Plans for improving care are being derailed by hospital deficits, GP leader warns

NHS transformation plans are being swept off course by acute care deficits that risk wasting the opportunity to improve patient services, doctors’ leaders have warned peers.

Royal college leaders warned that some health professionals working on sustainability and transformation plans (STPs)—the process for 44 areas in England to come up with proposals to improve health and save money (see http://bmj.co/stpMap)—are “blinkered” to long term change because of the severity of current financial problems among hospital trusts.

Representatives of several royal colleges appeared before the House of Lords’ NHS sustainability committee on 22 November to answer questions for the committee’s inquiry into the long term sustainability of the NHS.

Peers asked whether clinical commissioning groups (CCGs) were doing their job well enough to allow for better integrated health and social care for their local populations and whether they should be replaced with different bodies.

Helen Stokes-Lampard, chair of the Royal College of General Practitioners (RCGP), said, “I would strongly advise against another whole scale restructure. We need to work with what we’ve got. They [CCGs] are doing their best, but the reality is that they are in a very resource constrained environment and are struggling. The STPs, however, have to be the way forward.

“The STPs are aiming to look to the medium and long term future, but they are being distracted by shoring up the acute sector deficit, which is a real distraction from what they really need to be doing—fulfilling the aims of planning for the future.”

Peers asked whether the witnesses had been involved in developing STPs, to which Stokes-Lampard replied, “Yes. The RCGP has invested members’ money in producing an ambassador for every STP. We have seen a huge variety of engagement [including] involvement of local government and social care.

“Some of them seem to be getting the whole scale picture and embracing that. Others seem to be so focused on resolving the acute sector deficit they are inheriting, that they are completely blinkered and unable to see beyond that.”

Earlier in the session, other medical leaders emphasised the need to see social care as the funding priority above healthcare because of its dire position after six consecutive years of cuts to local authority budgets by central government.

Jane Dacre, president of the Royal College of Physicians, giving evidence, said, “Social care is in a worse position than healthcare. Even though I’m sitting at the top of a medical royal college, any [new] funding model has to put social care first because of the effects that the difficulties social care is experiencing are having on transfers of care around and out of medical practice, either in primary care or in hospitals.”

Sue Bailey, chair of the Academy of Medical Royal Colleges, also giving evidence, said, “We need to urgently ask that social care is properly funded, because healthcare is totally co-dependent on social care and we would be able to deliver better if the pressure is off social care.”

However, Ian Eardley, fellow witness and vice president of the Royal College of Surgeons, said that he had some concerns.

“I went to the launch of my own STP last week, and I was struck [by] the discussions that the social care people clearly saw the healthcare budget as an opportunity to bail out their problems,” said Eardley. “This is within the context of an NHS, which is, in many ways, cash strapped.”

He added, “It’s very difficult to see past a wider debate with the population and the service about whether the whole of healthcare should remain free at the point of delivery. We believe that is the right thing to do, but it’s challenging to achieve, given the economic constraints that we have got.”