Change law and raise taxes to enable STPs to improve NHS, report urges

A lack of statutory power and severe underfunding are creating barriers to promising NHS reforms set out in sustainability and transformation plans (STPs), a think tank is warning. 

A report from the Institute for Public Policy Reform (IPPR) found^[1]
that the STPs published at the end of 2016 for 44 regions in England had by and large correctly identified the right solutions, including moving care into the community and prevention.

But there are several barriers that will prevent the ‘vision’ being realised, including a failure of leadership, the risk the NHS is being ‘engulfed by funding pressures’ and a lack of legal power to deliver the reform set out by the STPs.

Among the IPPR recommendations is a call for the government to create a new ‘NHS tax’ by raising taxes for the highest paid to provide an extra £3.9bn a year to tackle the NHS ‘funding crisis’. 

The additional ring-fenced funding, which the IPPR says could raise £16bn over 5 years, should be used to resource STP plans, the report says.

In coming years, the NHS is facing a £22bn funding gap, which means limited resources are being spent maintaining the status quo rather than introducing a reform, the IPPR warns.

There should also be changes to the law to better enable the pooling of budgets and commissioning functions locally and to give regional bodies a formal role in the system and put into effect place-based health and care, the report says.

On a national level, the case for reform needs to be made much more strongly by high-profile leaders, especially the prime minister and the health secretary, the IPPR recommends.

Harry Quilter-Pinner, IPPR Research Fellow, says: “The 2012 Health and Care Act created silos through the dissolution of primary care trusts and the strengthening in legislation of the provider/commissioner split, which have not made reform easy. 

“It is an open secret that STPs are an attempt to undo some of the damage caused by the Health and Social Care Act; however, it is difficult to do this without the use of legislation.

He adds: “IPPR is arguing that part of the solution to the problems preventing STPs from driving real change in the system must involve wrapping governance around STPs both to give them real power but also to make them more accountable for how they use this power.”