The must read stories and biggest talking points in the NHS

Number crunching

In a series of stories, HSJ has examined the NHS’s unpublished proposals for dealing with the extreme funding pressure it faces in coming years. Our findings suggest it will employ thousands fewer nurses and other staff in the next few years, and treat tens of thousands fewer emergency patients in hospital.

The analysis is based on the detailed finance, workforce and efficiency plans submitted as part of the STP process. These templates have not been published, but HSJ has looked at a sample covering 11 of the 44 STPs, shared on the basis they are not identified.

However, it won’t escape anyone’s notice that reducing emergency admissions, at least in a single year straight off the current trajectory, is not very likely. Many people will say reducing the workforce and controlling acute spending growth (another theme) is unlikely too.

Confidence in STPs’ progress generally is low, some numbers in the templates have already been set aside in the 2017-19 contracting round, and national leaders have distanced themselves from some of the forecasts they’ve been sent.

Simon Stevens pre-emptively poured cold water on our story in last week’s triumphant Commons public accounts committee outing: “Some of the staffing projections within individual STPs will now need to be refined. To nip one potential future controversy in the bud… Anybody who looks at some kind of Excel spreadsheet and infers, ‘oh blimey, there is about to be big reduction’ is wrong.”

So why take any notice of these numbers?

Well, they are the only attempt we have and give us a useful insight about the direction the service will seek to take. Those drawing up STPs have said it is useful to compare them – it’s a shame NHS England has not made fuller figures available.

More importantly, and presumably the reason for the sensitivity, the templates are a clear reminder of some of the ugly choices and trade-offs the NHS faces as it goes through three years of historically low funding growth from 2017-18.