Essential insight into England’s biggest health economy

The past – March 2017 in this case – is a different country. During our long journey from there to now we’ve seen the capped expenditure process and scaling back of ambition in south east London, which has revised interesting estimates of bed reduction.

Nevertheless, there is a lot that is interesting in The King’s Fund/Nuffield Trust report on London’s five STPs, released this week but completed in March.

There are things we knew but are worth restating:

  • London’s STP capital plans call for more capital than there is in the national capital budget.
  • Engagement with local authorities can be problematic.
  • The savings plans are unlikely to close the gap.

But let’s get into the less well known issues.

Presenting the report on Tuesday morning, Nuffield Trust boss Nigel Edwards pointed out that more than half of the £4.1bn (by 2020-21) in savings in the plans were expected to come from provider efficiencies.

While the report pointed out that the 3-4 per cent average savings were more than had been achieved before, Mr Edwards said the researchers had been unable to determine the amount of double counting in the totals. And if the Nuffield Trust and King’s Fund can’t get to credible figures on the five plans then maybe the figures just aren’t credible.

Certainly the capital picture is, well, optimistic.

The capital’s capital ask is £5.7bn, roughly a third of which could be covered by land sales.

But all the STPs want some capital money and as the Naylor report into NHS estates showed, the distribution is pretty uneven.

And that’s before you get into the governance of “how do we persuade the NHS charities, to whom the big trusts have sold their land, to sell/develop the land with private developers?”

North west London STP’s £500m request has largely been approved by NHS England (barring some difficulties in separating the Imperial part from the rest), and now just requires NHS Improvement, the Department of Health and the Treasury to do the same – then it could be in business.

(Of course, this money might now be going into uncapping public sector pay.)

How are things going with local authorities?

As the report puts it: “Some local authorities in London have expressed concerns about these proposals for acute hospital reconfiguration. In north west London, for example, the plan states ‘Ealing and Hammersmith and Fulham councils do not support the STP due to proposals to reconfigure acute services in the two respective boroughs.’”

Here’s how that looks in practice (an ugly PR war between two publicly funded local bodies). Which is a shame for lots of reasons but partly because former Imperial College Healthcare Trust chief executive Tracey Batten was optimistic about work “behind the scenes” to solve this issue.

In a side note, in some FoI-ed Imperial documents about the Ravenscourt Park issue in 2015, Dr Batten believed there were channels for a compromise. These have apparently come to nothing.

So, overall on STPs?

“STPs lack detail on how their ambitious goals for improvement will be delivered in practice,” says the report.

As someone pointed out on Twitter: “Not sure who is to blame: STPs for not having the answers as there are few or policy for forcing STPs to pretend to know.”

Back in the real world, Mr Edwards pointed out to the King’s Fund crowd that the projected increase in births in London would require another whole maternity unit in five years’ time.