STPs unlikely to deliver sustainable NHS without regulatory change, say trust CEOs

Competition within the health and social care system risks undermining the goal of a sustainable NHS without a new regulatory framework, trust leaders told the House of Lords today.

At a hearing of the House of Lords NHS Sustainability Committee, Sir Andrew Cash, chief executive of Sheffield Teaching Hospitals FT and leader of the South Yorkshire and Bassetlaw STP, called the current regulatory framework under the 2012 Health and Care Act “essentially based on competition”.

He compared this to the “coalition of the willing” involved in the STPs. “We are edging towards a different sort of governance, and I think to see a sustainable future we’re going to need to look at that regulatory frame,” he said.

Sir Andrew noted that the STPs were “unlikely” to deliver a sustainable NHS without a change of regulation. Furthermore, he said the STPs “played against” payment by results and that there was a need to introduce a system which incentivises hospitals “in a different way”.

The STPs have been the subject of controversy recently, after it was revealed that one-third involve A&E closures.

Chris Hopson, the chief executive of NHS Providers, recently described the STPs as “over-ambitious” and at risk of “blowing up” to MPs.

Dame Julie Moore, who also appeared before the committee, said the competition framework had hindered her efforts to act as chief executive of two trusts.

Dame Julie is chief executive of University Hospitals Birmingham NHS FT, and has also taken on the same role at the troubled Heart of England FT.

“It’s fiendishly difficult to pick your way through that minefield of competition law while you’re trying to run two big organisations, as well as expensive,” she said.

The committee’s third witness, Sir Michael Deegan, chief executive of Central Manchester University Hospital FT, argued that the devolution of health services and subsequent drive for integration of services in Greater Manchester had made it easier to get around competition regulations.

Manchester’s three CCGs and its city council are due to merge in April 2017, and it is also planning to join its three hospitals in a single trust.

Sir Michael described this as groups of providers bidding for contracts together “on behalf of our organisations and our local communities”.

However, he agreed there was also a need for “a regulatory framework which actually enhances and supports the levels of collaboration”.

Furthermore, the trust chief executives said a sustainable NHS could not be delivered in the long term without increased funding.

Sir Andrew said: “We see no reason why tax-funded, high-quality NHS should not be sustainable in the long term, but we do feel spending levels would have to return soon to their long-term average of 4%.”

He also warned that the STPs were in danger of being labelled as “just the finance and efficiency issue” and should also be used to deliver the longer term goal of health equality.

Sir Michael said that while devolution in Greater Manchester was “the most exciting initiative” he’d been involved in throughout his career, he was “unsure” whether it would fully address the financial problems in the system.

Dame Julie also raised the issue of staff shortages in the NHS, saying there “simply weren’t the staff there to employ anymore”.

She added that staff had reported “racist abuse” from patients since the vote to leave the EU, which was “of great concern” and could make shortages worse.

“If we wish to attract international staff over here then I think we have to think very carefully about the message we send about how we treat our staff,” she said.

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