Dr Blogs

STPs: “Don’t underestimate the time or effort needed to make these fundamental changes”

The new King’s Fund report – Delivering sustainability and transformation plansechoes many of the RCP’s views about STPs.

We welcome the drive towards providing care nearer the patient in the community as embodied in STPs; however we must not close hospital beds before we have invested in those community services.

Our hospitals and NHS staff are only just coping, and we cannot underestimate either the time or effort needed to make these fundamental changes, as shown by the lack of progress in integrating health and social care services.

While the plans are still under discussion, now is the time for STP leaders to involve patients, healthcare staff and the wider public in designing services that meet the needs of patients now and in the future.

The RCP’s registrar Dr Andrew Goddard has also produced an analysis of STPs.

Key points include:

  • The financial efficiency savings planned will be challenging. The median financial gap for healthcare is £320 per person in the STP’s population (range £215–608) and the median financial gap for social care in the 29 STPs that have assessed this is £102 per person (range £28–233).
  • Reliance on Sustainability and Transformation Fund (STF) monies in financial plans is high, with a median proportion of 19% of the financial gap for 2020/21.
  • Shortages in all areas of the health and social care workforce will need to be addressed. Most plans rely on expansion of GP-led services to reduce acute sector demand and manage care closer to home. Engagement with GPs and improvement of GP workforce issues are therefore critical to STP success, and there is variable evidence in the plans for this.
  • There is lack of evidence for meaningful engagement with the social care challenge in some STPs, which is concerning for those plans.
  • Planned reductions in urgent and emergency care (UEC) measures, when given, are very optimistic. Accident and emergency (A&E) attendance reductions of 2–36%, non-elective admission reductions of 7–30% and bed reductions of 9–37% are proposed. Such reductions, while laudable, seem highly aspirational and should be viewed with scepticism.
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