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Just 16% of finance directors think sustainable STPs achievable by 2021

NHS finance directors fear the quality of services will get worse and sustainability and transformation plans (STPs) will not succeed in their goals of delivering sustainable integrated care, according to a new survey.

The latest NHS Financial Temperature Check survey of more than 200 finance directors from the Healthcare Financial Management Association (HFMA) shows that just 16% were ‘very or quite confident’ that their organisation could deliver a sustainable STP for the period up to March 2021.

STPs, which trusts were due to complete by 30 June, have faced setbacks recently, with NHS England papers saying that they lack the “degree of scale and pace” required to deliver changes, and minister George Freeman admitting that they have no legal basis.

An investigation by NHE’s sister title PSE also revealed that health devolution could be better for delivering integrated care than STPs.

Furthermore, only 35% of respondents said that the relationships between organisations in their STP footprint were strong enough to deliver the changes required.

Speaking at the Health+Care conference last week, Stephen Dorrell, the chair of NHS Confederation, said that local government involvement in STPs was vital to reduce the risk of the STP “talking to itself”.

Fears about impact of financial problems on services

Among the respondents, 28% said they had ended the year in a worse financial position than expected and the 47% who had a better than expected performance attributed it to non-repeatable measures such as selling assets.

NHS trusts ended the last financial year with a £2.45bn deficit.

Paul Briddock, director of policy at HFMA, said: “The scale of the NHS deficit continues to reach unparalleled levels, and it is unlikely the provider position will be in balance at the end of 2016-17, as originally planned.

“Our report confirms that while finance directors are feeling the pressures of the current financial situation, many also feel like short-term gains such as cash injections and non-recurrent savings are merely storing up more problems for the future.”

Moreover, the report found that 21% of CCG finance directors and 23% of trust finance directors felt that quality of patient services would decline in 2016-17.

The most common areas the directors said were vulnerable were waiting times (76%), access to services (69%) and the range of services offered (61%). One third of trust directors also said they thought services would get worse in 2017-18.

In addition, 67% of CCG and 48% of trust directors reported a high degree of risk associated with their organisation’s 2016-17 financial plans.

The biggest risks to trusts achieving planned savings were identified as slippages in cost savings (78%), spending on agency staff (72%), the impact of social care financial constraints (56%) and increasing demand (52%). For CCGs, the biggest risks were increases in emergency care activity (76%), continuing healthcare (69%), increased demand for services (67%) and slippages in cost savings (65%).

Better leadership and accountability needed

Briddock added that fears about the impact of the “financial turmoil” following the UK’s vote to leave the European Union were “a real concern.”

He said: “To avoid this, there is a need for NHS organisations to work together to address these financial and operational pressures by the efficient redesign of services and to put an end to the shifting of financial problems between sectors. 

“Although many see the STPs being key to future sustainability, finance directors highlighted that better leadership and clearer lines of accountability to drive the implementation of plans, are needed."

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