Concerns have been raised that cost-cutting plans, which could see major changes to NHS services across local regions, are being kept closely guarded, with calls for the proposals to face public scrutiny before being introduced.
An investigation into the 44 service and transformation plans (STPs) across England found that around half included proposals for either accident and emergency reconfiguration, major service change or bed closures in the coming years.
“This is new evidence that plans are being made to close local NHS services…We all rely on these services, yet we are being kept in the dark”
The STPs were announced at the end of last year by national NHS organisations to help deliver NHS England’s Five-Year Forward View, which included a requirement for the health service to make £22bn savings by 2020. The STPs are expected to be implemented from October 2016 to March 2021.
They found that, while the plans were looking at how to transform services to improve care and quality as well as health and wellbeing for local populations, the “core imperative” was to address funding and efficiency challenges and “as such much of the focus has pivoted to financial control”.
In some regions hospital closures have been proposed, according to the investigation.
Across Leicester, Leicestershire and Rutland hospitals will be reduced from three to two, said the analysis, while to the west Midland Metropolitan Hospital is expected to close its A&E and a district general hospital could be shut as part of a merger.
In North West London plans to integrate services includes closing 500 acute beds, while in Devon is proposing fewer inpatient beds in the area.
“Where changes are made, they must be fully scrutinised to ensure that care is shifted to meet demand rather than simply reduced to save money”
Analysis of the draft plans also revealed that many regions expect to fall short of funding by 2020.
However, while the existence of the plans is no secret, concerns over the lack of public scrutiny facing them have been raised, with calls for nurses and other clinicians to also be more involved in the assessment of the proposals.
38 Degrees director Laura Townshend said: “This is new evidence that plans are being made to close local NHS services. We all rely on these services, yet we are being kept in the dark.
“These proposed cuts aren’t the fault of local NHS leaders. The health service is struggling to cope with growing black holes in NHS funding,” she said.
She called for full public disclosure of the plans for all 44 areas that they cover. The Royal College of Nursing agreed that the plans, while necessary in some places, must be “fully scrutinised”.
Lara Carmona, RCN associate director of policy, international and parliamentary, said NHS care provision needed to change but that shifts to more community care should be based on patient need and “not solely driven by finances”.
“Sustainability and transformation plans will not be credible unless they demonstrate how money and staff for these services will be found”
“Where changes are made, they must be fully scrutinised to ensure that care is shifted to meet demand rather than simply reduced to save money. This includes listening to the patients, nurses and other clinicians who can directly match local need and local decisions,” she said.
Meanwhile, Professor Chris Ham, chief executive of the King’s Fund think-tank, said major reconfigurations of hospital services “rarely saved money and do not necessarily improve care”.
“It would be a huge shame if a vital opportunity to improve services for patients is derailed by bruising rows about ill-conceived hospital closures,” he said.
He also suggested any plans to reduce the number of hospital beds would be hard to achieve due to demand for hospital care “rising inexorably, bed occupancy already at eye-wateringly high levels and services outside hospital not in a position to provide an alternative after years of under-investment”.
He said most additional government funding was now being used to recue deficits in acute hospitals, which left little money for investing in community services.
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“Sustainability and transformation plans will not be credible unless they demonstrate how money and staff for these services will be found. At the same time, the government must ensure adequate funding is in place for this,” said Professor Ham.
Shadow health secretary Diane Abbott added: “This analysis is a damning indictment of this government’s underfunding and mismanagement of the NHS.
“The government needs to properly fund the NHS and cut out the waste of [private finance intiatives], agency staffing and inflated drug prices,” she said. “These resources should be ploughed back in to frontline services.”