5 Things You Should Know About STP

The Sustainability and Transformation Plans have divided the NHS in England into 44 local areas, and each has been told to cut services as part of a nationwide ‘financial reset’. But what’s actually going on, and how much of the government’s reasoning is just spin? NHSpace brings you a handy myth-busting guide.

1 – NHS Trusts aren’t overspending

The narrative of STPs is that our hospitals are in debt due to overspending. That would be true if the government had matched the NHS budget to the actual healthcare needs of our country, but they haven’t.

The cost of healthcare increases by 4% each year. In the UK, this is referred to as ‘NHS inflation’. If NHS funding doesn’t keep pace with this inflation, then services have to be cut or closed.

David Nicholson and Simon Stevens have both used their time as NHS England CEO to implement austerity measures, leading to a cumulative shortfall in funding of at least £35bn per year by 2020:

Year Increase Needed Actual Increase Shortfall
2010-2015  £20bn  £7bn  £13bn
2015-2020  £30bn  £8bn  £22bn
Total (2010-2020)  £50bn  £15bn  £35bn

The NHS is underfunded, and is actually spending less than it should on healthcare. That’s quite the opposite of an ‘overspend’!

2 – The NHS isn’t unaffordable

Pundits love to tell us about the new challenges facing the NHS, claiming that we now cannot afford universal healthcare. We are told that hospitals are overspending and that they are in debt.

In fact, the NHS is extremely affordable. Here’s a list of healthcare spending in several westernised countries in 2014:

Country Per person ($) % of GDP
Belgium 4,884 10.6
Canada 5,291 10.4
France 4,959 11.5
Germany 5,410 11.3
Holland 5,693 10.9
United Kingdom 3,935 9.1
USA 9,402 17.1

As the table shows, the UK could easily choose to dedicate an extra percent of its GDP to healthcare, providing the NHS with the funds needed to sustain a modern health service.

3 – Hospitals aren’t overstaffed

The ‘financial reset’ planned for the NHS includes a limit on staff recruitment, the implication being that hospitals need to cut back on excessive hiring of permanent staff. Considering the billions spent on hiring agency staff to fill rota gaps, this is certainly not true.

The underlying issue here is safety. Following the Francis Report into the Mid Staffs scandal, hospital managers decided that they would rather exceed their budgets and hire more staff, than be guilty of manslaughter. Fed up with being ignored, the DoH is now coming down on managers with an iron fist. Anyone caught protecting staffing levels by overspending will be subject to a ‘failure regime’.

4 – This Isn’t About Centralisation 

Centralisation of specialised services can improve outcomes for patients with specific illnesses. But trauma, cardiac and stroke services have already become centralised. For many other illnesses, and for maternity and step-down care, it’s important to have smaller District General Hospitals (DGHs) and Community Hospitals. These provide care closer to home and take the pressure off the big, specialised centres.

So don’t be fooled. Closing A&Es and taking services away from local hospitals isn’t centralisation. It’s un-evidenced vandalism in the name of cost savings.

5 – This Is About Creating A Two Tier System

The level of cuts and closures required by the STPs is such that the NHS will become unable to provide a universal service. Rationing will increase, so that most routine procedures will be refused funding. Once various DGHs have closed, the hospitals still standing will struggle with their increased catchment areas and will be forced to provide essentials only.

This was already envisaged by Simon Stevens, who is keen to separate emergency care from routine care. Emergencies will be handled in NHS hospitals, whilst the routine work will be handled by the private sector. Patients wishing to undergo non-essential procedures will find themselves needing to pay to have their cataracts and hernias treated or their tonsils removed.

11 thoughts on “5 Things You Should Know About STP”

  1. The noxious bubble that has floated off the ELHT Think Tank, is to introduce a Sickness And Disability Tax, by charging all Blue Badge Holders for parking at Blackburn Burnley and Pendle Hospitals. The more ill you are, the more you pay – and I have to visit 3 times a month.

    How many chocolate hobnobs did it take for sentient beings to put this item on a meeting agenda? Unbelievably, the `justification’ for this iniquity is to improve front line patient care. For whom?

    Why is the cancellation of ruinous PFI Contracts never on the agenda?


  2. I think you misunderstood our meaning. The increase in annual budget needed to sustain the NHS was £20bn between 2010 and 2015. An additional £30bn would then be needed up to 2020, so that between 2010 and 2020 a total increase of £50bn should occur. This keeps the budget in line with NHS inflation.


  3. Hi, I think your sums may be wrong in the calculation of the yearly funding shortfall over the 10 years from 2010 to 2020.

    To calculate the annual increase needed over those 10 years you have added the £20bn/year over 2010-15 to the £30bn/year over 2015-20 and come up with an annual increase needed of £50bn/year. But I think you should have calculated it by taking the average of £20bn/year and £30bn/year which would give £25bn/year increase needed over the 10 years. Ditto annual increase over the 10 years = £7.5bn. This gives annual shortfall over 10 years of £17.5bn.

    Which is logical cos if you have an annual shortfall over 5 years of £13bn and then an annual shortfall over the next 5 years of £22bn, how can that amount to an annual shortfall over the ten years of £35bn?

    Hope this makes sense?

    best wishes



  4. Reblogged this on TheCritique Archives and commented:
    STP = Sustainability and Transformation Plans. (Remember, remember the golden rule of legislation; always put the difficult/reassuring bit in the title, but don’t let it get into the detail.)

    NHS Trusts aren’t overspending.
    The NHS isn’t unaffordable.
    Hospitals aren’t overstaffed. (I thought this one was painfully obvious.)
    STP Isn’t About Centralisation.
    STP Is About Creating A Two Tier System.

    Liked by 1 person

  5. I have been warning everyone forever, that they are trying to privatize the NHS. It will ruin the country, and be havoc for the welfare of the people. Simon Stevens background is CEO for US Health insurance companies; he needs to go without severance pay or any financial settlement. Jeremy Hunt needs to go, to be replaced by someone who understands the quality of the NHS. The top and mid level managers need to go- they are surplus and way over paid. All bonuses needs to stop for everyone, The NHS needs to be fully funded to train all nurses and physicians. Nurses should be hospital trained with universities only used for theory. Targets need to stop they are detrimental to good health care. What is happening now is insane and will cost the country dearly in the long run.

    Liked by 2 people

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