NHS Sustainability and Transformation Plans

Simon Burns Excerpts

Wednesday 14th September 2016 Commons Chamber

[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.

[Sir Simon Burns (Chelmsford) (Con)]

Will the hon. Lady give way?

[Maria Eagle (Garston and Halewood) (Lab)]

Will my hon. Friend give way?

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[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.

[Sir Simon Burns]

Will the hon. Lady give way?

[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?

[Sir Simon Burns]

Will the hon. Lady give way?

[Ms Abbott]

In some cases, even local GPs have not been fully involved in decision making. Hon. Members may not take that seriously, but I assure them that their constituents will. [Interruption.]

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[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.

[Sir Simon Burns]

Will the hon. Lady give way?

[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.

[Sir Simon Burns]

Will the hon. Lady give way?

[Ms Abbott]

I have to make some progress.

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[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.”

[Sir Simon Burns]

rose—

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[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”.

[Sir Simon Burns]

rose—

[Anna Soubry]

rose—

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[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.

[Sir Simon Burns]

Will the hon. Lady give way?

[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.

[Anna Soubry]

Will the hon. Lady give way?

[Sir Simon Burns]

Will the hon. Lady give way, and if not, why not?

[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.

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[Mr Dunne]

I am going to make a little progress, as I have only just started.

The “Five Year Forward View” also recognised that the challenges facing different areas of the country differ, so the issues facing Hackney are not the same as the issues facing Ludlow, and a single national plan would not be effective or appropriate. Indeed, the Labour party recognised that in its 2015 general election manifesto, which most Labour Members present stood on. It said:

“To reshape services over the next 10 years, the NHS will need the freedom to collaborate, integrate and merge across organisational divides.”

[Sir Simon Burns]

Will my hon. Friend give way?

[Catherine West (Hornsey and Wood Green) (Lab)]

Will the Minister give way?

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[Mr Dunne]

I will give way to my right hon. Friend the Member for Chelmsford (Sir Simon Burns), who has been most persistent in trying to participate in this debate but has not so far been allowed.

[Sir Simon Burns]

I am very grateful to my hon. Friend. So that there can be no misunderstanding, because the shadow Secretary of State does not seem to have fully grasped the brief, will my hon. Friend, with his superior knowledge, explain categorically to the House about transparency in the health service with regard to not only STPs but other reconfigurations? There automatically always has to be a public consultation with local communities before any decisions are made— something that the shadow Secretary of State seems to be totally oblivious of.

[Mr Dunne]

I am grateful to my right hon. Friend, who has a great deal of experience in this area, having served in the Department for many years. He has pre-empted what I am about to say, which is that all the STPs will be subject to full and appropriate public consultation once we are in a position to do that.