Community and primary care would see the fastest increases in funding, at the expense of slow growth in mental health and general acute spending falling in real terms, under detailed STP forecasts analysed by HSJ.

The findings are based on the detailed finance, workforce and efficiency plans submitted as part of the sustainability and transformation plan process. They have not been published, but HSJ has analysed templates for one in four of the 44 STPs, which were shared on the basis that they are not identified.



Most of the STPs do not project delivering overall financial balance until 2020-21

NHS England has said the figures are “incomplete” and in some cases superseded by the 2017-19 contracting round currently under way.

Total planned commissioner spending across the 11 areas, between 2016-17 and 2020-21, shows a 25.9 per cent increase in community health services spending; a 22 per cent increase in core general practice and other primary care; and a 20.4 per cent rise in spending on specialised services.

For mental health the increase is only 12.3 per cent, and the STP figures would see the sector only maintain its 8 per cent share of spending, rather than increase it, despite national commitments on mental health (see chart below).

Planned growth in general acute care spending in the same period across the sample of STPs is just 2.4 per cent in cash terms, with a small reduction in 2018-19 and growth of less than 1 per cent in 2017-18 and 2019-20. This would mean a real terms reduction for acute care each year.

These are the three years when, under the government’s current spending plans, the NHS will receive historically low funding growth, of less than 1 per cent each year in real terms. At the same time, pressures outside the NHS are expected to continue to push up costs and demand.

There is no reliable information on spending by category for recent years, but the STPs indicate general acute spend is on course to grow 3 per cent between 2015-16 and 2016-17.

The spending patterns in the STPs are consistent with the intention in many published STP documents to expand community and primary services, and contain or reduce demand for acute care.

Some acute provider trusts will benefit, however, from greater planned spending growth on specialised services, and potentially from nationally held funds.

Despite plans for reductions in staff and emergency activity, and severely constrained funding growth for acute care, most of the STPs in HSJ’s sample do not project delivering overall financial balance until 2020-21. Only one of the 11 forecasts balance in 2019-20, and nine estimate they will balance in 2020-21, when they assume receipt of a full share of the sustainability and transformation fun, which is due to be worth £3.4bn nationally.

This chart shows the proportionate change in different types of commissioner spending planned in the sample of STPs (from 2016-17 onwards):

This table shows the planned percentage change each year, and for the four years, across the 11 STPs for each category:

 2016-172017-182018-192019-202020-21Change from 2016-17 to 2020-21
Community services 3.70% 5.65% 6.88% 6.12% 5.03% 25.86%
Continuing care 2.45% 4.07% 4.93% 5.79% 6.03% 22.49%
Social care 3.25% 5.14% 4.34% 4.82% 6.20% 22.11%
Primary care total 5.00% 4.36% 4.24% 4.84% 6.95% 21.97%
Specialised services 7.51% 4.98% 4.47% 4.44% 5.13% 20.43%
GP prescribing 0.78% 2.45% 3.00% 3.47% 3.70% 13.22%
Mental health total 3.13% 2.42% 2.73% 2.84% 3.78% 12.29%
Acute total 3.03% 0.49% -0.24% 0.28% 1.83% 2.36%
Running costs (administration) 3.67% -2.42% -3.73% -3.28% 0.05% -9.09%

This chart shows the changing share of total commissioning expenditure for each sector, under the STP details:

This table shows in more detail the changing share of total commissioning expenditure for different catgories:

Acute total 42.63% 42.04% 41.04% 40.05% 38.99% 38.13%
Specialised services 14.60% 15.02% 15.32% 15.65% 15.88% 16.03%
GP prescribing 9.27% 8.94% 8.90% 8.97% 9.01% 8.97%
Primary care total 8.89% 8.94% 9.06% 9.24% 9.41% 9.66%
Mental health total 8.13% 8.02% 7.98% 8.02% 8.01% 7.98%
Community services total 7.25% 7.20% 7.39% 7.72% 7.96% 8.03%
Continuing care 4.46% 4.37% 4.42% 4.53% 4.66% 4.74%
CCG other including non-recurrent, contingency 2.68% 3.41% 3.83% 3.84% 4.14% 4.44%
Social care 1.38% 1.36% 1.39% 1.42% 1.44% 1.47%
Running cost (administration) 1.25% 1.24% 1.17% 1.10% 1.04% 1.00%

In relation to mental health spending, an NHS England spokeswoman said the analysis was out of date and said: “Since these tables were submitted the 2017-19 contracting round has been substantially completed, and will ensure that investment in mental health services will in fact go up by more than the overall NHS funding increase, just as it has in 2016-17 and in 2015-16.”

Spending figures by sector for recent years are not available publicly, and NHS England declined to provide its updated forecasts.

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