NHS chiefs have said a planned programme of radical changes to meet increased demand and plug funding gaps does not only involve cuts, after opposition politicians and campaigners expressed alarm at the plans.



An investigation by the Guardian and the campaign group 38 Degrees showed a possible shortfall of about £20bn by 2020-21 if no action is taken, prompting NHS England to ask 44 local areas to submit a cost-cutting “sustainability and transformation plan” (STP).

The shadow health secretary, Diane Abbott, called the report “a damning indictment of this government’s underfunding and mismanagement of the NHS”, while Chris Hopson, chief executive of NHS Providers, which represents frontline NHS leaders, said a “glut” of hospital services could shut down.

The NHS secret is out. And local communities won't like it Read more

But Stephen Dalton, chief executive of the NHS Confederation, which represents various service providers within the NHS, said it was unfair to represent the STPs as being purely about closures.

“These local plans are being made when funding is very tight but they are not about cuts, they are about modernising services to match people’s changing care needs,” he said.



“It is inevitable during such important changes that some services will be moved, reduced or enhanced. It is too simplistic to focus only on what appears to be lost. It’s also important to look at what alternatives are being provided.”

NHS chiefs and local politicians in the 44 areas would “do their best to reflect local needs and will want the wider community to be involved in the conversation”, Dalton added.

The Guardian has seen the detailed plans for north-west London, while 38 Degrees, a crowdfunded campaign group, commissioned the consultancy Incisive Health to collate and analyse proposals from across the rest of England. Also collected were figures showing the projected financial deficits in 2020/21 that will have to be plugged by cost-saving reorganisations.

There are proposals in the Leicester, Leicestershire and Rutland region to reduce the number of acute hospitals from three to two. In the Black Country region of the West Midlands there is a proposed reduction of the number of acute units from five to four and closure of one of two district general hospitals.

More general plans include reducing the number of face-to-face meetings between doctors and patients in north-west London through the use of more “virtual consultations”, and a proposal to give patients coaching to help them manage their own conditions.

The Liberal Democrat health spokesman, Norman Lamb, said STPs made some sense in principle. “However, it would be scandalous if the government simply hoped to use these plans as an excuse to cut services and starve the NHS of the funding it desperately needs,” he said.



“While it is important that the NHS becomes more efficient and sustainable for future generations, redesign of care models will only get us so far – and no experts believe the Conservative doctrine that an extra £8bn funding by 2020 will be anywhere near enough.”

Sarah Wollaston, the Conservative MP who chairs the Commons health committee, said more funding was needed so the NHS could put greater resources into prevention efforts.

“The trouble is that the money that was put into this so-called sustainability and and transformation programme is mostly being sucked into plugging the provider deficits, and relatively a very, very small amount of it is left for the so-called transformation – that’s to say, investing in new premises in the community that allow you to make those changes,” she said.

“I do think that there is a very strong case for saying that the health service now needs more money,” she told the BBC.



Hopson said NHS bosses were asking managers to identify “marginal acute services where you are trying to prop up what is really an unsustainable rota. So we would expect to see a bit of a glut of those kinds of decisions going forward because our guys have been specifically asked to identify them.”

Some of the proposals are likely to be given the go-ahead as soon as October, though consultation would then have to take place locally.



Last year’s Conservative manifesto pledged an extra £8bn a year for the NHS by the end of this parliament, as demanded by the NHS chief executive, Simon Stevens, in his 2014 “five-year forward view”. But Stevens made clear that was the minimum money needed, and radical reforms to the way healthcare was delivered would also be necessary to ensure the NHS stayed within its budgets.

A spokeswoman for NHS England said the health service needed to make major efficiencies. She said: “We need an NHS ready for the future, with no one falling between the cracks. To do this, local service leaders in every part of England are working together for the first time on shared plans to transform health and care in the communities they serve, and to agree how to spend increasing investment as the NHS expands over the next few years.

“It is hardly a secret that the NHS is looking to make major efficiencies and the best way of doing so is for local doctors, hospitals and councils to work together to decide the way forward in consultation with local communities.”