NHS Sustainability and Transformation Plans Debate
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Diane Abbott
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NHS Sustainability and Transformation Plans
Diane Abbott Excerpts(8 years, 3 months ago)
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Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
I beg to move,
That this House notes with concern that NHS Sustainability and Transformation Plans are expected to lead to significant cuts or changes to frontline services; believes that the process agreed by the Government in December 2015 lacks transparency and the timeline announced by NHS England is insufficient to finalise such a major restructure of the NHS; further believes that the timetable does not allow for adequate public or Parliamentary engagement in the formulation of the plans; and calls on the Government to publish the Plans and to provide an adequate consultation period for the public and practitioners to respond.
I am glad to open this debate on the NHS sustainability and transformation plans. As the whole House knows, the NHS has a special place in the affections of our constituents. No other public service engages with us all when we are at our most vulnerable—in birth, death and illness—and the public and NHS staff are increasingly aware that the NHS is under severe financial pressure, a matter I will return to.
In that context of financial pressure and concern about the availability of services, the sustainability and transformation plans are arousing concern. They sound anodyne and managerial, and there is undoubtedly a case for bringing health and social care stakeholders together to improve planning and co-ordination. But the concern is that, in reality, the plans will be used to force through cuts and close hospitals, will make it harder for patients to access face-to-face consultations with their GPs, and, above all, will open the door to more privatisation. It tells the public how little the Secretary of State cares about their concerns that he is not in the Chamber to listen or respond to this debate. We know that recently he has missed all seven recent meetings of the NHS board. The public are entitled to ask how much he cares about their very real concerns.
Helen Whately (Faversham and Mid Kent) (Con)
The hon. Lady mentioned cuts, but this Government are putting more money into the national health service—an extra £10 billion a year. The Labour party had no intention of making that sort of financial commitment to the NHS, as we saw in its failure to do so before the last election.
Dr Andrew Murrison (South West Wiltshire) (Con)
Will the hon. Lady give way?
Hon. Members
Steve McCabe
I want to check this with my hon. Friend. The last time I checked, Simon Stevens had said that STPs were designed to make up the £22 billion shortfall that the Government are not prepared to put in. Is that not the case?
Ms Abbott
It is indeed the case; rather than being an anodyne managerial exercise, the sustainability and transformation plans are designed to make up the missing £22 billion.
One of the most alarming aspects of the STPs is their secrecy. England has been divided into 44 regional footprints, and it is worth noting that they are called footprints to distract from the fact that they are ad hoc regional structures—they are the exact same regional structures that the Tory health Bill was supposed to sweep away. Because they are ad hoc and non-statutory, they are wholly unaccountable. In the world of the STPs, the public have no right to know.
Maria Eagle
I am grateful to my hon. Friend for giving way. We have a leak of the STP for Merseyside and Cheshire, which states that there is an “appetite for hospital re-configuration” because the existing set-up is “currently unaffordable”. Given that it also says that almost a £1 billion gap is to be expected by 2021, and that the public have not yet been consulted, does my hon. Friend agree that when the public are consulted, there will be an absolute outcry?
Norman Lamb (North Norfolk) (LD)
Does the hon. Lady agree that unless the local community are fully engaged in the process of considering how the health and care system needs to change their area, the process is destined to fail and simply will not work?
Ms Abbott
I am grateful to the right hon. Gentleman. For nearly the whole time I have been in Parliament, there have been attempts to reconfigure hospitals and close A&Es and make other changes in London. We have found that when the local community does not take ownership of the plans, it is impossible to take them forward. That secrecy runs counter to making the reorganisations we might have to make.
Ms Abbott
Initially, the STPs were discouraged from publishing their draft plans, freedom of information requests were met with blank replies, and enquirers were told that no minutes of STP board meetings existed. We are therefore bound to ask: if the plans are really in the interests of patients and the public, why has everyone been so anxious to ensure that patients and the public know as little as possible?
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. It is up to the hon. Lady whether she wishes to give way or not. Shouting and screaming will not help with the debate, because Members on both sides want to hear. I am sure that, when she wants to give way, she will do so, but screaming will not help, and it certainly does not help my ears.
Ms Abbott
GP leaders in Birmingham said that it would appear that plans by the STP to transform general practice, and to transform massive amounts of secondary care work into general practice, are already far advanced. Only at this late stage have they been shared with GP provider representatives.
Alex Cunningham (Stockton North) (Lab)
Freedom of information requests have also uncovered the substantial role of the private sector in formulating these plans. GE Healthcare Finnamore, for example, is advising STPs across the south-west, and I have no doubt that work is under way for it to get larger slices of the action in the future. In the name of transparency, does my hon. Friend agree that all their boards should publish everybody who is on them, with their declared interests as well?
Ms Abbott
I entirely agree with my hon. Friend. All STPs should publish who is on them, what their financial interests are, and how far advanced they are in planning. However, thanks to the work of organisations such as Open Democracy and 38 Degrees—and, frankly, thanks to leaks—the picture of what STPs will mean is becoming clearer.
We know from the information we have been able to glean that the reality of STPs is quite concerning. For instance, in the black country there are plans for major changes to frontline services at the Midland Metropolitan hospital, including the closure of the hospital’s accident and emergency. The plans also propose to close one of the two district general hospitals as part of a planned merger. We know that by 2021 the health and social care system in the black country is projected to be £476.6 million short of the funds it needs to balance its books. [Interruption.] Government Members may shout now, but they are going to need an answer for their constituents when the reality of some of these proposed closures becomes apparent.
In Leicester, Leicestershire and Rutland, there are apparently plans to reduce the number of hospitals in the area from three to two. By 2021, the health and social care system in the area will be £700 million short of the money it needs to balance its books. In Suffolk and north-east Essex, the STP plan refers to the
“reconfiguration of acute services within our local hospital, Colchester Hospital University Trust”.
The whole House knows that, historically, reconfiguration in the NHS has meant cuts. There are also plans to close GP practices.
The context of these plans, of which I have given an idea, is the current NHS financial crisis. Most recently, we have heard from NHS providers about this financial crisis. They represent the NHS acute, ambulance, community and mental health services. NHS providers say that despite the best efforts of hardworking staff, including junior doctors, hospital accident and emergency performance is the worst it has ever been. Waiting lists for operations, at 3.9 million, are the highest they have been since December 2007. We ended the last financial year with trusts reporting the largest deficit in the history of the NHS: £2.45 billion.
Ms Abbott
I have to make a little progress.
Many STPs will be facing a large financial deficit. [Interruption.] I have to say to Government Members that they do not seem to be taking this debate seriously. When their constituents come to them asking about these cuts and closures, they will have to take it seriously. Many STPs will be facing a large financial deficit, which is subject to “control totals”—that is, cuts. In the case of north-west London, which does not have the largest projected deficit by any means, spending on acute care is projected to fall in nominal terms over a six-year period, despite a population that is both increasing and ageing, and despite cost pressures such as the sharply rising cost of drugs.
STPs have made an assessment of their own deficits by 2020-21. Researchers have disclosed that approximately 29 of the 44 STPs have projected substantial deficits.
Richard Fuller (Bedford) (Con)
On a point of order, Mr Deputy Speaker. Is it a requirement for a Member of this House to know the difference between a debate and a monologue?
Mr Deputy Speaker (Mr Lindsay Hoyle)
It is for me to make that decision. I am quite happy for the shadow Secretary of State to decide whether she wishes to give way or not. In fairness, this is an Opposition debate, and the hon. Lady is leading it. Let us not have any more pointless points of order. I am worried about how many Members want to speak; I want to try to get everybody in.
Ms Abbott
So when the STPs talk about efficiency, they actually mean cuts. Increasingly at the heart of these STPs are asset sales of land or buildings to cover deficits. No wonder the leader of Hammersmith and Fulham Council, Stephen Cowan, has said of his local STPs that
“this is about closing hospitals and getting capital receipts”.
He went on:
“It’s a cynical rehash of earlier plans. It’s about the breaking up and the selling off of the NHS.”
Ms Abbott
I need to make some progress.
The King’s Fund has said:
“There are some concerns that NHS leaders have focused their efforts on plans for reconfiguring a few hospital services, despite evidence that major acute reconfigurations rarely actually save money and sometimes fail to improve the quality of care.”
The BMA has said the same thing. The King’s Fund has also said:
“The cuts under the STPs are eye-watering”.
Ms Abbott
I am anxious to complete my remarks so that Conservative Members will all get a chance to intervene in the debate.
The Health Select Committee's recent report on the impact of the 2015 spending review stated:
“At present the Sustainability and Transformation Fund is being used largely to ‘sustain’ in the form of plugging provider deficits rather than in transforming the system at scale and pace. If the financial situation of trusts is not resolved or, worse, deteriorates further, it is likely that the overwhelming majority of the Fund will continue to be used to correct short-term problems rather than to support long-term solutions”.
Ms Abbott
Other aspects of the STPs that relate to cutting expenditure involve a combination of factors, including the use of new technology such as apps and Skype, patients taking more responsibility for their own health, “new pathways” for elderly care, increased reliance on volunteers and the downgrading of treatment by skills, responsibilities and pay bands. It seems to me that while some of these proposals might have some merit in themselves, it is delusional to imagine that they will deal with the financial black hole in the NHS. There is no evidence that among the patient population as a whole, increased use of apps, Skype and telemedicine can produce the efficiencies required while beds, units, departments and hospitals are being closed.
I remind Members, many of whom speak to their constituents in their advice surgeries on a weekly basis, that the truth about speaking to people face to face is that it is often towards the end of the conversation that people will come out with what really concerns them. My concern about the increased use of Skype is that many patients will not get the familiarity and comfortableness with their interlocutors to enable them to say at the end of the Skype session what it is that they are concerned about.
The STPs talk a great deal about increasing preventive medicine. That would indeed have the effect of lowering demand for acute NHS care, but it would also require a very substantial investment in public health programmes—and this Government have just cut public health funding. The elderly, the poor and patients for whom English is not their first language are the least likely to use these apps, telemedicine and Skype. It is inappropriate and unrealistic to assume that elderly patients who, I remind Members, are the biggest users of acute care and the fastest-growing demographic, will want to use Skype for any sensitive matter. “New pathways” for the elderly is sufficiently vague as an idea to raise alarm bells, given the projected rise in demand for geriatric services and continuing cuts in social care funding.
Andrew Gwynne (Denton and Reddish) (Lab)
My hon. Friend is making a very important point. She has already touched on the financial problems in the NHS, but allied to those are the financial problems in adult social care. We shall not have the truly integrated health and social care that we all desire when these STPs are being swept under the doors without people knowing precisely what they will mean for public services in their areas.
Ms Abbott
My hon. Friend has made an important point.
The danger is that, in a blizzard of apps and Skype, patients—particularly the elderly—will find it harder to access one-to-one care, and that those who can afford it will find themselves forced into the private sector.
Let me now say a word about the increasing private sector involvement in the NHS.
Ms Abbott
It was the NHS England director of STPs, Michael McDonnell, who said that they
“offer private sector and third sector organisations an enormous amount of opportunity”.
We know that PricewaterhouseCoopers has been heavily involved in the formulation of a large number of these plans, and we know that—as was mentioned earlier—GE Healthcare Finnamore, which was taken over by General Electric in the United States, has been heavily involved in the formulation of plans in the south-west and possibly more widely. The strong suspicion is that a combination of cuts, the reorganisation of services on a geographical basis, and the growth of hospital “chains” will facilitate greater privatisation of the NHS.
Ms Abbott
Let me now draw my speech to a close. It is absolutely right that health and social care stakeholders should come together to plan for the future. It is absolutely wrong that social transformation plans should be hatched in secret and used as a cover for cuts and hospital closures—and it is increasingly clear that STPs may be a stalking horse for more privatisation. Conservative Members may not take this issue seriously—[Interruption]—and Conservative Members’ response may be to shout, but I stress to the House that the consequences of these STPs will be very material for all our constituents.