The change agenda for the NHS in England is itself undergoing a transformation. This much became clear last week when Chris Ham of the King’s Fund launched its comprehensive paper on Sustainability and transformation plans in London. https://www.kingsfund.org.uk/sites/default/files/2017-09/STPs-London-Kings-Fund-September-2017_1.pdf

The problem was that much of the analysis was undertaken in May this year, and was based upon the STP plans drawn up a year ago. Since then, the objections of local authorities who felt they had been inadequately consulted, an intensification of the NHS financial squeeze and the disruption of the General Election all work to make the King’s Fund’s Report sound a little out-of-date. Quite rightly, therefore, they added a preface that amounts to a commentary on the current state of play. And this is where it gets interesting.

1. The Fund’s view is that the financial plans submitted last year for the London STPs ‘are unlikely to be achievable’. Yet the link between financial credibility and NHS England’s confidence in the STP itself seems somewhat tenuous. In July, a dashboard was published showing the perceived performance of each STP on a four-point scale. London’s STPs were somewhere in the middle

2. The latest assessments need to take account of the new test on proposed bed closures. This has concentrated minds all over the country. Far too many health planners have made over-optimistic assumptions, and anyone who has attended public meetings on the subject will know that a great many people have not been convinced. In the words of the Kings Fund report ‘…reductions in hospital use on the scale proposed in London’s STPs are not credible’

3. Many projects for service change suffered from the delays of purdah earlier this year, but the Report asserts that ‘the outcome of the general election is unlikely to have a major impact on the NHS, social care and STPs in the short term.’ But then it adds that the Government’s very fragile Parliamentary majority will ‘lead to greater sensitivity on behalf of the government about any controversial service changes proposed by STPs, particularly those to acute hospitals’

Clearly this will impact the processes of engagement and consultation.
Only when proposals are subject to thorough local debate can the degree of controversy be assessed. And no Government will dare wave through an unpopular service change without being able to defend the quality of engagement that has preceded it. If change is to happen, consultation practices must be unchallengeable. The Institute expects to assist in this, but it is not obvious that all STPs have yet fully grasped the nettle.