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Sustainability and Transformation Plans

Volume 778: debated on Thursday 26 January 2017


Asked by

To ask Her Majesty’s Government what progress is being made with the Sustainability and Transformation Plans for England.

My Lords, proposals have been published for all 42 sustainability and transformation plans—also known as STPs—covering every part of England, with a goal of making the NHS five-year forward view a reality. NHS organisations have now submitted their operational plans for 2017-19. These are the next steps in turning STPs from proposals into practical action.

My Lords, with 42 areas, a huge number of meetings, a huge amount of report-writing and research and all kinds of things are taking place, diverting a large amount of time and resources. The Government see the operation as a way of slashing spending, but the professionals involved on the ground see it as a way of providing better services. Do the Government realise that they cannot carry out another huge wave of reorganisations in these 42 areas without extra resources, rather than less resources? Can they tell us how many staff are engaged on the STP process and at what cost, and how much is being spent on consultants and other outside support to carry out this operation? How much is it all costing?

My Lords, the sustainability and transformation plans are operational plans for putting the NHS’s own five-year forward view into practice. They are about the community and clinically led redesign of services to do things such as make it easier to see a GP, improve cancer diagnosis and give faster mental health support. Noble Lords might be interested to know some of the big opportunities for service improvement identified by the Lancashire and South Cumbria STP, which is local to the noble Lord: 27% of people seeing their GP could have had their issue resolved another way; 25% to 50% of hospital beds were used by people who did not need to be there; and 30% of A&E attendances could have been avoided. It has said that about £176 million of efficiencies could be found in the acute providers within that STP area alone. There are huge opportunities for change. It is clear that any changes cannot be approved without public consultation or without delivering clinical improvements. The Government are backing these plans in two ways. First, with the £1.8 billion—

The noble Lord asked about funding and I want to provide him with an answer. The plans are backed by a £1.8 billion sustainability and transformation fund and £19 billion of capital spending over four years to help make these changes.

My Lords, the Minister has talked about the public being involved. Why then have the public, local authorities and clinicians been excluded from the STP process so far, as shown by the King’s Fund? These plans depend on investment in primary care, community care and social care. Where on earth is the money going to come from to invest in those services, when the acute sector is under such pressure?

Clinicians and local authorities are involved in these plans. The whole point of the plans is that they bring everybody together within an area to create changes that are driven from the bottom up, so as to provide a much more efficient service. The noble Lord knows full well that more money is going into both primary care and the service overall.

My Lords, STPs are a major systems change in the way healthcare will be delivered. As the Minister said, there will be significant demand for the resources going into them. What are the governance arrangements for the STPs?

I thank the noble Lord for that question. STPs are voluntary groupings of all the relevant people—whether that is at the acute level, in primary care or local authorities—coming together under leadership to create the changes. Those then turn into operational plans that are delivered by individual hospitals, primary care settings and so on.

My Lords, these plans were supposed to have got under way last October. Have any of them actually started transforming services in their area, or are they still too busy figuring out how to balance the books?

All 44 sustainability and transformation plans have now been published and are being scrutinised by NHS England, which is helping to ensure that they are as successful as possible. Operational plans will then come forward from April 2017 onwards.

My Lords, the sustainability and transformation plans have been widely criticised for not yet allowing adequate public or parliamentary scrutiny. Does the Minister agree with me that any future rationing of cancer drug treatment, for example, should receive the public scrutiny it deserves? In particular, will he intervene with NICE and the pharmaceutical company Roche to demand a rethink on the proposal to stop from next week the effective secondary breast cancer drug, Kadcyla, being available to women on the NHS?

On public scrutiny, all the sustainability and transformation plans have had public involvement. They were published and consulted on. I do not recognise the picture that the noble Baroness paints in relation to cancer drugs. This Government created the cancer drugs fund in order specifically to fund innovative cancer drugs and bring them to market more quickly. She will know that decisions on availability and funding of drugs are properly taken by NICE on a clinical basis.

In July last year, the Government’s response to the national end-of-life choice offer was that end-of-life care would be part of all transformation programmes, yet 20 of the plans make fleeting or no reference whatever to end-of-life care and only six have clearly stated plans. That is despite approximately a quarter of a million patients dying each year in hospital. While some cases are acute, a large number of patients have a period where they need their care improved. What action are the Government taking?

I thank the noble Baroness for making that point. The purpose of NHS England’s review of the STPs is to make sure that they account for all the priorities set out in the Five Year Forward View. Clearly, that involves end-of-life care, and NHS England will work hard to make sure that it is properly reflected.

My Lords, a very interesting and good report has been published this week on pilot schemes in three London boroughs to treat the effects of female genital mutilation and prevent it occurring in future generations. We have already heard from one clinic in that pilot project that it will have to close at the end of March through lack of funding. Will Minister assure us that such projects, which are vital for many women in our communities, will continue in future?

I thank the noble Baroness for raising that issue, which I was not aware of. I would be very happy to write to her on it.