NHS reforms

Ministers pressed to ‘sort out STP mess’ as plans deemed promising but financially unrealistic

While STPs are promising, they are not yet detailed enough to realistically tackle the problems the NHS faces, the Chartered Institute for Public Finance and Accountancy (CIPFA) has said.

CIPFA has analysed the first nine of the 44 STPs which are being developed with the aim of improving NHS services while reducing costs, covering a wide geographical and socio-economic spread.

The report found that while CIPFA supported the use of STPs as a solution to stabilise the health service’s financial position, some of the STPs analysed have as yet failed to credibly explain how the savings they propose would be achievable, particularly in case of dangerous contingencies. 

Rob Whiteman, chief executive of CIPFA, said: “In order to improve care for local communities, STPs will have to make tough choices to deliver meaningful change.

“However, it is of vital importance that STPs fully assess whether the actions proposed can actually meet savings targets and boost the quality of services by doing robust financial planning. STPs are our best shot at making our health and social care sustainable for future generations. Therefore, local leaders and NHS providers must do all they can to ensure that the proposals are deliverable.”

STPs are being designed as part of the Five Year Forward View (FYFV) which aims for NHS bodies to make savings of £22bn by 2020, equivalent to 20% of spend over five years.

However, the CIPFA estimates that £30bn will actually be needed to make up the shortfall if savings were put into context as a percentage of relevant spend, meaning that STPs are currently failing to appreciate how challenging their saving plans would be.

The report added: “All the STPs conclude that major transformation is required in order to deliver what is needed. How soon, though, can such transformation be taken to the point at which it generates significant savings?

“Most of the plans set out proposals as being necessary to long-term financial stability but don’t expect the savings to tackle much of the deficit reduction needed in the plan period. Indeed, investment is needed up front, which is a potential problem given the reducing capital available to the NHS.”

CIPFA also found that there is greater scope for integration between the NHS and non-health bodies such as councils and the police in order to assess potential social care and public health pressures.

It recommended that health authorities put their savings plans into context compared with their best past performance, and to review what integrated working might contribute to the STP delivery process.

‘Greater engagement needed’

Concerns about how STPs will be delivered have already been raised by a range of health experts, including the BMA, whose recent survey revealed that 64% of doctors have not yet been consulted on changes despite the impact STPs will have on their services.

Today, the union urged ministers to “sort out the mess” of the STPs, with its council chair, Mark Porter, adding that the BMA has serious concerns about the “impossible” scale of savings required with no extra funding promised by central government.

“The STP planning process has turned into a mess,” he added. “It is crucial that any plans about the future of the NHS must be drawn up in an open and transparent way and have the support and involvement of clinicians and the public from the outset.”

However, the BMA has also expressed cautious optimism about STPs, admitting that they could generate more collaboration between local services and aid long-term planning.

A report by the King’s Fund last week into STPs made clear suggestions for patients and all parts of the health and care system to be involved in the STP consultation process in order to prevent risks, along with improved governance supported by changes in NHS regulation.

But trust leaders told the House of Lords last Tuesday that competition within the health and social care system risks undermining STP goals without a new regulatory framework to back it up.

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