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Some reasons to be cheerful – and one of them might be STPs

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The public are suspicious of sustainability and transformation plans but some positive news shines through anyway, writes Michael White

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375_lgc_hsj_reporting

Three cheers for sustainability and transformation plans? Oh dear, that didn’t go down very well, did it? But most voters still don’t know what STPs are and most of those who vaguely know regard them as secretive and menacing, so we must make allowances.

But the King’s Fund session I attended on STPs last week put them in a more wholesome light than you would ever imagine listening to Jeremy Corbyn playing Labour’s time-worn “NHS in crisis” card at PMQs ahead of a couple of tricky by-elections.

Local STPs for both Cumbria and the Staffordshire and Stoke area featured in both Thursday’s contests more prominently in Copeland,  where Labour’s incumbency candidate, councillor Gillian Troughton, briefly a hospital doctor in the early 90s – more recently an ambulance driver – got beaten by a Tory novice and community activist, Trudy Harrison.

The “secret” STP’s proposal to move maternity services 40 miles along the winding coast from the West Cumberland hospital in Whitehaven to Carlisle has been a hot local issue for months, but Mr Corbyn’s ambivalence on nuclear power – the area’s major employer – seems to have counted for more.

Candidates not being rewarded for using the NHS as a political football must be healthy. But the current NHS drama will require more positive contributions from the political class

There are familiar problems with Stoke’s STP, too. The Royal Stoke has had 35,000 A&E waits over four hours in the past year – no wonder its STP hopes to cut A&E attendances by 30 per cent. But, for what it is worth, it has also had 10 local STP “conversations” with voters.

That may have lanced the boil and helped Labour see off Ukip leader Paul Nuttall’s challenge – not that Ukip ever has coherent or useful things to say about the NHS, quite the reverse on migrant staffing.  

Candidates not being rewarded for using the NHS as a political football must be healthy. But the current NHS drama will require more positive contributions from the political class – courage to support restructuring, closures and service redesign, as well as more cash in Phil Hammond’s (I called him Phil Hunt here last month) 8 March budget. Oh yes, less chopping and changing in Whitehall policy too.

Such thoughts inevitably recurred in the King’s Fund session, which struck me as full of gritty optimism, grounded in realism as well as some wishful hopes. In his opening remarks on the fund’s own report - Delivering STPs: from ambitious proposals to credible plans – the ubiquitous Chris Ham reminded his expert audience that it is more “nuanced” (laughter) than media reporting had suggested.

Cheery note

More important, he and others pointed out that STPs – all 44 of which are loose coalitions of 20 or 30 organisations – are navigating their local environment with no statutory framework of their own.  

So their governance, as well as their engagement with local stakeholders and voters, will have to be strengthened if they are to deliver the changes envisaged in the far less cash-strapped days of Simon Stevens’s Forward View.

Quite so. One of the funniest lines of the morning came when David Pearson, Nottinghamshire’s social services chief, currently heading its STP too, quoted his health and wellbeing chair on the perils of too much secrecy: “When I’m not consulted early I get capricious.”

NW London’s STP posse tried to bounce two local council leaders in my own patch into endorsing their plan after allowing just half a morning’s reading time. As the fund report ruefully notes, “these proposals are not supported” by the two councils.

The other cheery note I took away from the King’s Fund session was that, amid all the mayhem, a great deal of that long-sought and creative diversity in UK healthcare provision is under way despite years of austerity – and in the public sector, too.

The point was underlined by a brief contribution from the SNP MP, Dr Philippa Whitford, a breast cancer surgeon, who reported that in SW Scotland – she represents Ayrshire – NHSS has actually rebuilt, not closed, three small community hospitals for flexible step up/step down use.

Right or wrong? With general and acute beds down overall, from 160,000 in 1990-91 to 103,000 and falling, that certainly bucks the trend. Yet the average hospital stay has been cut from eight to five days just since 2000, I read the other day, and a scornful Theresa May tells Jeremy Corbyn – apparently she’s correct – that half of England’s delayed discharges come in just 20 local authority areas, many of them larger and affluent counties.

Astonishing facts both, symbols of rapid change and of challenges that can’t be ducked along with efficiency, obesity (does it really cost £26bn a year?) flagging staff morale and the flood of issues currently flagged up by waves on “NHS in crisis” investigations on the BBC.

Where’s Jeremy Hunt in all this? Fielding the easy questions on health tourism while his juniors tackle the tough ones at Westminster, that’s where. A low profile is fine, near invisibility quite another. Time to shape up or ship out, minister.

Michael White is a former political editor of the Guardian.

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