Exclusive: New capital funding regime for STPs

The idea is being explored by NHS England as part of a set of measures designed to help realise proposals contained within the sustainability and transformation plans.

NHS England chief executive Simon Stevens revealed the strategy as part of interview addressing concerns over the content and publication of the STPs.

He also responded directly to criticism from Birmingham City Council chief executive Mark Rogers that STPs were being forced to adopt an “NHS first” approach.

He added that he expected all STPs to be published “over the course of the next few weeks, and certainly by Christmas”, and defended the focus in some plans on shoring up the finances of acute services as a “pragmatic” response to circumstances that nobody “would’ve chosen”.

Mr Stevens said a number of STPs included proposals which would require “a level of capital investment”, the affordability of which could not be assessed by any “individual geography” while NHS capital funding remains constrained nationally.

As a result NHS England is examining the return on investment offered by each proposal and will then let the relevant STP know whether they are likely to get funding. This analysis would also address other factors such as “how shovel ready projects are”, said Mr Stevens.

For projects that pass those tests, he said: “We are debating whether we can create a new capital regime in which parts of the country which are able to dispose of their own surplus land are able to keep the all proceeds for reinvestment.”

Mr Stevens said he hoped this would address the “incentive problem” created by fears that land sales would be “snaffled centrally”.

NHS England’s work includes aggregating the “new investment required” and the ability of various STPs “to contribute to that if they had the right incentives to do so.” It will also attempt to “sync up” with the review of the NHS estate being undertaken by University College Hospitals London Foundation Trust chief executive Sir Robert Naylor.

Mr Stevens said he expected all the STPs to be published “over the course of the next few weeks, and certainly before Christmas”.

He added: “In some places these are pretty fully worked through proposals, in others they are directional rather than the final word” and this “spread of granularity across the 44 geographies” was not well enough understood by those critiquing the STP process.

Addressing the balance between sustainability and transformation, the NHS England chief said: “I think it is legitimate to recognise that there are genuine pressures in acute hospitals and therefore recognising that through the £1.8bn allocation [to tackle trust deficits in 2015-16] was a pragmatic thing to do under the circumstances. They’re not the circumstances that anybody would’ve chosen but they are the circumstances that we are facing.”

He added: “What we are seeing in the proposals is they are clearly putting their thumb on the scale in terms of wanting to put more of the investment in to mental health services and primary care in the way we would all believe is the right thing to do. What they can’t do is ignore they go into this process with hospitals under more pressure than they might have been 18 months ago.”