NHS England’s controversial Sustainability and Transformation Plans (STPs) are back in the spotlight again after an investigation by the British Medical Association revealed “eye-watering” salaries for those in charge of their delivery, and that related cuts to services could affect millions of patients.

New figures, obtained by the BMA through Freedom of Information requests, show that more than 150 jobs - including operations managers, communications executives, administrators and financial analysts - with combined annual salaries of at least £8.5 million have been created to deliver the STPs.

The Association believes the actual numbers are actually likely to be much higher, as only around half of the 44 STP footprints responded to its request while others were unable to provide details of remuneration for some staff.

Also, its investigation found that at least £1.1 million is being spent on external consultancy firms and agency staff, and that there was “major disparity” in the processes for STPs being carried out across the country.

The findings were published alongside a separate analysis of the current 44 ‘footprint’ STPs by the Union, which warns that 17.6 million patients could be affected by hospitals closing or merging, 22.9 million patients could be affected by A&Es closing or downgrading, and 14.7 million patients could be affected by acute bed closures as a result of the plans.

Its report also claims that there has been a poor engagement with clinicians, patients and the public considering the scale of patients affected, that implementation of STPs is rushed and not backed by appropriate evidence, and that upfront funding needed for to deliver plans has not been provided.

This follows previous BMA research concluding that the 44 STPs will have to make at least £26 billion in cuts to keep inside the public funding constraints set by the government, and that the plans require at least £9.5 billion of capital funding.

“Millions of patients will be affected by hospital and bed closures under these so-called ‘transformation plans’, which are a cover for delivering £26 billion in cuts to health and social care,” said BMA council chair, Dr Mark Porter.

“It makes no sense to spend this kind of money on staffing and structure when we already know there is a huge shortfall in capital funding needed to actually put the plans in place. Any money spent here runs the risk of being completely wasted.

“With the NHS at breaking point, doctors and patients will be horrified to see millions being spent on another layer of bureaucracy to deliver these controversial plans. The NHS needs more GPs, junior doctors and consultants - there is nothing sustainable or transformational about creating another costly team of managers while staff on the frontline struggle and patients suffer as a result.”

Transforming care?

STPs are eventually to be produced by every health and care system in England to show how local services will evolve and become sustainable over the next five years, pursuing the 'triple aim' set out in the NHS Five Year Forward View of improved health and wellbeing, transformed quality of care delivery, and sustainable finances, says NHS England.

"Rather than just commenting from the sidelines, local health and care leaders and clinicians are coming together to actually try and solve some deep-seated problems by identifying practical ways to improve services,” a spokesman previously said, defending the plans.

"Yes, there are well known pressures and constraints facing the NHS, but for patients' sake we should obviously all try and make the best of the situation, rather than just stand to one side and say 'well I wouldn't start from here'."

But a report by the Public Accounts Committee released earlier this year concluded that NHS England and NHS improvement "have much more to do before the public can feel confident that they are about delivering transformation and efficiencies and not just a cover for cuts in services".