We will learn something about new plans for Wiltshire's NHS by the middle of November - but even then not everything about them

Written by Tony Millett on .

It is now apparent that the current round of NHS restructuring was designed to avoid headlines and to avoid political interference at the local level.  

NHS England divided the country into 44 'footprints' of varying size - the smallest has a population of 300,000 the largest a population of 2.8 million.  Each area has had to design a Sustainability and Transformation Plan (STP) - four words that do not trip easily off a newsreader's tongue or fit a Daily Mail headline.  Wiltshire's 'footprint' includes Swindon and Bath and North East Somerset.

The main gripe about this process is that it has been carried out behind some very closed doors and without public consultation.  We are told that already in some areas MPs are queuing up to complain about services being moved from one constituency to another or about bed closures that are so toxic with voters.  

With that lack of prior public consultation it is entirely possible that some STPs will have to wend their way through the courts.

We are assured that the STP for the Wiltshire area "...isn't a plan for merging organisations, but a plan for how we can work together on the same issues we are all facing and reduce some of the pressures we all experience."  No closures then.

Some months ago, the 'footprint' leader James Scott (chief executive of Bath's Royal United Hospital) sought to reassure people about the STP: "Ours is not that contentious - it sets out priorities".

Certainly it is very unlikely to involve much new building as the STP leaders have been told the capital budget is very tight - hospital trusts have already had to scale back their capital spending plans.  The capital budget is getting so tight that the Treasury might soon insist on signing off even the smallest project.

The final 'draft' plans have been submitted and now have to be signed off by NHS England and NHS Improvement.  So, once again, the promise of no more 'top down reorganisations' (made before the Lansley Health and Social Care Act shifted the NHS' tectonic plates) may or may not be kept - according to the ambitions of each individual plan.

A handful of councils have rebelled against the STP process' lack of public accountability and have gone ahead and published the plans for their areas.  They may well have felt left out of the process - as Wiltshire Council Leader Baroness Scott did when she discovered that her council's Health and Wellbeing Board had been downgraded to being a mere 'consultee' in the STP process.

However, the plan for Wiltshire, Swindon and Bath & North-East Somerset will be revealed in the middle of November in the form of a 'public summary'. The complete plan will be published at the end of November.

One of the unknowns is whether Clinical Commissioning Groups (CCGs) will survive the shifts envisioned in STPs.  We were once told that the STP 'footprints' would not exist as stand alone organisations once the plans were agreed.

Just across the border from Wiltshire three 'struggling CCGs' (Bristol, North Somerset and South Gloucestershire) are considering appointing a single accountable officer or even moving to a full merger.  And in London five CCG's making up the North Central London STP are considering moving to a single chief officer.

Talk of joint commissioning across STP 'footprint' areas has been one straw in the wind for the future existence of CCGs.  More serious has been the policy proposal that would give STPs the full NHS budget for their constituent CCG areas.

Of course, the effectiveness of the STPs will come down to cash - how much they cost to implement and how much they save.  NHS funding is once again at the centre of the political debate about health and social care.

The General Medical Council has taken time out from its regulatory duties to lambast the low level funding for the health service.

A week before that intervention, the free school pioneer and Tory apologist, Toby Young told the audience on an ITV programme that the government had 'ring fenced' NHS funding and increased it in 'real terms'.  No one took him up on the claim.

However, as has been pointed out before on Marlborough.News, a 'real term' increase of 0.1 per cent merely allows politicians to repeat the mantra "We've increased NHS funding" - it does not allow the NHS to cope with a huge rise in demand, an ageing population and the blow-back from cuts to social services.

Even while 'real term' increases have been given, the Treasury has been busy clawing back significant parts of that funding - as well as making cuts elsewhere that impact on the NHS budget - such as the cuts to public health and training budgets.  

No one has yet, we think, quantified the claw-back the Treasury has made on this 'real terms' funding.  

The Treasury cut the Care Quality Commission's budget, so hospitals and GPs have to pay up to 70 per cent more in inspection fees.  They changed health workers pensions - adding major costs to NHS employers. They made the new NHS Property Services Limited charge 'commercial rates' for the hospitals and surgeries they now own.  And so on and on - not forgetting the £3billion cost of the Lansley reorganisation.

Even Chancellor of the Exchequer Osborne's stringent cap on pay for nurses and other health workers has cost the NHS huge sums in the consequent use of agency staff and overseas recruitment drives and drooping morale.  And so on and on.

Which brings us to the Prime Minister's remarks that the NHS should stop whinging as the government paid what NHS boss Simon Stevens asked for.  But she and her Health Secretary obviously - and conveniently - only read his smaller figure and then ignored his following words.  

So last June he had to remind Jeremy Hunt that his document had very plainly said the NHS would need £8bn-£21bn by 2020, and would only cope with the £8bn if there were major improvements to social care, public health and how health care was delivered.  Now the House of Commons' Health Select Committee - chaired by Dr Sarah Wollaston MP - have joined the outcry against the government's fictitious claims on their funding of the NHS.

With local authorities largely side-lined in the STP process, where is the evidence of those 'major improvements' in social care that the NHS so desperately needs  - especially as the blocking of beds when patients are ready to leave hospital but social services cannot cope, reached record levels in August?

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