A lethal combination of secrecy and jargon has overshadowed NHS plans
|
Version 0 of 1. The NHS is in danger of losing control of public debate around the sustainability and transformation plans (STPs). Days after the unnecessary secrecy around STP blueprints for change predictably backfired, with lurid headlines about closures and cuts, both NHS England and the government have been trying to get a grip on public understanding of what all this frantic management work is trying to achieve. At this week’s Health and Care Innovation Expo in Manchester, NHS England chief executive Simon Stevens said that in the next few days his organisation will be spelling out expectations on how the public will be involved in discussions. This is a reversal of its previous position, which was to discourage STPs from publishing their draft plans. Meanwhile, at prime minister’s questions, STPs put the prime minister, Theresa May, on the defensive, forcing her to reiterate the importance of taking into account the concerns of local people. The emerging plans are sensitive because a large number involve substantial changes to hospital services. It is far from clear how many of these will eventually go ahead, because there is a desperate shortage of capital funding with which to implement them. While some of the emerging hospital changes, such as those in south-west London, are trying to resolve disputes about the right shape of hospital services which have dragged on for many years, there is a serious risk in some areas of pursuing highly controversial changes of questionable benefit on dubious evidence. The King’s Fund and others warned that major changes to acute services rarely deliver the anticipated substantial savings. It has been repeatedly proved that the quickest way to trigger massive opposition to hospital changes is to make them look like a secret plan that is to be sprung on the public. Yet the NHS keeps on doing it. Local political leaders are key. When councillors – not just the handful involved in the STP process – and MPs are involved early on, understand the case for change and feel their concerns are being taken seriously, they can be engaged in productive public debate. And what about patients? One of the guiding mantras of the NHS is supposed to be patient involvement, but at the Expo a small band of community campaigners gave voice to their complaint that service users are being excluded from these crucial discussions. With much of the work supposed to be completed by December, it is stretching credulity to believe that much more than token consultations with patient groups can take place. One of the difficulties around consultations faced by the STP teams is that some of them have made too little progress to present credible, watertight arguments. It is difficult to overstate the huge variation in STPs. A handful involve organisations that have been working together for years, have well-developed plans and are poised to deliver. These areas are likely to have already carried out extensive consultations through their clinical commissioning groups. Others are trying to work to unfamiliar boundaries and admit privately to having little more than “plans to have plans”. Public understanding of the issues is minimal, the evidence base is thin and they have little of substance to discuss. It is these ones at the back of the queue that are most nervous about consultations. The crucial error NHS England has made is to allow the process to be seen almost entirely through the lens of cuts, obscuring the vast amount of work underway to reshape services around the needs of patients, particularly in the community. As NHS staff giving talks at the Expo proved, across the country from pharmacy management in Wessex to musculoskeletal services in Wigan, clinicians, managers and commissioners are delivering the vision captured in the Five Year Forward View of a patient centred NHS – and driving up productivity along the way. But the lethal combination of unnecessary secrecy and impenetrable management jargon has obscured the most important part of the story – that the health and care system would still need drastic reform even if it was awash with money. Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views. |