HSJ Catchup: All STPs published, social care funding and merger mixed fortunes

All STPs published

All 44 sustainability and transformation plans for England have now been published – nearly two months after each footprint was asked to submit its final proposals.

The final plan to be released was Staffordshire and Stoke-on-Trent’s, which said an accident and emergency department will close on the patch, as will more than 100 community hospital beds. The solutions outlined in the STP will deliver £245m of savings.

HSJ has been keeping track of the publication pipeline on our map, and you can download every STP from it.

In his expert briefing, Dave West has analysed what we can learn from the plans, and what comes next for the STP programme.

STP gets moving

Commissioners in Nottinghamshire are some of the first out of the gate on implementing plans in their STP to shift activity from acute settings to the community.

A message to staff at Nottingham University Hospitals Trust has revealed 13 services that clinical commissioning groups in the area plan to decommission at NUH, and another 17 services where the model of delivery could be redesigned.

The CCGs’ ambitious plan will see all the services re-tendered by July 2017 – a timetable some people think is unachievable.

Commissioners say the trust, one of the largest in the country, will be able to bid for the services but it also faces the risk that another community provider could enter the local market.

£10m badly spent on work to prepare for abandoned merger

Work to prepare for the now abandoned merger of a flagship teaching hospital with its struggling neighbouring trust cost £10m, NHS Improvement has revealed.

A breakdown of spending by Nottingham University Hospitals and Sherwood Forest Hospitals Foundation Trust on the project shows it included £6.6m on professional advice fees alone. Of this, HSJ understands £6.1m was paid for consultancy advice with £500,000 on legal fees.

This will presumably deal another blow to those trying to propagate provider merger as a big part of the solution to the NHS’s troubles – and in turn to hopes riding on these as a means of cost saving. Nottingham and Sherwood said it was operational pressure which led to them giving up, though there are those who think there were other reasons.

But the real beauty of this story is how the costs were dealt with: they have not been laid at the door of Nottingham or Sherwood (an admission at the centre that the local trusts were given little choice?). But nor has the Department of Health, yet, put its hand in its pocket.

Instead, the joy and magic of the current provider financial regime means it can be dealt with via a simple paper control total adjustment of £10m in Sherwood’s favour. Unfortunately, those professional advisers have been – or will be – paid by someone, so the bucks (10 million of them) will stop somewhere.

Social care funding: good but not good enough

HSJ’s sister title Local Government Chronicle reported that local authorities will be able to raise the social care precept by 3 per cent in each of the next two years. According to Sajid Javid, the communities secretary, the rise could generate up to £208m in 2017-18 and £444m in 2018-2019.

On top of this, social care will receive £240m in funding that is being diverted from the new homes bonus scheme. Mr Javid said that alongside the increase in the precept, this will mean an additional £900m for adult social care.

The news of any more money for social care will surely be music to the NHS’s ears, but the NHS England chief executive made clear on Thursday that the precept increase will by no means be enough.

Addressing the issue of funding for social care at NHSE’s board meeting, Simon Stevens said it would need a “three part approach” – including “immediate financial support” and a debate on “profound changes” to the way social care is financed from 2020.

Despite welcoming the funding raised through increases in the precept, Mr Stevens was clear that it won’t “by any means close the [social care funding] gap”.

Mind the gap in funding

Greater Manchester is one of the best equipped regions to deliver financial sustainability over the next five years, thanks to a jump-start that was years in the making and a £450m transformation fund awarded by NHS England.

Yet Greater Manchester has warned that it cannot reach financial balance by 2021, due to a £176m gap in social care funding, and may have to raid its own transformation pot in order to prop up its day-to-day statutory services.

This is worrying stuff just six months into the five year cycle, and obviously raises big question marks over the region’s ability to invest in the new models of care which will be crucial to delivering sustainability.

Trust merger date set

Birmingham Children’s Hospital and Birmingham Women’s Hospital FTs are going “full steam ahead” to merge by 1 February next year, their joint chief executive has said.

Sarah-Jane Marsh also said a £16m capital loan from the Department of Health over the next three years will be used for work on the women’s hospital estate.

Ms Marsh took over running both trusts in July 2015, and the trusts confirmed their plans to merge last December. This was shortly after a £70m programme to rebuild the women’s hospital was scrapped by the new leadership.