A “secretive” plan to reorganise the NHS risks failing patients, a report warns.

Widespread bed cuts, closures of accident and emergency units and even shutting hospitals have been proposed by NHS bosses who are often more focused on saving money than improving care, the King’s Fund think tank says.

Simon Stevens, head of NHS England, has conceded that managers in many areas are not up to the job of implementing his vision for the health service and is warned today that it risks failure in most of the country.

Mr Stevens is attempting to undo Andrew Lansley’s 2012 NHS reforms without the need for another structural reorganisation, and has divided England into 44 areas where local bosses have been told to come up with “sustainability and transformation plans (STPs)” to move care closer to home.

He insists that doing more in local clinics will keep older people with long-term illness out of hospital. The report published today endorses that aim, but says that STPs are the “right thing being done badly”. Short-term savings are being prioritised over long-term improvements as the NHS faces a £22 billion black hole by 2020, it says.

Plans have been drawn up behind closed doors with patients “largely absent” and with little input from frontline staff, the King’s Fund says. Uncertainly over accountability for the plans is hampering the ability to get anything done, it adds. Chris Ham, chief executive of the fund, estimated that a third of plans were likely to succeed, a third had little hope and the rest would need more help.

“I don’t think the deliverability of STPs is something we can be confident about,” he said. “If STPs do not work then there is no plan B.”

Katherine Murphy, chief executive of the Patients Association, said the plans were “more about saving money”, adding: “They cannot axe services in a secretive way and expect the public to be happy.”

Professor Ham said that cutting hospital services was unlikely to work without money for local clinics to replace them. “GPs and district nurses are under massive pressure. It’s unrealistic to expect them without more staff and resources to take on more of the workload,” he said.

About a quarter of the plans have now been published or leaked and many include centralisation or shutting hospital units or cutting beds. In southwest London, one of Epsom, St Helier, Kingston and Croydon hospitals would be shut entirely.

Taj Hassan, president of the Royal College of Emergency Medicine, said that shutting A&E units would be “potentially catastrophic” and put lives at risk. “Furtively producing plans without involving patients is unacceptable,” he said.

Mr Stevens has acknowledged problems, telling NHS bosses last week that councils might need to take over from health service managers. “In some parts of the country the reality is we are short of leadership that is capable of engaging in the task ahead,” he said.

Sir Bruce Keogh, medical director of NHS England, insisted the plans would be “making it easier to see a GP, providing more specialist services in people’s homes, speeding up the diagnosis of cancer and offering help faster to people with mental ill health”.

He conceded that “to realise these benefits some communities might need to make choices about where to put resources and the NHS will need to be clear with the public about the options” but argued: “Claims of secrecy have been overtaken by the fact that we’ve asked that all STPs are now published over the next few weeks.”

Analysis

Most patients would agree that it makes more sense to keep elderly patients well at home rather than letting them tip into crisis and have to go to hospital (Chris Smyth writes).

In essence, this is what Simon Stevens’s “sustainability and transformation plans” are trying to achieve: getting the local NHS to pay more attention to preventing illness, improving mental health and working with social care.

Of course, it is not quite that simple. Nothing brings patients out on to the streets faster than plans for hospital closures. When Theresa May met Mr Stevens for the first time, she warned him not to use the threat of closures as a weapon to try to prise extra cash out of the government.

Often, there are good clinical reasons for shutting poorly performing units. But when so much emphasis is put on saving money, many in the NHS understandably fear this will mean cost-cutting masquerading as better care.

Among the possible cuts…

Southwest London One of St Helier, Epsom, Kingston or Croydon hospital to shut.

Northeast Stockton or Darlington could lose A and E.

Devon Cut 600 hospital beds and A and E, maternity, stroke and children’s services are deemed “not sustainable”.

Northwest London Ealing and Charing Cross hospitals to be downgraded.
Merseyside Merger of four Liverpool hospitals.

Cheshire Downgrade Macclesfield A and E.”