In England, a sustainability and transformation plan (STP) is a non-statutory requirement which promotes integrated provision of healthcare, including purchasing and commissioning, within each geographical area of the National Health Service.
[2] In February 2018 it was announced that these organisations were in future to be called integrated care systems, and that all 44 sustainability and transformation plans would be expected to progress in this direction.
When established in 2016, there were 44 STPs which varied considerably in size, the largest having more than ten times greater population than the smallest.
NHS England would organise national support programmes, particularly for “primary care provider development”, support urgent and emergency care systems, rather than to individual organisations, and set up clinical standardisation and productivity initiatives under professors Timothy Briggs and Tim Evans.
[15] Steven Broomhead, the chief executive of Warrington Borough Council, complained to NHS England in July 2016 that decisions were being made "without any local transparency".
Professor Chris Ham of King's Fund maintains transferring services to the community is a potential improvement in many cases and plans should be considered on their merits.
[17] The Nuffield Trust reported that some STPs were planning up to 30% reductions in some areas of hospital activity - going against trends which have persisted for the last 30 years.
Sally Gainsbury of the Nuffield Trust said many current plans involve shifting or closing services... "Our research finds that, in a lot of these kinds of reconfigurations, you don't save very much money - all that happens is the patient has to go to the next hospital down the road.
John Lister of Keep Our NHS Public said there are too many assumptions, and managers desperate to cut deficits were resorting to untried plans.
[22] A survey of ninety-nine clinical commissioning group chairs and accountable officers conducted by the Health Service Journal in October 2016 found very little confidence that the plans would deliver.
The article suggests NHS England 'made up the policy on the hoof' and managers were under pressure to produce plans fast.
NHS England gave fragmented guidance, coming in bursts with frequently insufficient time for responding to requests.
Senior Liberal Democrat MP Norman Lamb accepted that the review made sense in principle but stated: "It would be scandalous if the government simply hoped to use these plans as an excuse to cut services and starve the NHS of the funding it desperately needs.
While it is important that the NHS becomes more efficient and sustainable for future generations, redesign of care models will only get us so far – and no experts believe the Conservative doctrine that an extra £8bn funding by 2020 will be anywhere near enough.
The King's Fund reported the public and patients were mostly absent from plans potentially involving large scale service closing.
Chris Ham of the King's Fund described suggesting out-of-hospital services and GP's could take over work now done by hospitals as a “heroic assumption” since both are under too much pressure.
"[30] Organisers of a protest march in London where tens of thousands of people took part fear the Sustainability Transformation Plans are a "smokescreen for further cuts".
It is the fault of a government who have made a political choice.” Corbyn also said, "The Tories and the coalition before them managed to cut taxes on big business.
Len McCluskey of Unite stated, hospitals, GPs, mental health, ambulance and community services are on their knees".