NHS sustainability plans unlikely to work without greater government commitment

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Local sustainability and transformation plans (STPs) — designed to transform the way health and social care services are organised, delivered, and used across England — are unlikely to work without a much greater commitment from government, warns an expert in The BMJ today.

Kieran Walshe, Professor of health policy and management at the University of Manchester, argues that while STPs aim to keep people well and help them to care for themselves, and use health and care services more appropriately, there are four main problems, which if not resolved make it unlikely that these plans will work.

First, he warns that they are being launched at a time of huge, unprecedented levels of financial constraint and challenge in the NHS, which will require considerable investment.

Second, he argues that the plans have been written in a rush, and professional and public consultation and engagement have been largely neglected, resulting in "suspicion and opposition" from the medical profession, the public, and the media.

Third, he says these plans have no statutory force or authority, adding that the Health and Social Care Act 2012 "contains a host of provisions on competition and market access that make these changes open to legal challenge and difficult to implement."

Finally, these plans are founded on the sound idea that we should bring health and social care services together – but he points out that "social care services are funded separately by local authorities, whose funding has been cut by 37% in real terms over the last six years."

Fixing these problems and giving STPs a real chance to succeed requires action from government, writes Walshe..

He therefore calls for government action to provide realistic transitional funding for the changes and to give political backing to the changes and allow for proper consultation at a national and a local level.

He also calls for legislation to remove the competition and market access provisions of the Health and Social Care Act and to allow for statutory bodies to be created to lead STPs.

Finally, he suggests the government tackle the health and social care divide by implementing the recommendations of the Barker commission for a single system of funding to commission health and social care.

"The NHS and its leaders have done what they can to map out a sustainable future health and social care system for England. But without a much greater commitment from government, it seems very unlikely that these plans will work," he concludes.

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Editorial: Sustainability and transformation plans for the NHS in England: radical or wishful thinking?
http://www.bmj.com/content/356/bmj.j1043

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The BMJ has been at the forefront of innovative thinking and practice in healthcare since 1840 and is now the fourth most cited general medical journal in the world. For more information, visit the website.

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