Nursing and medical unions have joined together to call on mayor of London Sadiq Khan to protect the capital’s NHS from what they claim is a £4bn cost-cutting programme.
The concerns, raised by the Royal College of Nursing and the British Medical Association, centre on the sustainability and transformation partnership (STP) plans being drawn up for London.
“Nurses and doctors in London are sending a clear message that they will no longer be ignored”
Part of a national programme run by NHS England, the capital has five STPs – covering North Central London, East London, North West London, South East London and South West London.
The efficiency plans were badged by NHS leaders as a way of transforming how care was delivered, especially boosting the integration of services, but have been dogged by concerns that they will lead to cuts.
Some have drawn criticism for setting out ambitions to cut staffing levels, while others have attracted negative media coverage and public opposition over suspicions they will lead to hospitals being shut or downgraded.
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The two unions have today reiterated such concerns in a joint letter to Mr Khan (see PDF attached below), urging him to play a greater role in preventing the scheme from endangering patient care in the capital.
The bodies, which say they represent the city’s 60,000 nurses and 22,000 doctors, argue that savings are being prioritised over safety and that health professionals are being “shut out” of NHS decisions.
Their letter said patients and clinicians were currently “after-thoughts” in the plans and were being “left in the dark” about the future of services, because of a lack of transparency and accountability.
“Changes of this magnitude must be clinician-led and have the relevant public engagement”
It follows a critical report on STPs in London, which was commissioned by Mr Khan and published by the King’s Fund and the Nuffield Trust think-tanks in September. It concluded London’s STPs contained “unachievable savings targets” and “neither desirable nor credible” plans to cut hospital beds.
The unions noted today that London’s five STP areas had been asked to make savings of over £4bn and claimed it was unclear how these financial targets would be met without damaging patient care.
They noted that three of them were among the most financially challenged in the country and had been placed under the Capped Expenditure Process – a system whereby NHS England and NHS Improvement put tighter spending controls on providers deemed to be “overspending”.
The letter specifically asks the mayor to seek assurances that London’s STP leaders will commit to “meaningfully engage” with the healthcare workforce at “every stage of the transformation”.
They must also put transparency at the “heart” of decision making and publish full details of all proposals, and ensure that all service changes are supported by clinical evidence, said the letter.
RCN London board chair Cynthia Davis said: “Nurses and doctors in London are sending a clear message that they will no longer be ignored during the STP process or remain silent when financial targets are prioritised over patient care.
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“STPs represent the biggest change to the health service since its birth – it is time that the input of clinicians and the public was recognised as being fundamental to making sure this change can be safely delivered,” she said.
“Unfortunately, we are still seeing parts of London being asked to make eye-watering savings without any clear evidence adequate services will remain in place,” said Ms Davis.
She added: “Doctors, nurses and above all patients need the mayor to use his voice and standing in the city to demand better from those charged with delivering STPs.”
Dr Gary Marlowe, the BMA’s London regional council chair, said: “These plans are being rushed through at a worrying speed without the necessary transparency and governance to ensure they will improve the delivery of patient care as opposed to being a vehicle for plugging funding gaps.
“Changes of this magnitude must be clinician-led and have the relevant public engagement to ensure that patients and frontline services are not jeopardised,” he said.
Bernell Bussue, regional director for RCN London, has also previously warned that a lack of sufficient funding and staffing is the “elephant in the room” for the capital’s STP plans.
In a blog published in September, he said the plans could only be achieved by providing the funds necessary to transform care rather than trying to deliver change “on the cheap”.
In the same month, NHS England revealed that it was planning to establish a new “national network” of STP clinical leaders to address a lack of clinician engagement in the programme to date.
Meanwhile, back in March, the chief nursing officer for England Jane Cummings also urged nurses to get involved more in redesigning local and regional services.
She said she had noted concerns that had been raised in some parts of the country about a lack of engagement from nurses in the development of STP plans.
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NHS England first gathered together local health and social care organisations into 44 STP groups in January 2016 to cover what it called geographical population “footprints” around England.
They were told to look at how they could make services more efficient and also move away from acute models in favour of more community provision. All 44 have now published plans in draft form.
Responding to today’s letter, a spokeswoman for the mayor of London said he had already called for much of what was being asked for, citing the think-tanks’ report published earlier in the autumn.
She said: “Sadiq Khan has championed the NHS since the outset of his mayoralty and earlier this year confirmed his willingness to provide the strategic leadership required for the STPs in London.
“The mayor has warned that before he will give support for any changes to NHS services in the capital the government must provide key assurances to ensure Londoners get the best healthcare possible,” she said.
“The mayor is clear that any plans around the future of NHS services in London must be given proper investment, and must not have an adverse impact on health inequalities, social care or hospital capacity,” said the spokeswoman.
“He also wants every assurance that London’s doctors, nurses and healthcare professionals get all the support they need to realise these plans, and that Londoners and patients are properly consulted,” she added.
Also responding to the letter, London’s chief nurse Professor Oliver Shanley said: “Engaging with and working alongside healthcare professionals is a priority for NHS plans in London.
“Any service change will always be backed up by clinical evidence and there is widespread agreement about the need for prevention and out-of-hospital care providing a safe, modern and efficient NHS of the future,” he said.