The government's Sustainability & Transformation Plans (STP) have been shrouded in secrecy. Despite being the biggest change to the NHS since the Health & Social Care Act 2012, they will not be voted on them in parliament.
So what exactly are the STPs? The NHS will be divided up into 44 footprints, but you need a glossary to translate these terms. Sustainability means cuts. This is part of the drive towards £22bn in cuts by 2020 – bearing in mind that we've already had £15bn in NHS cuts in the last parliament generating a manufactured crisis. Cuts mean a massive programme of hospital closures across the country and it will also lead to mergers and permanently selling off the NHS estate of land and assets.
The bogus narrative around unsustainability and unaffordability has been spun by the private healthcare and insurance industry, captured politicians and the media. In truth, we spend much less on healthcare than other advanced economies.
In order for these footprints to receive funds, there are strings attached. The footprints will have to sign up to transformation, which basically means privatisation. The footprints will have to adopt unproven models of care.
The bigger picture here is integrated healthcare. It sounds great but it's imported from the US. The NHS five year plan – the Five Year Forward View – specifically states that the NHS should emulate US style integrated or accountable care. Integrated care organisations are springing up all over the place.
This is all being sold as care in the community, but there are no extra resources for GP and community services.
In fact, we already have a major bed crisis. The NHS has lost over 50 per cent of its bed capacity in the past 25 years. Our bed to population ratios are now below Eastern European countries. Further hospital closures will simply be disastrous.
Patients – often the elderly or young mothers and children – will be forced to travel much further. In rural areas, this may mean long distances along country roads. When it comes to emergencies, patients will die. Clearly what is needed are high quality local services.
Instead, NHS England are offering virtual Skype consultations, health apps, self-care and pharmacies as a substitute for high quality medical and nursing care. We are also seeing deliberate deskilling and de-professionalisation of NHS staff, hence the cost-saving seven day plans, the junior doctors' contract and the removal of the student nursing bursary.
According to the Dalton Review, the aim is to create chains of super hospitals, which can be run by the NHS or private companies. The GP Forward View states that GPs will be merged into networks of federated organisations. This restructuring is designed to entice the private sector. Chains of hospitals and networks of GPs can be bought out by corporations or private equity. This is a far more attractive prospect for investors than running a small GP surgery or a district general hospital.
And the starting gun has been fired. In my neighbourhood of Southwark, several GP surgeries are merging into Nexus Health Group.
The worst part is that integrated care may not even lead to savings. All of which will mean denying access to hospitals, specialists and sometimes life-saving treatment. To put it bluntly, private healthcare, Private Finance Initiative (PFI) consortia, platoons of management consultants, “big four” accountants and lawyers will continue to cream off billions whilst patients suffer.
The ultimate destination is a two tier system. The majority of ordinary people will have a third-class service and the wealthy will be forced to take up private healthcare insurance.
None of this is inevitable or unavoidable. There will be fierce, local resistance. Abstract privatisation legislation is one thing. The concrete reality of your local hospital closing will mobilise thousands of people.
The mainstream media coverage of STPs comes on the back of Jeremy Corbyn's announcement to renationalise the NHS. The NHS Reinstatement Bill aims to restore a publicly provided, owned and accountable health service. Removing the market, the private sector, the Private Finance Initiative (PFI) and outsourcing would release tens of billions to spend on patient care. This is the progressive alternative for a 21st century NHS.
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