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09.03.17

Extra STP cash ‘pointless’ if NHS budget is raided to plug running costs

The chancellor’s decision to back the first tranche of good-to-go STPs with £325m over the next three years, with more money to come in this year’s Autumn Statement, is an “important recognition that transformation needs resources” – but a pointless one nonetheless if capital reserves are going to be continuously raided to plug funding gaps, health leaders have warned.

In his last Spring Budget, Philip Hammond defied expectations – including those of Simons Stevens himself – by revealing the Treasury would invest £325m to support “a small number of the strongest STPs” that are already in a position to implement their plans.

More money is then expected in this year’s Autumn Statement, at which point the chancellor is due to announce a “multi-year capital programme” to support the remaining STPs.

Speaking at the jam-packed House of Commons, he told MPs: “We recognise the progress the NHS is making in developing STPs. And we recognise, too, that in addition to the funding already committed, some of those plans will require further capital investment.

“So the Treasury will work closely with the Department of Health over the course of the summer as the STPs are progressed and prioritised. And at Autumn Budget I will announce a multi-year capital programme to support implementation of approved high quality STPs.”

The Budget document explained that the second round of STP proposals to be considered in the autumn will also be “subject to the same rigorous value for money tests” as the first-tranche plans.

Importantly it revealed that any investment decisions will also take into consideration whether the local NHS area is “playing its part in raising proceeds from unused lands to reinvest in the health service”.

Dr Graham Jackson, co-chair of NHS Clinical Commissioners, argued the new capital investment in STPs is “an important recognition that transformation needs resources”, adding: “Our members have been concerned that the focus in the past year has been on maintaining the current system rather than supporting transformation.

“If we are to have a sustainable NHS going forward we must see change – commissioners and our partners across health and care must be able to work together to transform services to meet the needs of the populations they serve.”

The chief executive of NHS Confederation, Niall Dickson, also welcomed the extra cash, arguing that, without it, “it will be impossible to develop the new services that are so desperately needed”.

In its detailed briefing of the announcements, however, NHS Confed said the extra funding has not actually increased the total NHS budget, leaving the organisation unsure, even from the formal Budget documents, how this money is being financed – despite the Treasury confirming it is new money.

Yet from a more critical perspective, Nuffield Trust CEO Nigel Edwards said it was indeed a “sensible idea” to open up extra funding immediately to help local partnerships finance plans for new facilities, but added: “Given that £1.2bn has already been taken from the NHS’s capital budget this year by the Department of Health simply to plug the gap in trusts’ running costs, there is no point topping up capital reserves if they’re going to be raided in this way in the future.”

Although more capital details will be revealed in the autumn, NHS England has already said that further information will be released later this month with regards to a “delivery plan” for the next couple of years.

According to Stevens, this will include “certain changes” that NHS England needs to make to ensure footprints make the best of their funding envelopes and will be “very explicit” about what integration will look like in each of the 44 STPs.

Ahead of these revelations, he has already indicated that footprints will need to pass a critical ‘patient care test’ that assesses whether plans to close hospital beds will jeopardise high-quality care or not, and that around six to 10 STPs are going to be accountable care organisations or systems.

Comments

Clued-Up   11/03/2017 at 14:51

I'm working through my own letter of objections to the STPs as they're now designed ... it's a "heart in mouth" experience. The STP design and payment incentives repeatedly target the wrong problems and ignore the most dangerously pressing ones. Minor example:- In the Budget Hammond says extra GPs will be put into A & E departments to "triage" patients towards more appropriate healthcare options. Leaving aside the facts that "triaging" is already done by triage nurses and there's such a shortage of GPs the hospitals may not be able to recruit any, the difficulty for A & E isn't so much the "wrong type of patients" are arriving. Instead, A& E's problem is that the 12% arriving at A & E in urgent need of in-hospital care can't be admitted because there are no vacant beds. Everyone knows there's a shortage of hospital beds. Hospital bed occupancy levels have exceeded the maximum safe limit (85%) for the last 2 years. For a frightening number of days, hospital be occupancy rates have reached towards 100% - absolute gridlock. It's the shortage of hospital beds that should be the target of government action, not the crowding in A & Es.

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