Re: David Oliver: Binary truths don’t help health policy debate
David Oliver states that STP could “in theory” deliver benefits while acknowledging that they have been criticised for “being rushed, for overpromising savings and for lacking clinical engagement”. The key words here are “in theory”, since in fact there are much more fundamental problems with STP. As the mechanism for delivering the new models of care envisaged in the ‘Five Year Forward View’ (1), STP are based on flawed financial assumptions including the availability of sufficient capital to transform NHS services; a fall in the rate of growth of health care in acute hospitals; a continuing 1% pay cap; falling agency staff costs; investment in public health and education to rapidly reduce patient demand; adequate investment in social care (2).
Furthermore, no STP demonstrates any evidence for the central assumptions it makes or its ‘innovative solutions’ (3). Worse still, the ‘Five Year Forward View’ is drawn directly from the World Economic Forum’s diagnosis of the healthcare crisis, and also reproduces the Forum’s prescription for supply-side change and the various levers available to policy makers (4). This is ‘reform’ in the interests of big business not for patients. It is difficult to disagree with the thesis that an intentional market failure has been created in the NHS by underfunding, paving the way for treatment rationing and shifting the costs of care to patients. Of course, STP could “in theory” deliver benefits through empowering local teams and integrating care, but the reality is their cost saving imperatives mean they are not actually designed for this purpose. To many supporters of the NHS they articulate something altogether sinister in health policy.
Rapid Response:
Re: David Oliver: Binary truths don’t help health policy debate
David Oliver states that STP could “in theory” deliver benefits while acknowledging that they have been criticised for “being rushed, for overpromising savings and for lacking clinical engagement”. The key words here are “in theory”, since in fact there are much more fundamental problems with STP. As the mechanism for delivering the new models of care envisaged in the ‘Five Year Forward View’ (1), STP are based on flawed financial assumptions including the availability of sufficient capital to transform NHS services; a fall in the rate of growth of health care in acute hospitals; a continuing 1% pay cap; falling agency staff costs; investment in public health and education to rapidly reduce patient demand; adequate investment in social care (2).
Furthermore, no STP demonstrates any evidence for the central assumptions it makes or its ‘innovative solutions’ (3). Worse still, the ‘Five Year Forward View’ is drawn directly from the World Economic Forum’s diagnosis of the healthcare crisis, and also reproduces the Forum’s prescription for supply-side change and the various levers available to policy makers (4). This is ‘reform’ in the interests of big business not for patients. It is difficult to disagree with the thesis that an intentional market failure has been created in the NHS by underfunding, paving the way for treatment rationing and shifting the costs of care to patients. Of course, STP could “in theory” deliver benefits through empowering local teams and integrating care, but the reality is their cost saving imperatives mean they are not actually designed for this purpose. To many supporters of the NHS they articulate something altogether sinister in health policy.
References
1. https://www.england.nhs.uk/five-year-forward-view/
2. https://chpi.org.uk/papers/analyses/the-five-year-forward-view-do-the-nu...
3. https://chpi.org.uk/papers/analyses/sustainability-transformation-plans-...
4. https://www.sochealth.co.uk/2017/05/25/truth-stps-simon-stevens-imposed-...
Competing interests: No competing interests