Editor in Chief Sarah Cheverton and a Portsmouth NHS doctor (who prefers not to be named) report on proposals to cut over £500 million from the NHS in Hampshire and Isle of Wight by 2020, which are due to be signed off today.
Today is the deadline for the submission of NHS plans and contracts for the next two years based on the Hampshire and IOW NHS Sustainability and Transformation Plan, known as STPs.
For those who don’t know – and there are a lot of us – STPs are 5 year plans for all aspects of NHS spending in England. 44 plans have been drawn up by health services, local authorities and health provider across the country, each one covering geographical areas known as ‘footprints’, and representing an average population of 1.2 million people. As well as covering NHS spending, each plan also has to show how NHS services can better integrate with local authority services such as adult social care – ‘known as place-based planning’ – and is expected to cover the period from October 2016 – March 2021.
Nationally, STPs have proved highly controversial with activists often referring to them as ‘Slash, Trash and Privatise’ plans.
National charity The Kings Fund have highlighted the difficulties of the government’s approach to STPs, including a lack of public involvement, with ‘patients and the public largely absent from initial stages of the planning process’ and timescales that are ‘extremely tight’. The charity has also stated concerns about the broader context of the cuts, including ‘an NHS environment that was not designed to support collaboration between organisations.’
Former NHS England Director Julia Simon – who resigned earlier this year – described the STP process and the government approach as ‘shameful’, ‘mad’ and ‘ridiculous’. Speaking in September to GPOnline, Julia Simon added:
‘Everyone will submit a plan, because they have to, but it means there is a lot of blue sky thinking and then you have a lot of lies in the system about the financial position, benefits that will be delivered – it’s just a construct, not a reality.’
Senior public health academic Alex Scott-Samuel wrote about STPs for the British Medical Journal in August 2016 and concluded:
‘The ultimate intended outcomes of this massive, dictatorial reorganisation process are privatisation, co-payments, charges, and insurance funded care.’
The STP for Portsmouth covers Hampshire and the Isle of Wight and responds to the financial pressure on NHS services in the region, most notably £577 million of NHS cuts required by 2020/21 compared to current levels of spending. This is alongside £192 million of cuts to adult social care across Hampshire, Southampton, Portsmouth, and IOW councils, creating a total of £769 million cut to the area’s NHS and social care by 2020/21.
Despite the funding ‘challenge’ described in the Hampshire and IOW STP, it concludes that even with less funding, increased demand and a lack of capacity and resources, it will still deliver ‘better’ outcomes and impacts for local residents.
The plan to achieve improved patient outcomes includes proposals to cut 300 hospital beds across the region and to reduce the GP workload by 30% by shifting work to non-clinical staff.
The Hampshire and IOW STP is proving to be controversial, as is the lack of public consultation and the reluctance of Portsmouth City Council to take the lead on ensuring local residents are aware of the proposed changes, and protecting vulnerable residents from the impact of major cuts to services.
National campaign website C&K 999 Call for the NHS reported recently:
‘The Hampshire and Isle of Wight STP proposes huge cuts and changes to the area’s NHS and social care services – but it has not come to Portsmouth City Council Health Overview and Scrutiny Panel, which has the duty and responsibility to scrutinise proposals for significant NHS and social care changes.
‘The STP was not even on the agenda for the Portsmouth City Council Health Overview and Scrutiny Panel’s December meeting.
‘The next Portsmouth City Council Health Overview and Scrutiny Panel meeting is 24 Jan, but there’s no agenda yet – and by then it will be too late, since there is a 23rd December 2016 deadline for signing off 2 year STP contracts and operational plans 2017-19.’
Instead, Cllr Luke Stubbs recently called on Portsmouth Healthwatch to undertake a consultation on the plans, despite campaigners’ insistence that local authorities should be prioritising the impact of STPs on local communities given council cuts to social care.
National director of Healthwatch, Susan Robinson, criticised the lack of public engagement on STPs in a statement made in August:
‘Reports about these plans will obviously be of concern to the communities mentioned and, unless the way people are engaged in making big decisions improves, the approach taken so far risks undermining wider public confidence in the NHS.’
National Healthwatch Chair, Jane Mordue, has also stated her concerns about the government’s approach on STPs, including a lack of public awareness about the plans, limited opportunities for public involvement and the fact that patients and residents were not involved in the design of the STPs themselves and are only being consulted once the plans have been prepared.
The Healthwatch Chair also warned that ‘consultations are not the only point at which communities should be involved’ in deciding the future of the NHS, and cited Healthwatch’s recommendations for working actively with local communities.
Other critics highlight that the narrow timeline for the preparation, publication and sign off on the STPs has prohibited consultation with the public, leading many critics to refer to the controversial proposals as ‘secret plans‘ for privatisation and service closures and prompting a flurry of FOI requests – including this one to Portsmouth CCG, overdue for a response at the time of writing – asking for the STP and related communications to be published.
A recent investigation by the Kings Fund uncovered reports from NHS managers who said they were told to keep STP plans ‘private and confidential’, while another reported that no ‘real people’ have been involved in their preparation.
In the course of investigating this report, we discovered only two organisations committing to public consultation on the Hampshire and IOW STP.
Southern Health NHS Trust released a statement in November including the following:
Over the coming months, there will be comprehensive engagement with local people. If, after this engagement period, any proposal emerges that is considered to represent significant service change, we will also undertake a full consultation with local citizens and local stakeholders.
Similarly, in August, Hampshire Hospital NHS Foundation Trust released a statement as follows:
The plan will need to be developed with, and based upon, the needs of local patients and communities and command the support of clinicians, staff and wider partners such as local government. We cannot develop care built around the needs of patients and users without understanding what our communities want. So we are building plans to engage with local people about all aspects of the plan.
In their statements, neither Trust describes how the public will be involved, and it is likely these consultations will only focus on services delivered by the two Trusts, not the entire Plan.
At the time of writing, we found no evidence of concrete plans to consult Portsmouth residents on the STP or the impact it will have on local services and communities, despite the long list of CCGs, health trusts and councils – including Portsmouth – who have been involved in preparing it.
Moreover, while the list of organisations involved in the preparation of the STP is long and wide-ranging, Cllr Stubbs has highlighted in local reports that the STP is very much ‘an NHS plan’, perhaps signalling that the Portsmouth Conservative administration would prefer not to be associated with it.
Despite the Council’s reluctance to give a voice to local residents on the STP, campaigners have been gathering signatures for a petition to Portsmouth City Council (see below). Further action on raising awareness of the STPs and overturning their rollout is planned for next year.
However, with the majority of local residents still unsure of the meaning of the STPs – if they are aware of them at all – preventing the rollout of these plans will prove challenging.
Increasingly, it is being left to activists, campaigners and concerned professionals to raise public awareness of the real impact of the government proposals, not only for the NHS, but across policy areas. Campaign organisation and petition site 38 Degrees is currently crowdfunding to continue its own investigation into the cuts as shown in this video.
Recent mainstream media coverage of the Hampshire and IOW STP has clustered around Cllr Stubbs’ calls for public consultation from Healthwatch, rather than critical assessments of the STP itself or the council’s role in representing local communities who will significantly affected by it.
Mainstream media reports often fail to outline what the STP is, what it means for local communities, or the broader context of public sector cuts to health and social care services, which seem set to completely change – and in many cases significantly reduce – health service provision in Portsmouth and the surrounding area.
Even in more detailed coverage, NHS press releases and statements which highlight ‘efficiencies’ and savings’ are often extensively quoted from and placed against quotes from campaign groups on ‘cuts’ to provide an alternative narrative to the government’s official line. Although this ‘he said’/’she said’ reporting is a mainstay of conventional reporting thought to bring ‘balance’, local residents are often left without enough factual information to decide who to believe, as these 2 comments on a recent article about the STP from The News’ website highlight.
In a landscape where mainstream media organisations such as the Johnston Press – which owns and operates the News, as well as the i newspaper – are under increasing financial pressure, local reporters are tasked with delivering more stories in less time, making it much harder for journalists to report on context or in depth. Moreover, the drive for traffic to deliver returns on advertising leads to a pressure on the media to promote ‘clickbait’ stories over more in-depth or critical exposes of government policy.
Star & Crescent would not have been able to publish this report without the assistance of a local GP, who has worked closely with us to help us understand the implications of the STP and the local campaign attempting to prevent it. This is part of S&C’s renewed focus on investigative, critical journalism and our exploration of how it can be funded without compromising editorial independence through advertising or ‘advertorial’ (articles that have been paid for by businesses for promotional purposes).
Find out more
Hampshire and Isle of Wight STP – read it for yourself and share it with your friends, colleagues and families
British Medical Journal blog – ‘Alex Scott-Samuel: Tory plans for NHS privatisation released during parliamentary recess’
Health Campaigns Together – crowd-sourced information on all STPs across the 44 ‘footprints’
Open Democracy – ‘Councillors must look before they leap into secret NHS cuts plans’
Support national and local campaigns calling for public information and involvement in NHS cuts
- Contact your councillors and/or your MP to ask what they think – and what they’re doing – about the STP
- Sign the local petition asking Portsmouth City Council to publish and consult on the plans