Warning over challenges to STPs and Carter Review implementation

Speakers at the Health+Care conference have warned that sustainability and transformation plans (STPs) may face challenges to implementation.

Speaking in a debate at the Health+Care Conference, Tom Jackson, chief finance officer and deputy chief officer at NHS Liverpool CCG, pointed out that the timeframe for implementing STPs is less than five years, because 2016-17 would be spent on planning and 2020-21 on evaluation.

Jackson said: “I think there’s some challenges which we need to address within that period, and we definitely need to get the plans right and pick up where we are at the planning stages. Not a lot of STPs are ready at this point.”

“I think there’s a fair chance that we can deliver a lot of the elements, but it does require commitment on a macro level,” he said, adding that STPs need to be “more ambitious” in integrating with social care.

He also said trusts could face challenges in cutting their deficit because of new pressure in negotiating salaries with employees if inflation lowers as a result of the UK’s vote to leave the EU.

Professor Jane Cummings, the chief nursing officer, said on Tuesday that NHS EU staff are "valued and hugely appreciated" following concerns about the impact of the referendum result on NHS staffing.

Putting sense back into the system

Simon Worthington, finance director and deputy chief executive of Bolton NHS FT and leader of the team named Finance Team of the Year in the North West Healthcare Financial Management Association Awards, said that STPs had to be used to put greater limits on trust spending.

“What the STP is trying to do – and I think it’s more sustainability than transformation to be honest” – is try to put some sense into it, to say we will give you this money if you meet certain conditions, one of which is that you deliver your financial plan,” he said. “Hopefully that will put some sense back into the system so we can start to hold people to account again on what they’re spending.”

He added that using STPs to reduce deficits was “very, very sensible” but “very challenging” and had met initial opposition from trusts.

The NHS ended the last financial year with 67% of providers in deficit. Its commitment to STPs has been questioned, with life sciences minister George Freeman admitting recently that the plans, due to be submitted today, will have no legal basis and will instead “form the basis for discussion”.

Worthington also issued a warning about the Carter Review, saying: “Lord Carter said that this information should not be used as a stick to beat people with, and lo and behold, it is being used as a stick to beat people with.

“I worry that the emphasis on pushing out top-down initiatives will disengage people, which is the worst possible thing to do. They need to be really engaged on the challenge of saving the maximum amount of money whilst providing services that are good quality and sustainable. We’re still working on it but I am slightly disappointed with the way it’s been pushed.”

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