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STP governance flaws causing ‘angst’ and may prevent NHS finance fix

NHS finance managers have significant doubt about the capability of STPs to be delivered because of concerns about leadership and finance, according to the latest NHS Financial Temperature Check from the Healthcare Financial Management Association (HFMA).

The report found that nearly three-quarters of NHS finance managers are concerned about the governance of STPs, with only half believing that the associated risks have been recognised and just 5% thought adequate risk management arrangements were in place.

Furthermore, many expressed a lack of commitment to the STP objectives, with two-thirds suggesting their organisational objectives were a higher priority.

Paul Briddock, director of policy at HFMA, said: “Although STPs were met with enthusiasm and positivity when they were introduced, there is scepticism from finance directors that the STP frameworks can work in practice.

“It is encouraging to see reported improvements in collaboration and some strong leadership in place, but when operating in a ‘club versus country’ framework, where there are conflicting priorities between individual organisations and footprint areas, the lack of clear governance is causing some angst.”

He added that implementing the STPs would need to be done “in an open and transparent manner”.

At a Communities and Local Government Committee hearing on Monday, Mark Lloyd, the chief executive of the Local Government Association, said that the STPs “will meet opposition” due to a lack of involvement from local councils.

Respondents to the HFMA survey were positive about some aspects of their STP, with over half saying there was clear and effective leadership, and 46% said relations between commissioners and providers had improved.

However, there was also significant fear about the state of NHS finances, with 52% of trusts and 21% of CCGs expecting to end the year in deficit. The latest figures revealed the total NHS deficit stands at £648m.

Nearly a third of respondents do not expect to meet the control totals set by NHS Improvement and said that the risks associated with them were high, with 47% saying they would not sign up for control totals next year.

This made the STPs even harder to deliver. Only 6% of trust finance directors and 17% of CCG finance directors believed that the STPs were compatible with the financial control totals.

Chris Hopson, chief executive of NHS Providers, has warned that the STPs risk “blowing up” because of a lack of funds.

Furthermore, 79% of finance managers suggested a change of financial regime might be needed to deliver the STPs, and 82% supported regulatory changes.

Briddock warned that current NHS finances were “merely a sticking plaster over a much bigger problem”.

A recent National Audit Office report warned that existing plans for delivering sustainable NHS finances have not been properly assessed and may not fulfil their goals.

Stephen Dalton, the chief executive of the NHS Confederation, said: “Our members are being put under incredible pressure with many concerned about being able to sustain what remains, despite very real challenges, a reliable, quality service that maintains public confidence."

He called for “further support to sustain social care services" in order to relieve the "unprecedented demand" on emergency care.

Last week's Autumn Statement contained no additional funding for health and social care, despite the Health Select Committee warning that the lack of funding would put the Five Year Forward View in danger.

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