Eleven “financially challenged” health economies are going to receive support from private companies to help with their strategic planning, it has been announced.

Monitor, NHS England, and the NHS Trust Development Authority will pay the companies to help groups of commissioners and providers to “work together to develop integrated five-year plans” which deal with the “particular local challenges they face”.

The 11 health economies are:

  • South West London
  • North East London
  • Cumbria
  • Eastern Cheshire
  • Staffordshire
  • Mid Essex
  • Cambridge and Peterborough
  • Leicestershire
  • Northamptonshire
  • East Sussex
  • Devon

HSJ understands the bodies will between them make about £800,000 available in each area to fund a supplier who will “bring together all partners in the health economy” and act as “critical friend” as plans are drawn up.  

Overall responsibility for the plans will however remain with commissioners and providers.

Monitor will be leading the procurement process to select the suppliers. A spokesman for the regulator said the support was being offered because it was the first time trusts have been required to undertake five year planning and because clinical commissioning groups were also new to the planning process.

The spokesman said the national bodies wanted to ensure commissioners and providers plans are “as connected and joined up as possible”, and that the 11 health economies were selected because they offered “the biggest bang for buck”.

He added that the suppliers would also identify potential risks and alert the national bodies if they identified “gaps…in the plans that might provide problems down the road”. This information would then feed into the bodies’ assessment of the provider and commissioners’ plans in June.

Appointments will be made in March by a tripartite panel of the three national organisations, and each programme of work will last about 10 weeks.

An existing framework agreement has been used to issue invitation to tender documentation to a list of providers which includes Deloitte, Ernst & Young, McKinsey and PricewaterhouseCoopers.

In many cases the health economies being targeted are in the midst of controversial service reconfigurations or are locations where this is thought to be necessary in the future.

For example a reconfiguration in south west London involving the downgrade of Epsom and St Helier University Hospitals Trust is currently stalled, and substantial changes are expected in the Cambridgeshire and Peterborough region.


Leicestershire’s health economy faces a £290m spending gap by 2017 and needs to address an “imbalance” which places too great an emphasis on acute services.

To try and bring about a sea change in the provision of health services, all providers, commissioners and local authorities have signed up to the Better Care Together transformation programme. This aims to rebalance the economy and put University Hospitals of Leicester Foundation Trust onto a sustainable footing in the long term.

However, there is currently little granular detail on how activity and finances will shift to deliver service change. University Hospitals of Leicester’s forecast deficit doubled to almost £40m in the space of a month, its December 2013 board papers revealed, adding to the pressure.


Extra demand is being placed on the Northamptonshire health economy by a population which is getting larger and older.

Sixteen per cent of the population covered by Nene Clinical Commissioning Group is already over 65 and the proportion will reached one in five by 2020. Meanwhile, Corby CCG has one of the fastest rates of population growth in England, with a projected rise of 16 per cent by 2021. These pressures are expected to result in the health economy facing a funding shortfall of £274m by 2019.

It is hoped integration and collaboration will ease the pressure. Bodies including Nene and Corby CCGs, Northampton County Council, Northamptonshire Healthcare and Kettering General Hospital foundation trusts, Northampton General Hospital Trust, and the Hertfordshire and South Midlands NHS England local area team are devising a whole system response through the Healthier Northamptonshire Programme Board.