The £22 billion

Our Johnston Press investigations department scrutinises what is set to be the biggest health service

The NHS is facing its biggest shake up in a generation with nearly 20 hospitals marked for closure, and care from cradle to grave put through a wholesale overhaul to plug a £22bn black hole in health service funding, aninvestigation by this newspaper can reveal.

An analysis of the 44 regional blueprints drawn up by health service leaders to remodel the NHS in England - in a process which critics complain has largely by passed patients-has revealed for the first time the extent of the cuts and drastic changes in the delivery of care that the Government wants to achieve by March 2021.

Until their recent release, the plans were a closely guarded secret with health chiefs instructing managers to keep draft details out of the public domain to prevent“politically sensitive” changes from leaking out. The final documents are in some cases so riddled with jargon and vague assertions that clinicians and politicians have said the impact of the plans is unknown.

But an in-depth review of the proposals by the Johnston Press Investigation Unit, in consultation with professional bodies, shows the farreaching nature of the changes which supporters say are necessary to produce a viable NHS designed to refocus the health service on community care.

Doctors’ leaders have told this paper that the NHS is being“deliberately under funded” and the changes amount to a charter for cuts and creeping privatisation which together pose a threat to the founding ideals of a free at the point of delivery health service. Our findings include:

The proposed or likely closure of 19 hospitals, including five major acute hospitals. nT he closure of more than 2,000 beds in acute and community hospitals and the loss of nearly 3,000 jobs to create a “smaller, more agile” workforce.

Major re-organisations of emergency and maternity care.

A massive move to “outof-hospital” carewithpatients encouraged to manage their own health needs, aided by technology which may include “virtual doctors”.

Primary care “hubs” will bring health services closer to home - in one case potentially using libraries to see patients.

Hundreds of millions of pounds are to be saved by cutting prescription costs and in some cases rationing care or operations.

A drastic reduction in face-to-face outpatient appointments with doctors using video links to assess and discharge patients.

A wildly-varying deficit per head of population. In the Durham, Darlington andTees area the amount that needs to be saved by 2021 is £216 per capita, but in Surrey Heartlands the amount is more than triple at £768.

Known as Sustainability and Transformation Plans (STPs), the plans represent the fruit of more than a year of consultations between more than 440 NHS organisations and 152 local authorities. But despite a timetable that is due to see them finalised by April, with far-reaching consequencesfor some55million people, the documents are almost unknown to the public.

A survey last month found that six out of seven people have never heard of the STPs, prompting warnings that the shake up is being pushed through without meaningful consultation or consent.

The sweeping changes to balance the books of a health service struggling to cope with its worst winter crisis on record brought accusations from doctors’ leaders that they amount to a ploy to hollow out the NHS while shifting blame away from ministers onto health service chiefs.

Dr Mark Porter, chairman of the British Medical Association, told this newspaper: “We are being asked for too much and are being deliberately underfunded. Whatthis means is our inability to deliver on our promise to patients of a comprehensive service that meets the needs of everyone, when they need it, free of charge.

“We have increased numbers of patients while resources are not rising in the same way. They are deliberately cutting into the service we provide rather than streamlining services.

“What is being asked goes far beyond efficiency savings anddips into the area of cuts.”

At the heart of the 44 blueprints is astrategy to movethe fulcrum of the NHS away from hospitals to a new set of community services integrated with social care.

Analysis of the documents shows that specialist care from stroke services to major trauma will be in many cases centralised to fewer units, where research suggests the results for patients can be improved despite longer journeys.

But the STPs make clear such changes cannot be brought about without significant changes to hospital provision, including closures. Some 44 per cent of the blueprints contain plans for the consolidation of services on fewer hospital sites.

Campaigners argue the end result will be a move to a health insurance-based model of care. Deborah Harrington of the National Health Action Party, said: “TheSTPplansare pushing the NHS into the US model of ‘medicare’. We will have fewer hospitals and reduced access to qualified staff. The NHS will become a provider of last resort .”

The plans to change to a health service focused on preventing serious illness and moving care into the community while centralising services in acute hospitals have also received backing from clinicians and policy makers.

The left-leaning IP PR think-tank said many of the reforms proposed in the STPs “deserve a fair hearing” while at the same time calling on the Government to close the NHS funding gap by creating a ring-

fenced “NHS tax” funded by a 1p rise in National Insurance.

A poll for Sky News recently found that 68 per cent of people would support such a tax rise, with a similar proportion arguing that the NHS is getting worse.

Harry Quilter-Pinner, a health specialist at the IPPR, said: “Thereis a funding crisis in the NHS but the answer to that is not a return to the original model of the health service paid for with extra money.

TREATMENT

“There is evidence that treatment can be moved nearer to home and improve access andquality of life for patients.

“Despite the opposition that hospital reforms generate, nobody really wants to spendtimeonthem. Butthese changes must be funded and the Government should sup- port STP leaders rather than play a blame game with those in charge of the NHS.”

NHS England has set April as the deadline for its transformation plans to be finalised.But, those who work for it warn the STPs amount to a “gamble” with the service’s future.

Dr David Wrigley, a Lancashire GP, said: “All the STPs are doing is moving the deckchairs around on the Titanic and they are not going to resolve the current crisis facing the NHS.

“There is a real gamble being taken with the NHS as these plans keep talking about moving care from hospitals into the community. But, the problem is there is no leeway - social care is collapsing, general practice is on its knees and that’s all on top of the hospital service being in meltdown.”

A Department of Health spokesman said :“We are committed to the NHS-that’ s why we have invested £10b in its own plan to transform services and improve standards of care including almost £4bn this year.

“NHS England are introducing Sustainability and Transformation Plans to help ensure the best standards of care, with local doctors, hospitals and councils working together in conjunction with local communities for the first time.”

NHS England says the NHS needs to make major efficiencies to live within the financial budgets set by Parliament and government.

It believes the best way to do this is for local doctors, hospitals and councils to work together to identify ways that unnecessary future costs can be avoided, such as the sale of surplus land.

NHS England believes it is missing the point to suggest that STPs are all about saving money – and says they are a big opportunity to improve the care that patients receive, based on the experience of areas who are performing best and practical things that doctors and nurses have been saying for years.

An NHS England spokesperson said: “STPS are about planning collaboratively for patients, breaking out of siloed working and short termism that fragments people’ s care.

“They don’t replace the statutory responsibilities of the organisations involved.

“And all the plans are fully published and being discussed.”

Hospital staff