16th November 2016
Despite the announcement of a shake up for all of England’s NHS via 44 new Sustainability and Transformation Plan (STP) plans, little is known about what they actually mean for patients. The planning process has been secretive and details have not been published. But for a large part of the North East London footprint detailed proposals are available – the three boroughs in East London – Newham, Tower Hamlets, and Waltham Forest. In the face of a predicted 30% increase in the area’s population over the next ten years,
- over a quarter of A&E treatments will be shifted out of hospital and into the community;
- a shortfall of 395 GPs needed by 2025/26 will be substituted for by 38 science graduates with a 2-year diploma, 63 more nurses, and 106 pharmacists;
- a shortfall in hospital beds with only an additional 240 extra beds compared to the 550 needed by 2025;
- many more patients will be expected to care for their own health;
- access to urgent care will be by telephone appointment only.
A new report by the Centre for Health and the Public Interest (CHPI)  reveals the draft plans contained in ‘Transforming Services Together’, which the North East London STP has committed to implementing in its latest draft. The planners predict that by 2020/21 the deficit for East London’s NHS will be £398m, a more than threefold increase over the £108m deficit in 2015/16. To close this deficit the local Clinical Commissioning Groups (CCGs) and hospitals have been forced to propose drastic changes to the local NHS.
As well as a major cut in the proportion of patients treated in hospital, the primary and community care workforce will be radically reconfigured.
The CHPI report looks at the assumptions underpinning the plans and finds them to be unrealistic:
- It is unlikely that the shortfall of GPs can be replaced with enough lower-paid staff (nurses, physician associates, pharmacists) when the pay of such is below the minimum income level need to live in London. Already the staff turnover rate is 15% and 13% of nursing posts are unfilled.
- It is uncertain whether these staff can handle the increasingly complex workload being shifted out of A&E.
- The plans call for £173m to be spent over the next five years to transform buildings and patient records but it is unlikely that this will be available.
- Over the full ten years, from now to 2026, the amount of investment needed rises further by £463m.
- Expecting 90% of patients to book appointments for urgent care online or by phone is testing in an area with high levels of English as a second language, a population turnover of 28% a year, and where only 42% of over-60s have internet access.
Report co-author Vivek Kotecha  said:
“With a £398m deficit local commissioners have no choice but to propose drastic changes. However, the plans put forward for East London’s NHS are based on heroic assumptions. There is a strong risk that a Frankenstein Framework of new and old health systems will emerge when cuts are made but the investments do not deliver as expected. This would lead to poor quality care for East Londoners and confusion for patients and doctors.”
Report co-author Professor Leys  said:
“It is clear from the documents that the planners themselves have severe doubts about many of their assumptions. If the plans are adopted in the new year as NHS England intends there is a strong probability that East Londoners will find that health care is increasingly rationed and those who do get care will get a worse quality.”
The full report is now available here.
Contact: Vivek Kotecha at [email protected]
Notes to editors
- The Centre for Health and the Public Interest is an independent think-tank. The Centre aims to ensure the policy debate on health and social care is more varied, more evidence-based and more open and accessible to citizens.
- Vivek Kotecha is a Research Officer at the CHPI. He previously worked as a manager in Monitor and NHS Improvement analysing and reporting on the operational and financial performance of the hospital provider sector. Prior to that he worked as a management consultant at Deloitte for 4 years. Vivek holds a BSc Economics (Hons) from the LSE and is a chartered accountant. He is currently studying for a MSc Economics at the University of London.
- Professor Colin Leys is an emeritus professor at Queen’s University, Canada, and an honorary professor at Goldsmiths, University of London. He is the author of Market Driven Politics: Neoliberal Democracy and the Public Interest. Since 2000 he has written extensively on health