Sustainability and Transformation Plans (STPs)

[See more on Accountable Care Systems and ACOs here]

STPs are 5-year plans that divide up England into 44 ‘footprint’ areas and call for a massive change to the NHS in each area. Despite claims that they are there to ensure regional health services better cater to local populations’ needs, they are in fact a way of cutting services to meet ever-dwindling budgets and allow easier privatisation of what is left.

The plans were developed in secret, with no public consultation. They include widespread cuts to acute services (hospitals), with people having to travel further and further to get the treatment they need. This is hidden by using obtuse, ‘managementese’ language (eg, ‘the wellness paradigm’). They mention ‘community care’ as alternatives when in fact the community does not have the capacity, funding or in some cases expertise to pick up the demand. Further cuts are being planned which go beyond the STPs in some areas even before they have been implemented, because the under-funding is so serious. STPs will also make it even easier to ‘contract out’ services to private suppliers, further undermining the NHS in that area.

Keep Our NHS Public is opposed to STPs. They are a way of breaking apart the NHS, not the regional improvement in integrated care they are proclaimed as.

You can find the details of the STP for your area on the Health Campaigns Together web site.

STP now stands for ‘Sustainability &Transformation Partnership’

In March 2017, Simon Stevens published his implementation plan for STPs to deliver changes equivalent to £22bn of cuts, Next Steps on the NHS Five Year Forward ViewHe introduced his assumed organisational form that the new sustainability and transformation partnerships would take – a coalescence of provider trusts and CCGs with any willing local authorities in area-based alliance organisations.

Stevens named these ‘Accountable Care Systems’ (ACS). But in new NHSE guidance issued 2 February, he renamed them Integrated Care Systems (ICS). He predicted that these would evolve in a varied number of years but in all areas, into hardwired structures he unashamedly had given the USA-derived title of ‘Accountable Care Organisations’ (ACOs) the ‘ownership’ of which would be via a 10-15 year contract tendered out to an interested party or parties, explicitly including the private health and financial industry. Model contracts put forward the possibility of a Special Purpose Vehicle. SPVs are notorious in the case of financial wheeler-dealering of private finance initiative contracts (PFIs). See our review of ACSs and ACOs and the very helpful full briefing.

Read about the Health & Social Care Select Committee’s inquiry into accountable care organisations and integrated care systems – oral hearing 27 February 2018.

Important sources of further analysis and data on STPs

  1. See KONP’s review of ACSs and ACOs and the very helpful full briefing by Jan Savage.
  2. Documents on Accountable Care in our Resource Cabinet
  3. All KONP posts relating to STPs can be found here
  4. See John Lister’s political analysis of the 44 Sustainability & Transformation Plans, May 2017 STPs and the Five Year Forward View – the case of the missing evidence
  5. London South Bank University, School of Health & Social Care’s STPs – How serious are the proposals? A critical review here and at Health Campaigns Together