The NHS likes to talk about transformation, but when transformation competes against performance pressures there is only one winner.
Judging by the latest capital bids submitted by health economies, it is clear immediate pressures on emergency care and finding space in acute hospitals continues to trump plans for new IT solutions or moving care out of the acute hospital.
In last year’s budget, the government announced £3.5bn of extra capital funding to the NHS over five years.
Of the £3.5bn, around £2.6bn was earmarked for projects submitted by sustainability and transformation partnerships.
Of the £2.6bn, the government allocated just over £1bn in 2017-18, which leaves around £1.6bn up for grabs.
Prepare for disappointment
It is unclear how much money will be allocated in 2018-19, but given the funding is earmarked for five years it would seem likely the figure will be south of £1bn.
Over the summer, NHS estates teams were busy working up bid submissions for capital funding due for release this autumn.
The bids first had to be cleared by each trust’s board, and then prioritised by leading figures in the STP.
All bids were submitted to NHS England in July, along with an “estates strategy” for the STP.
So how much money are the STPs asking for? HSJ has so far received responses from half of the 44 STPs, and at the time of publication, the total value of bids had already crossed the £2bn mark.
This means the majority of bids will be turned down.
A&E still high on estates agenda
When the government announced the extra £3.5bn last year, it was implicit that bids would need to demonstrate how the investment could help introduce new care models or lead to significant annual savings.
Examining what types of bids have been prioritised gives good insight into the issues facing STPs and how they plan to address them.
The number of bids submitted varied drastically, from Greater Manchester STP (14) to Mid and South Essex STP (0). The latter said it had received funding in previous waves.
For all the talk of moving care out of the acute sector, it remains difficult for STPs to ignore the requests of trusts whose emergency department is grappling with inadequate space.
Several STPs’ top priority bids focus on reconfiguring emergency and urgent care departments, such as Greater Manchester, Leicestershire, Leicester and Rutland, Suffolk and North East Essex, Northamptonshire, Devon, and Coventry and Warwickshire.
Others focus on services outside the acute sector, with bids for investment to build new primary and community care hubs (Kent and Medway), and new wards or space for inpatient beds for mental health patients (Norfolk and Waveney, and Buckinghamshire, Oxfordshire and Berkshire).
Little room for IT
Meanwhile, the new health and social care secretary will be disappointed to note the lack of bids for IT and technology projects.
Of the 22 STPs which responded to HSJ, only two submitted prominent bids for IT or technology projects (Northamptonshire and Bristol, North Somerset and South Gloucestershire STPs).
There are a number of other avenues trusts can go down to apply for technology funds, such as the Provider Digitisation Fund and other pots of cash, but the lack of bids submitted in this batch underlines the NHS’s difficulty in agreeing IT plans across health economies.
It is not known exactly when successful bids will be announced by the government.