‘Transformation? Does that just mean cuts and privatisation?’

At Tuesday’s Full Council meeting, Green, Labour and Lib Dem councillors united to vote through a motion calling for the Government to increase NHS funding to at least 10 per cent of GDP in line with other EU countries. Green councillor Eleanor Combley, who sits on the council’s People Scrutiny Commission, reflects on why Greens believe the Government’s new Sustainability and Transformation Plan disguises yet more cuts and privatisation in health and social care.

The government, through NHS England, is dividing the country into 44 areas, and requiring health and care leaders in each of these to come up with a Sustainability and Transformation Plan (STP) laying out how they will work together to continue to meet healthcare needs within an ever-tightening budget. So, what does this STP process mean for the Bristol area?

The Green Party believes that healthcare is not a commodity to be bought or sold. Our NHS must be funded through taxation, at a level that makes it possible to provide healthcare free at the point of need. Healthcare must remain a public service funded by, run by and accountable to local and national government and devoid of all privatisation and market forces.

Sadly, our government does not seem to agree. Instead of investing in our much loved NHS, Government has spent years trying to push the square peg of the NHS into the round hole of marketisation.  Different groups within the NHS are now required to compete with each other for funds through an artificial “commissioning” model. This creates an internal market which pushes managers away from making the best clinical decisions and paves the way for private firms to take an ever bigger role in the provision of health services. At the same time, there have been cuts to both public health budgets and adult social care budgets across the UK and chronic underfunding of the NHS, with increases to funding barely keeping ahead of inflation, and falling far behind increases in demand and the costs of new treatments.

Against this background, it is not surprising that the STP programme has been regarded with a huge amount of suspicion. Allowing different health bodies to cooperate locally, and plan strategically, could be seen as the first glimmerings of a retreat from dog-eat-dog competition within the NHS and a recognition that disbanding Strategic Health Authorities was a bad idea. However, it’s hard not to remain suspicious when across Bristol, North Somerset and South Gloucestershire the STP will have to deliver cuts of £305 million, and when the rollout of STP has been rushed and shrouded in completely unnecessary secrecy.

Representatives of NHS trusts and clinical commissioning groups, local authorities, and other concerned bodies across our area have been expected to come up with their local plans without any budget for time spent developing it, just fitting in extra meetings around their day jobs. Despite this, local health leaders have managed to pull together a plan with many good features. Three of these which stand out to me are:

– using resources to support adult social care so that people have the support they need to enable them to leave hospital

– working towards better cooperation across the Bristol, North Somerset and South Glos area to ensure people get the same service regardless of which side of the county line they live or receive treatment

– spending more on prevention, for example, placing a specialist alcohol adviser in A&E to approach people who come in for an alcohol related incident and catch people at that moment of early crisis in their drinking, which can have a big impact on their future drinking and consequently their health.

In short, saving money by reducing the need for hospital admissions and lengthy stays through better care and prevention, rather than by simply not meeting the need.

Of course, the devil is in the detail, and we still need thorough scrutiny of these plans as they develop. But most of all, we should remember that reallocating scant resources is no substitute for properly valuing and investing in our NHS. The STP may be the least worst response to the current situation, but the bottom line is that health needs to be public provision, properly funded through general taxation, and we should all continue to fight for that.

Eleanor Combley is Green councillor for Bishopston and Ashley Down

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