NHS England has told local health leaders not to reveal the plans to the public or the media until they are finalised and have been approved by their own officials first, according to published documents and a new analysis by the King’s Fund.

The national body even told local managers to refuse applications from the media or the public to see the proposals under the Freedom of Information Act.

Local managers accused NHS England of being intent on “managing the narrative” about the plans.

The sustainability and transformation plans (STPs), some of which have been published or leaked, could see some hospitals, A&E units or maternity units close, and other services merged.

The proposal for Cheshire and Mersey includes the downgrading of at least one A and E department, while in south-west London the number of acute hospitals could be cut from five to four.

In north-west London there are plans to reduce the number of sites offering a full range of services, while Birmingham and Solihull’s STP proposes a single “lead provider” for maternity care.

NHS England and some health experts say the changes will improve patient care and are necessary to fulfil the plan of the health secretary, Jeremy Hunt, for full seven-day services. Opponents argue they are just a way of cutting services.

Some councils have objected so strongly to the lack of public involvement that they have ignored NHS England’s demand to keep the documents private until a later stage and have published them on their websites.

The report from the King’s Fund, based on a review of plans and interviews with local managers, says NHS England set very tight timescales, which is partly to blame for patients and doctors being shut out.

Expensive management consultants have been brought in but clinical teams and GPs have often been only “weakly engaged in the process”, it says.

The report says: “It is clear from our research that STPs have been developed at significant speed and without the meaningful involvement of frontline staff or the patients they serve … Patients and the public have been largely absent from the STP process so far.”

One local manager said of the lack of public involvement: “I’ve been in meetings where I’ve felt a little bit like, you know, where are the real people in this?” Another described the secrecy demanded by NHS England as “ludicrous”.

The report says: “As well as the timeline creating a barrier to meaningful public engagement, national NHS bodies had also asked STP leaders to keep details of draft STPs out of the public domain. This included instructions to actively reject Freedom of Information Act requests (FoIs) to see draft plans.”

On management consultants, the report says some leaders “felt that STPs had ‘created an industry’ for management consultants – and questions were raised about why money is being invested in advice from private companies instead of in frontline services”.

However, the King’s Fund said STPs still offered the “best hope” of improving health and care services.

Sustainability and transformation plans are ‘least bad option’ for NHS
Chris Ham, chief executive of the thinktank, said: “The introduction of STPs has been beset by problems and has been frustrating for many of those involved, but it is vital that we stick with them.

“For all the difficulties over the last few months, their focus on organisations in each area working together is the right approach for improving care and meeting the needs of an ageing population.

“It is also clear that our health and care system is under unprecedented pressure and if STPs do not work then there is no plan B.”

Ham said it was a “heroic assumption” to say out-of-hospital services and GPs could take on more of the work currently done by hospitals, given how under pressure they were.

He said there was “mixed evidence at best” that moving services closer to home improved care.

The NHS medical director, Prof Sir Bruce Keogh, defended the plans. “Advances in medicine mean it is now possible to treat people at home who would previously have needed a trip to hospital. It also means those with the most serious illness need to be treated in centres where specialist help is available around the clock,” he said.

“So this is not a moment to sit on our hands. There are straightforward and frankly overdue things we can do to improve care. We are talking about steady incremental improvement, not a big bang. If we don’t, the problems will only get worse.”