Doubts have been raised about the credibility of the blueprints for NHS reform with which ministers expect to stave off an impending financial crisis.
A BMA review of England’s 44 STPs (sustainability and transformation plans) has found that many of their claims to save £26bn from NHS and council social care budgets appear unrealistic.
Many such savings plans also depend on securing large sums of upfront capital cash – to modernise or construct new health facilities – a demand the NHS admits it cannot meet.
Most STPs claim costs will be cut by moving NHS services out of hospitals, the review finds, despite research suggesting that shifting care into the community does not make significant savings, particularly within the five years that STPs cover.
‘Evidence to support the impact of large-scale reconfigurations of hospital services on finance is almost entirely lacking,’ the King’s Fund paper, The Reconfiguration of Services: What is the Evidence, concluded in 2014.
And despite the widespread expectation of savings by providing more care in the community, many plans fail to make clear how over-stretched GPs will be funded to take on the extra work.
Several plans even propose cutting the number of community and acute hospital beds, such as those in Staffordshire and Stoke-on-Trent, Derbyshire and Nottinghamshire.
Most list ‘public health and prevention’ as a priority but are unclear how this squares with the Government’s cuts to the budgets of councils that have run many such services since 2013.
Several councils have already publicly opposed the plans drawn up for their areas, the review found.
The review is part of the BMA’s continuing analysis of STPs, which are being drawn up for 44 areas of England by health and council officials and were all finally published late last year.
While the association supports the principle of integrated planning across health and social care – rather than just services – doctors leaders believe they must be credible, realistic and fully funded.
While few STPs currently have formal consultations, several are planned.
BMA council chair Mark Porter said the detail uncovered by the review was further evidence that STPs were ‘aspirational to say the least’.
‘It’s hard to find anything convincing about how existing services can be provided within the heavily constrained future funding,’ he added.
‘And doctors, patients and others are discovering that where the gap is joined by reducing or eliminating services, the plans have been made without adequate or even any proper consultation.
'The tragedy of the unravelling plans is that the Government appears to have nothing to put in their place.’
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