"You gain strength, courage, and confidence by every experience in which you really stop to look fear in the face. You are able to say to yourself, "I have lived through this horror. I can take the next thing that comes along." . . . You must do the thing you think you cannot do." Eleanor Roosevelt, Former First Lady
So the homework has been done, the project completed, job done, and handed in to NHS England. Phew. CCGs and their providers heave a collective sigh of relief. Pop that one on the shelf, box ticked, and on we go.
What am I talking about here? Sustainability and Transformation Plans (or STPs to their friends), of course. 44 of them to be precise, where CCGs and local leaders have been put into local “footprints” and mandated to come up with a clever plan of how they’re going to deliver NHS services within the funding that they have available. Easy peasy, then.
Well no, not really. As we are all only too aware, the care system is under huge pressure, with no provider or commissioner untouched by ever-increasing deficits and the need to tighten the purse strings. The length and breadth of the country belts are being tightened and tough decisions are being made.
The press, in both its medical and non-medical guises have already spotted the fatal flaw: most of them are not deliverable on the basis that they are completely over-ambitious – trying to make sure they’ve answered the question in the way that NHSE wants to hear it, rather than being based in any form of reality.
And now that their content is in the public domain, what’s even less palatable to the populous is that services are apparently going to be slashed and burned, seemingly without any need for consultation, where once it would have been mandatory and obligatory, and quite frankly necessary. This includes hospital beds being closed, maternity units being closed, some entire hospitals being closed. Services rationalised to the point of oblivion with the sole aim of balancing the books.
A myriad of organisations in each area have been involved in drawing up these plans, and they include plans for primary care. Yet despite an apparent and complex cast of thousands being party to the developing these plans, this was a party that the majority of GPs as providers were not invited; the vast majority saying they know nowt about it. Along with the public: those on the sharp and receiving end of decisions made by others.
And now our esteemed Secretary of Health wants all the “-ologies” moved into general practice, with a one-stop shop process. This is actually something that I suspect many working in general practice would welcome in principle – as long as it’s not something else that’s being added to the long list of work that is not resourced and consequently not safe. However, where does this appear in STPs?
It all rather smacks of plans being made on the hoof, finger in the air stuff, and without any proper and meaningful engagement. And on this occasion without even any pretence that there’s been proper and meaningful engagement.
As I’ve said a number of times before, without this engagement even the best of plans (and I do quite like the sound of the –ologies one, clearly with caveats duly attached) will not work.
Everybody that has a stake in something should have the opportunity to be involved in plans and decisions around change if they choose to. For STPs, given their magnitude and complexity, as well as the timescales involved in drawing them up, this seems to have been too big an ask. But it needn’t have been. On the face of it, it seems likely that STPs are going to fail to deliver before they’ve even started, and that is a real shame; a missed opportunity.
The care system needs to rise to the challenge of increasing demand against a backdrop of resources that aren’t keeping pace. The only way to do this is to properly, genuinely and meaningfully involve everyone who wants to be, whether it’s 9, 90, 900 or 9000, so that the need for change is understood and the plans put forward, no matter how challenging they may be, will be properly implemented.
Turning back to the quote at top, the STP leads appear to have been afraid to genuinely engage everyone affected by the proposed changes. They are therefore likely to pay the price in the form of disquiet, cynicism, bureaucracy, resistance and complete disenegagement, meaning the planned changes in the main will fail.
For STPs, the homework’s been marked, and the red pen has written “could do better”
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