UK already have contracts worth £6m in the city. Just in Brighton and Hove. They are one of the biggest players. We’ve had quite a strange situation with the private sector – three private companies have pulled out, one after two months. There was more private involvement here before but they’ve been taken back into the NHS, for how long we don’t know. But the CCG set up it’s own private company to privatise things called Brighton Integrated Care services. In fact we found out without a whisper they had absorbed our muscular skeletal services. We just found out. No notice, no nothing, it had quietly been absorbed into this company. That’s the problem we have – there is so much happening behind the scenes, and you can’t find any information about it until it happens. Again, we’ve tried sending FOIs, no luck – we’re just blocked.

Aside from STPs, what other services have been affected by privatisation locally?

Many subcontractors took over the patient transport service about a year ago, within two months it collapsed. The workers were left in limbo. Very vulnerable patients left, stranded. No one turned up to their appointments on numbers of occasions. And one elderly person did die and it was maintained at the time by the family that the stress of patient transport contributed to his death, and there was a media splash about that locally. Nothing can be proved and that’s part of the issue.

There was a report into needless deaths by the London School of Tropical Medicine and Oxford University. They demonstrated that between 2015/16 there was a 30,000 spike in deaths which they attributed mainly to austerity measures. Not all those deaths were elderly vulnerable people but most of them were. And that is so scandalous, the fact that that is not being emblazoned across all of the media. A lot of those deaths you can’t say is directly attributable to that, it’s the social disintegration that’s happening, it’s the disintegration of support services, the stresses and strains in families that weren’t there before that contribute to these deaths. 

These kinds of abuses are happening everywhere.

The one thing that is important to say is the Place Based Plans I mentioned mean massive cuts. You’re talking about a 50% reduction in elderly people being referred to hospital. It is horrifying but that is not reflected anywhere. Although we know the operational CCG is based on the Place Based Plan, there’s no mention. I raised the question at the last CCG – you’re talking about massive cuts in one arena and in related reports you’re not making any reference to them.

The words democratic deficit don’t come close to what’s happening.

Look out for Part Two of our interview covering the presence of US companies, data capture and what the future holds for the NHS. 

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