Essential insight into England’s biggest health economy, by Ben Clover

In common with most sustainability and transformation plans, north east London would like some capital.

In common with all STPs, it is unlikely to get it.

Well, it will get some to invest in primary care (already in train), but it won’t get anywhere near “the central support to cover private finance initiative costs above normal levels” it wants.

The NEL STP’s “asks” note that they have “the UK’s largest hospital development” (Barts Health Trust).

The Department of Health assessed that in 2011 – and while agreeing that Barking, Havering and Redbridge University Hospitals Trust needed some support with its PFI, it decided Barts did not.

Perhaps the boldness of this ask is to make the case for NEL keeping its capital receipts seem like a compromise.

What capital receipt is that? Selling part of Whipps Cross to fund rebuilding a bit of Whipps Cross.

This approach worked in Stanmore for the Royal National Orthopaedic Hospital but took years, and the agreement that its pedigree orthopaedic surgeons would go out across England and embarrass subscale outfits into centralising. It is not clear what north east London can offer the centre in return.

Organisational mess

The own-goal secrecy of the STP process and the search for any radical content in the plans can obscure what an organisational mess many of them are.

In any STP there will be the statutory bodies – commissioners and providers – each with their own board and subcommittees. The leads from these organisations make up the membership of the STP, which is not a statutory body.

But although they don’t legally exist, everyone must comply with what an STP says because their authority is mandated by NHS Improvement (a non-statutory body made up of two statutory bodies stuck together) and NHS England (a statutory body).

NHS Improvement and NHS England can make life difficult for providers or commissioners which don’t want to play ball.

(Remember when Lewisham Clinical Commissioning Group vetoed the closure of Lewisham Hospital’s accident and emergency, and then Jeremy Hunt lost the judicial review? NHS England could replace the board of a CCG that did that now. It could have done it then, but this was before “committee in common” rules were introduced that would put the consensus view of a group of CCGs over an individual CCG.)

That’s before you get into local authorities (statutory bodies) sitting on STPs.

You can’t talk about an integrated sounding system without involving local authorities and their social care budgets.

But local authorities also tend to hate downgrading hospital services, and have backed judicial reviews of decisions to close them (Lewisham and Ealing for example).

They’ve been told STPs won’t go ahead without councils’ agreement. Awkward.

Add to all this the committees in common CCGs have had to set up to do things together over their collective patch. Who oversees appointments to this “complex” area of governance? CCG audit chairs? It’s a lot to ask on top of their existing duties.

The CCG, the STP and the CIC – three layers of abstraction from the swamped GP practice who just want a bit of capital money.

London Eye features a look at what’s going on in England’s biggest health economy. London has the best and worst regarded hospital trusts in the country. It has excellence and dysfunction in commissioning and primary care. I will cover all of this.

Please get in touch to tip me off about stories you think I should cover: ben.clover@emap.com.