The Humber Coast and Vale Sustainability and Transformation Plan (STP) sets alive a new conversation about how we take forward health and social care. Needless to say at the heart of the plan is the call to mitigate against the predicted £420m deficit in the service by 2020/21.

The plan’s analysis of the below national average health indicators for the area correlate with the fact that 23% of the 1.4m people the plan covers live in the most deprived areas in England. In the region there are huge health inequalities (20 years for men and 17 years for women), and there are higher levels of premature mortality linked with the higher prevalence of cancer and resultant from more people who smoke, drink alcohol and or overweight than elsewhere. The report also highlights the serious underfunding in mental health.

The plan makes a start at looking at how it can develop a different approach to healthcare through multidisciplinary locality teams which would be a step forward in primary care, so in future you may see an advanced practitioner nurse rather than a GP if this was determined. Fully utilising the skills of all health professionals is a good thing, providing that skill mix does not lead to staff working above their professional competencies. The plan also hopes to focus people away from A&E where 40% of people who currently go there receive no treatment.

There are, however, gaps in the plan for it to really have an impact. The savings sought spell out service cuts unless more transitional money is made available for the plan, especially in the light of the health deficits that currently exist. The Government has to properly invest in funding, not cuts, to make this plan work. There are gaps in mental health services, and while it is right to focus on under 5s, we need to ensure that children and young adults have direct access to services and the necessary therapeutic inputs when they need them. I deal with far too many cases concerning adolescent mental health challenges, and the plan needs to put greater emphasis on this too.

The plan is also too silent on elder care and dementia care with an aging population the region needs to get to grips with this. The STP follows a medical model too closely too, rather than looking more holistically at patients and their needs. I trust that the STP will put more of a focus on the social determinants of ill health. While it is right to focus on smoking cessation, alcohol is now one of the biggest reasons why people go to A&E and alcohol abuse is now a serious cause of ill health and chronic problems like diabetes. A proper plan around developing a better diet and exercise is also missing from the plan.

Most worrying of all, the plan is silent on where cuts will fall to save £420m. Clearly NHS England, which has reviewed the plan, is concerned that the disastrous funding model and fall out from the Health and Social Care Act is not exposed. The plan does hint at rationing but is not brave enough to spell it out just yet.

Looking at best practice for the NHS is essential, but the STP leaves open many more questions than it answers and is now in the need of intense scrutiny. The partnership of 20 organisations is not accountable to any body, so it is now essential that the Government spells out how they will be held to account for its expenditure and governance.