Investigation by the Guardian and 38 Degrees reveals NHS faces £20bn funding shortfall by 2020-21 if no action is taken

NHS bosses throughout England are quietly drawing up plans for hospital closures, cutbacks and radical changes to the way healthcare is delivered in an attempt to meet spiralling demand and plug the hole in their finances, an investigation by the Guardian and campaign group 38 Degrees has revealed.



Without the changes, the NHS at local level could be facing a financial shortfall of about £20bn by 2020-21 if no action is taken, the research suggests.

The cost-cutting shakeup is being overseen by NHS England, but is already sparking a series of local political battles over the future of services, and exposes the health secretary, Jeremy Hunt, to fresh criticism after his controversial role in the junior doctors dispute.

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 is delivered would also be necessary to make the NHS hit its budgets.

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NHS England has divided England into 44 “footprint” areas, and each was asked to submit a cost-cutting “sustainability and transformation plan” (STP).

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.

The picture that emerges includes:

In the Leicester, Leicestershire and Rutland region, there are proposals to reduce the number of acute hospitals from three to two.



In the Black Country region of the West Midlands there are proposals to reduce the number of acute units from five to four and close one of two district general hospitals.

A reduction in 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 without seeing a doctor.

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.



Health policy experts, doctors and campaigners say that the public are unaware of how significant the changes are going to be, and while some elements are likely to be welcomed, hospital closures tend to be highly unpopular among voters.

A spokesperson for NHS England said the health service needed to make major efficiencies: “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.”

North-west London’s draft plan highlights risks to the implementation of the programme, including a failure to shift enough acute care out of hospitals, a possible collapse of the private care home market, and a failure to get people to take responsibility for their own health.



Two local authorities in north-west London, Hammersmith and Fulham and Ealing councils, have refused to sign up to the draft plans because of concerns about hospital closures. Officials claim that pressure was exerted on them to sign off an executive summary of the draft plans quickly without seeing the full document. NHS officials have denied this.

A spokeswoman for NHS North West London insisted the policies were based on evidence, saying: “There is a whole body of clinical evidence, research and best practice that clinicians are using to deliver better clinical care for patients.”

Hugh Alderwick, senior policy adviser at the King’s Fund, said that while some elements of the plans were positive others were less so: “There are some concerns that NHS leaders have focused their efforts on plans for reconfiguring acute hospital services, despite evidence that major acute reconfigurations rarely save money and can sometimes fail to improve quality of care.”

Dr Eric Watts, consultant haematologist and chair of the campaigning group Doctors for the NHS, said: “We as an organisation welcome any plan that holds true to the founding principles of the NHS and gives our patients the fairest possible treatment. But from what we can already see, STPs do not bode well for the future health of the NHS itself. Plans to move services into the community have been given as a reason for reducing hospital beds for many years now but we see the beds being closed without increases in community provision.”

Steve Cowan, leader of Hammersmith and Fulham council said: “This is about closing hospitals and getting capital receipts. It’s a cynical rehash of earlier plans. It’s about the breaking up and selling off of the NHS. It will lead to a loss of vital services and will put lives at risk.” He added: “Our job is to protect the NHS and this plan is about dismantling it.”

Laura Townshend, of 38 Degrees, said: “This is new evidence that plans are being made to close local NHS services. We all rely on these services, yet we are being kept in the dark.

“These proposed cuts aren’t the fault of local NHS leaders. The health service is struggling to cope with growing black holes in NHS funding. These new revelations will be a test of Theresa May’s commitment to a fully-funded National Health Service.