What NHS England isn’t telling you, and more indispensable weekly insight for commissioners, by Dave West
It’s time to publish the STPs
Summer is nearly over, and a painful, complex, two-year early planning round is here.
Updates sent to sustainability and transformation plan leaders in recent days confirm the expectation that operational plans and contracts for the 24 months from April 2017 will be pinned down by the end of December. This may come as something of an unwelcome shock to those still wrangling over 2016-17 figures.
Messages and briefings in recent days also give early details of the context and rules for both the final stages of STPs and the (closely linked) planning round.
These include a reiteration that capital remains “severely constrained”, and pointers on where IT funding (also pretty constrained) will be focused in the next couple of years. There will be no windfall of transformation funding, because much of the national pot still needs to go into plugging acute deficits.
This screams “more of the same” and won’t shock those who can read the financial runes. But it does mean disappointment for areas hoping for IT or infrastructure to oil their change plans, or to use budget flexibility to expand non-acute services. In many areas there will be no meaningful, locally owned growth funding at all.
System control totals will be on the table, and it seems several areas are now serious about adopting these, though they will be strictly tempered with clear organisational responsibilities.
The most difficult practical questions are so far unanswered, though, with fewer than 90 working days to 31 December.
Some are about the process: how can contracts be settled if the size of 2016-17 deficits (and therefore subsequent control total and sustainability fund requirements) are not known? When will national decisions be made about which service reconfigurations will be backed, and which will have their capital requests met? How much transformation funding will be available, and who will control it? Does the new approach mean national officials want a big shift to block contracting, to save time and encourage a common focus on cutting the total cost base?
For commissioners one issue surfaces above others: What will bind providers to sign up to deals which match the aspirations set out in STPs - and indeed to put the necessary effort into implementation?
This is against a background of simmering public concern about the plans in some areas, as covered today by the BBC and others. The concern is being exacerbated by unnecessary secrecy, encouraged by the centre and irritating to most STP leaders.
Some STPs are taking forward reconfiguration, but often these are well-trailed proposals, and the current silence is undermining months or years of previous discussions with the public. There are undoubtedly some points of controversy (ambitious bed reductions will be hard to explain, for example), but delay and obfuscation is doing little to help.
Several areas have more work to do, and national officials would like to retain a power of veto or to demand changes. But time is running out fast and, for the majority, no huge rewrites are going to happen by the 21 October deadline.
Space needs to be found in the tight planning timetable for STPs to be published, and to be signed off by NHS boards and health and wellbeing boards. Not only would this allay suspicion and give the process some legitimacy – it would also, critically, help tie all the players into delivery.
The Commissioner’s reading list
A weekly pick from the barrage of publications, articles and tweets which may interest commissioners:
- How are sustainability and transformation plans coming together? Nigel Edwards on STPs’ priorities and challenges, and why relying on reconfiguration for savings is often unwise
- Trust to face legal challenge over A&E closure More reconfiguration challenge
- What could Theresa May do about the ‘burning injustice’ of health inequality? I collected suggestions from experts and practitioners
- ‘Big question marks’ over how CCGs will pay for £200m care hike We covered this in July - but the financial hit involved on many CCGs has not been sufficiently appreciated
Dave West, senior bureau chief
- If someone forwarded this to you, click here to get your own copy
- Senior commissioning leaders are invited to the HSJ Commissioning Summit event in September – a high level forum for debating how commissioning should develop, delivering STPs, and the financial climate. Confirmed contributors include Simon Stevens and NHS England’s new director for commissioning operations and informatics, Matthew Swindells, and Alberto De Rosa, chief executive of the Ribera Salud Group in Spain, whose model of accountable, integrated care is widely praised internationally. Get in touch via the website.