Reports and Analyses

Sustainability and Transformation Plans: Five key questions for planners

Vivek Kotecha

Analysis, 22nd June 2017


This analysis identifies five key questions to ask of each of England’s 44 ‘Sustainability and Transformation Plans’.

The Five Year Forward View: do the numbers add up?

Vivek Kotecha

Analysis, 18th May 2017


The financial assumptions underpinning the Government’s plans to close the NHS’s 30-billion-pound funding gap by 2020/21 are unrealistic and are likely to lead to a decline in the quality of and access to healthcare for patients. Subsequently there is a growing risk that that some vital services will collapse.

Can we afford to close any more A&E departments? Evidence from North West London.

Dr Gurjinder Singh Sandhu

Analysis, 24th April 2017





Closing A&E departments has led to a deterioration in the performance of those that remain in North West London. This analysis warns of the risk to patients if further A&Es are closed.

The Sustainability and Transformation Plans: a critical assessment

Lister STPs cover

John Lister

Analysis, 25th January 2017




John Lister assesses the published drafts of the plans for implementing the Five Year Forward View published by NHS England in 2014. They envisage a major switch of treatment from hospitals to non-hospital settings, and a reduction in the need for healthcare through measures to prevent illness and through helping people to take more care of their own health. NHS services are expected to become more accessible and effective while at the same time costing less, and thus closing the growing funding gap between what the government is committed to spend and what the NHS, as currently organised, needs.

The assessment finds that the plans rest on implausible assumptions and lack credible implementation measures. It concludes that the scale of the planned reduction in hospital services implies rationing and risks the collapse of some services.

The failure of privatised adult social care in England: what is to be done?


Bob Hudson

Report, 23rd November 2016




This report describes the role that privatisation has played in the decline of the provision and quality of adult social care. It outlines a number of reforms which could help reverse the decline in the sector.

‘Transforming Services Together’: what does East London’s plan for health services imply for East Londoners?

tst-area-in-ne-london-stpVivek Kotecha and Colin Leys

Analysis, 17th November 2016



Transforming Services Together (TST) is a five-year plan to radically reconfigure health services in the London boroughs of Newham, Tower Hamlets and Waltham Forest. The draft plan was drawn up between 2014 and 2016, at a cost of £3.49m for external consultants alone. It now appears to form part of the draft Sustainability and Transformation Plan (STP) for the wider North-East London area or ‘footprint’.

This report reviews the changes proposed by the TST plan and assesses the impact on East London’s patients and whether they are likely to work. It asks the following questions:

  • What problems is Transforming Services Together seeking to address?
  • What is the planner’s solution to closing the funding gap?
  • If all goes ahead as planned what will this mean for patients?
  • Are the plans based on realistic assumptions?
  • What will it mean for patients if the planner’s assumptions are wrong and the plans cannot be achieved?

Submission to the House of Lords Select Committee on the long-term sustainability of the NHS


CHPI Research Team

21st October 2016




This submission focuses on:

  • the meaning of sustainability when applied to a public service;
  • rising healthcare costs as an international trend;
  • why an ageing population may not bring greatly increased costs;
  • the burden of payment through changes in the dependency ratio;
  • how cost effective the NHS is; and
  • the lessons to be learned from the current hospital deficit.

It also contains recommendations on how to best manage future need and contain costs by appraising: the costs of the current marketised structure, PFI schemes, adult social care, the value of general medicine in treating long term conditions, mental health, socio-economic inequality, investment in prevention and models for service delivery. It was published by the House of Lords Select Committee on October 18th 2016.


Who cares about the rising number of suicides by mental health patients?

Who cares about the rising number of suicides-1

Dr Minh Alexander

Analysis, 15th August 2016



In spite of government pledges and plans to reduce the number of suicides, data from the ‘National Confidential Inquiry into Suicide and Homicide by People with Mental Illness ‘ shows the annual number of suicides by patients with mental illnesses has been rising for nearly a decade, from 1,453 in 2006 to 1,876 in 2013. Halting the the number of suicides by mentally ill patients depends on action to secure adequate reporting


Sustainability and Transformations Fund – why it is not enough and what are its implications for the provider sector?

Sustainability and Transformation Fund -01

Vivek Kotecha

Analysis, 1st July 2016



This analysis looks at:


  1. Why is the STF not sufficient to eliminate the providers’ deficit in 2016/17?
  2. What are the implications for providers who accept the funding, and for the NHS in general?


Can Simon Stevens’ Sustainability and Transformation Plans save the NHS?


Colin Leys 

Analysis, 16 May 2016


This analysis asks how far the new Sustainability and Transformation Plans being drawn up by ‘local health economies’ or ‘footprints’ can be expected to overcome the impending financial crisis of the NHS. It also draws attention to the apparent lack of a legislative basis for the planning process, and a corresponding lack of transparency and accountability.


How safe are NHS patients in private hospitals: learning from the Care Quality Commission *



Colin Leys and Professor Brian Toft

Report, 30 November 2015


This report uses findings from the Care Quality Commission’s new inspection regime for private hospitals to show that there continue to be risks to patient safety associated with the distinctive nature of private hospitals in England, compared with the NHS. In addition, the lack of systematic collection and reporting of patient safety data raises questions about the adequacy of the CQC’s new approach to regulating private hospitals.


The contracting NHS – can the NHS handle the outsourcing of clinical services?

CHPI report cover


CHPI research team

Report, 19 April 2015


This report raises questions about the capacity of the NHS to handle the increasing outsourcing of its services to the private sector and its ability to ensure that services provided by the private sector under contract with the NHS are safe, effective and value for money.


The return of PFI – will the NHS pay a higher price for new hospitals?

PF2 cover


Dr Mark Hellowell

Report, 26 November 2014


This report analyses the financing structure of the new Private Finance 2 scheme and finds that it is likely to increase costs to the NHS. Restructuring the balance of debt and risk capital would increase the rate of return to private investors by 15% compared to the original Private Finance Initiative.

The report also notes that private finance is ‘the only game in town’ for the NHS following unprecedented reductions in government capital spending and that a marketised healthcare system introduces perverse incentives for providers to pursue large-scale investments as a means of increasing their claim on the resources in the local health economy.


Patient safety in private hospitals – the known and the unknown risks


Colin Leys and Professor Brian Toft

Report, 20 August 2014

This report brings together what is known about patient safety in private hospitals. It offers new insights into the number of patient safety incidents in private hospitals, analyses the potential risks inherent in the way that these services operate, and makes recommendations to improve transparency in the private sector.

The report also confirms that the NHS serves as a ‘safety net’ for the private sector with around 6,000 people a year transferred to NHS hospitals following treatment in private hospitals.


What market-based patient choice can’t do for the NHS: The theory and evidence of how choice works in health care

market choiceMarianne Fotaki

Analysis, 26th March 2014

This analysis looks at how the concept of patient choice has worked in the NHS in recent years. It finds that the type of patient choice that contemporary health policy draws on almost exclusively is based on a flawed account of what choices actually mean for patients. Such conception of choice rests on the simplistic and erroneous assumption that appealing to patients’ self-interest will make them behave as consumers in a market place. For choice to work, policy design needs to recognise patients’ multiple needs and their bonds as community members, addressing them as socially embedded individuals. Users’ prior experiences, including their experience of health services, and how the reality of being ill might affect their health-related decisions, need to be accounted for.


At what cost? Paying the price for the market in the English NHS

At-what-costCalum Paton

Analysis, 17th February 2014

This analysis looks at the evidence showing that creating and maintaining markets in the NHS has incurred huge financial costs and significant ‘opportunity costs’ – money which could have spent upon patient care and clinical redesign. The analysis goes on to argue that it is possible for the NHS to offer patient choice and high-quality health-care without the market.



Democratic engagement in the local NHS

Dr Sally Ruane

Joint essay with Democratic Audit UK, January 2014

This essay looks at the recent history of patient and public involvement in the NHS, and those elements of the health system lying outside the NHS. It identifies the barriers to democratic engagement and sets out ways in which accountability can be strengthened, particularly through Healthwatch and local authorities.


A reorganisation you can see from space: The architecture of power in the new NHS

reorgScott L. Greer, Holly Jarman and Andrew Azorsky

Analysis, 27th January 2014

This analysis argues that this Government’s NHS reform has created great uncertainty surrounding who makes health policy. It finds that the reformed Department of Health has diminished authority and capacity to steer the health system, but this has not resulted in a less political NHS. Meanwhile, a power struggle has developed between the two most significant non-majoritarian bodies charged with regulating the NHS. These developments raise important questions about who can or should decide the future of healthcare in England.

Briefing on the Care Bill


January 2014

This briefing outlines concerns around the Care Bill during its passage through Parliament. These concerns cover three main areas: 15-minute care slots for recipients of home care services, dealing with the failure of a major provider of residential or domiciliary care, and dealing with providers giving false or misleading information to regulators.


Getting behind the curve? Is the NHS ready for pandemic flu?

pandemicDr Hilary Pickles and David Rowland

Report, 3rd January 2014

This report finds that reforms made to the NHS following the Health and Social Care Act of 2012 have impacted upon its ability to deal effectively with a possible flu pandemic. It highlights three potential problems which the new NHS now faces in dealing with a possible pandemic. A loss of expertise, personal relationships and institutional memory in dealing with public health emergencies from within the NHS as a result of the 2012 reforms, the lack of clear accountability arrangements and a ‘clear line of sight’ under the new system and the co-ordination of increasing numbers of private providers of NHS services in a health care system underpinned by contracts.


Mental illness and its treatment today

Bell picDr David Bell

Opinion piece, 4th December 2013

This analysis looks at the state of care for people with mental health problems today. It argues that the changes in the structure and scale of health services and benefits available to them has made treatment and recovery more difficult and that a changed cultural context has weakened society’s sense of obligation towards people with mental health problems.


The future of the NHS? Lessons from the market in social care in England


Report, 22nd October 2013

This report looks at how the market in social care services in England provides the best available example for policy makers of what happens to the quality of care and the terms and conditions of the care workforce when competitive pressures are used to bring about a reduction in the cost of care to the taxpayer. It calls for public debate and the development of informed mitigation strategies to prevent this happening in the new market in the NHS in England.


The boundaries of budgets

report_July_2013Dr Catherine Needham

Analysis, 31st July 2013

This analysis looks at four key arguments that have been made to justify the use of individual budgets. It focuses primarily on personal budgets in social care since this is the sector in which the evidence base is most mature, but also considers the existing or likely impacts of personal health budgets.


To market! To market!


Professor David J Hunter

Opinion Piece, 18th July 2013

This opinion piece looks at why governments of all political hues are fixated on markets and competition and runs through the current state of the evidence around the limits to markets in health care.


Competition and collaboration in the NHS

report_28_June_2013Professor Bob Hudson

Analysis, 28th June 2013

This analysis explores how the Health and Social Care Act 2012 has placed requirements on NHS commissioners to engage in both collaboration and competition. Yet there is no indication that the two are compatible. Competition has primacy over collaboration despite rhetoric to the contrary.


Healthcare fraud in the new NHS market: a threat to patient care

report_smallProfessor Mark Button and Colin Leys

Report, 12th June 2013

This report warns that the introduction of greater use of for profit providers of healthcare services as a result of the 2012 Health and Social Care Act is likely to substantially increase the amount of healthcare fraud in the NHS. This will result in less money for patient care when funds are already scarce.

* This report has been amended following a number of errors in Tables 1 and 3 of the report which were brought to our attention after initial publication.