More STPs being 'milked' to bail out neighbours

Birmingham and Solihull is the latest sustainability and transformation partnership to commit to additional savings in 2019-20, this time to offset overspending elsewhere in the West Midlands region.

Papers that went to the Birmingham and Solihull Clinical Commissioning Group board on Tuesday show commissioners will now have to find an additional £4.6m savings after NHS England/Improvement intervened. The change means the CCG is now targeting a £4.6m surplus for 2019-20.

The paper said similar requirements had been made of a number of CCGs and providers in the region. It is unclear which STP(s) will benefit from the additional savings, as NHS England had not responded to questions on this in time for publication.

In response to questions from HSJ, a CCG spokesman said: “The CCG recognises that it is part of the overall NHS system and that this surplus will be used to support the regional control total. We will be considering all options to create this surplus, including reviewing existing [Quality, Innovation, Productivity and Prevention] schemes, and holding discussions with our STP partners.”

However, Rob Pocock, who chairs the Birmingham health and social care overview and scrutiny committee, said he was concerned the move was the centre’s “back-door attempt” to cover for underfunding the service.

He said: “Birmingham and Solihull is a well-run CCG and it would be alarming if it was about to be milked to patch up holes in the system elsewhere. Our scrutiny committee will be looking with great concern at the risk this may pose to our local healthcare services.”

It comes after five STPs in the east of England were asked to bail out Cambridgeshire and Peterborough STP.

In a letter sent to trust chief executives and finance directors by NHS Providers last week, seen by HSJ, the membership body suggested regional control totals had been introduced across the country because of “the fact that the aggregate of current provider and commissioner plans remains some way off what NHSE/I believe is required for the NHS to stay within its overall allocated financial envelope”.

The letter suggested various approaches are being taken in response to this, such as a top slice being applied to all commissioning allocations, local systems being asked to help another, or regions creating a set of rapid savings schemes.

It added: “We know that members have concerns about some of these approaches including the fact that it is late in the day to re-open plans; that savings targets were already stretching enough; and that some feel they are being asked to subsidise providers/systems in other parts of their region with a less deprived profile, at the expense of their own services and more deprived patients.”

Chris Hopson, chief executive of NHSP, told HSJ: “We recognise why, to deal with a remaining 2019-20 financial gap, NHSE/I have asked each of their seven regions to hit an aggregate regional control total.

“There are two issues here. One is that this was introduced very late in terms of financial planning for 2019-20 and at a point when the new regional operations are still being set up.

“Second, we are now at risk of working to a potentially confusing mix of regional, system and individual provider control totals with no real clarity of how they work and interact. This, and a range of other issues, point to the need for greater clarity on how accountability works in the new regional NHSE/I and more local system focussed structure we now have. This clarity must be created quickly, and collaboratively with front line leaders.”

Responding to the story, an NHSE/I Midlands spokeswoman said: “We expect every NHS organisation to live within their means, and the benefit of taking a joined-up regional approach is that we can tackle the issues together to maintain the right access and quality of care for our patients across the whole of the Midlands.”

The story was updated on 5 June to include comments from NHSE/I