Dear XXX XXX MP

As you will know NHS England has now published all of the 44 Sustainability and Transformation Partnerships covering the different geographical footprints across the country.

As Emergency Medicine is in many ways the front line of the NHS, Emergency Departments (EDs) – including those within STPs in your constituency – are not immune from these changes. I am concerned that these plans envisage service reconfiguration or closure, or are in part predicated on the assumption that they can deliver significant reductions in ED demand.

There is a need for change within the NHS, but I think we must guard against further closures without well thought out measures being put in place to cope with the fallout. If one in six emergency departments are downgraded – as the Health Service Journal has suggested - the effects would be disastrous.

Closure of any emergency department will naturally require more beds to be found elsewhere – patients do not just disappear when an option for care is removed. We already have among the lowest number of acute beds per capita in Europe yet many plans assume that the number of beds can be cut still further.

I think this is nothing more than a misguided attempt to align demand with resources, rather than the other way around.The ambitions of sustainability and transformation partnerships may be admirable, but in my view, in their present form they are unworkable.

I am writing to you, as my local MP to ask that you ask the following critical questions about the STP(s) in this constituency to ensure that damage to local Emergency Medicine services is avoided.

Questions to Ask

Question:Are the plans themselves written in a way that means that what is being proposed is clear and comprehensible to either clinicians or patients?

Question: To what extent are the funds available for STPs being spent on sustainability or transformation and does this compromise their viability?[1]

Question: To what extent is the STP in question actually proposing to cut ED attendances and admissions?[2]

Question: If ED closures are being proposed, has the impact on surrounding ED facilities been adequately considered?

Question: Are levels of financial savings being proposed realistic and can they be achieved without compromising patient care?[3]

Question: If prevention is being proposed as a way of cutting ED attendances and admissions, are the resources devoted to this likely to be sufficient, and are the measures being proposed likely to have a significant impact on patient demand?[4]

Question: If improved primary care provision is being proposed as a way of cutting ED attendances and admissions, are the resources devoted to achieving this sufficient to have the intended effect?

Question: What happens to services if these plans fail to work?

In my view, a realistic alternative to STPs would be to start planning for the continuing growth in the demand the NHS is almost certain to see based on England’s growing population and increasingly elderly demographics.

I look forward to hearing your response.

Yours sincerely,

[1]NAO: Health and social care integration

[2] RCEM Policy Analysis February 2017Taken as a whole the 44 STP – if properly implemented – forecast cuts to admissions ranging from 0 to 30%. However, 25 of the 44 plans leave the proposed level of reductions unspecified.

[3]Cambridgeshire and Peterborough Sustainability and Transformation Plan – October 2016While some of the STP are proposing relatively modest financial savings, other are very considerable. For example, the Cambridgeshire and Peterborough STP envisages savings of £504 million by 2021 from an annual budget of £1.7 billion.

[4] In the past twenty years all attempts to produce a reduction in year on year demand have failed to work..