Council funding crisis 'not a reason' to block STPs, warn Stevens and Mackey

The chief executives of NHS England and NHS Improvement wrote to sustainability and transformation plan leaders and other NHS and local authority bosses today, giving an update on STPs and contracting for 2017-19.

They also state that:

• Areas which have agreed 2017-19 contracts by the 23 December deadline “within the total resources available to their STP”, will be eligible to take on a “system control total”, as was offered in the September planning guidance.
• NHS England and NHS Improvement will “refine and prioritise” capital bids “over the next eight to 12 weeks”. A new capital framework will be published within two weeks.
• The national vanguard programme funding is “rolling-over… into 2017-18 for a final year”. National new care models funding this year is around £200m, of which around £100m is going to local vanguards. Applications are now open to transformation funding pots for cancer, mental health, learning disabilities and diabetes. The total national transformation funding for 2017-18 or 2018-19 is not clear.
• STPs “are understandably a work in progress”. They must start engagement to turn their “proposals” into “plans”, and also in 2017-18 “become implementation partnerships”. For “a small number” this will mean quickly becoming an “integrated or ‘accountable’ care system [where] providers and commissioners will come together, under a combined budget and with fully shared resources, to serve a defined population”. For others it will “take the form of forums for shared decision making and performance accountability”.

In an apparent reference to senior local government figures’ complaints about STPs putting too much of their focus on the NHS, and sidelining the social care funding gap, the letter says: “While the NHS spending review settlement nationally was never intended to – and is obviously not able to – offset pressures in local authorities’ budgets, this fact is not a legitimate reason for councils or the NHS to stand in the way of action needed to put local health and care services onto a sustainable footing.”

Council officials and councillors have raised a variety of concerns about STPs. In one case, Birmingham City Council chief executive Mark Rogers, also the area’s STP leader, used an interview with HSJ to criticise NHS England and NHS Improvement for a “sort out the NHS first” attitude.

The letter says: “The best STPs have built strong relationships with local councils, on the basis of shared goals and reciprocity of support.”

It also says: “We will also work with STP leaders with the most advanced plans to give you greater direct influence and freedom over how NHS England and NHS Improvement staff and resources – as well as the talent in CCGs, CSUs and other bodies – can be better aligned and deployed in your area to support your STP’s implementation.” The letter does not describe how or when this process will take place.

Mr Stevens and Mr Mackey say the “most immediate task now is to focus on completing the contracting round by 23 December”.

They say: “In its autumn statement, the government made explicit its intention that all parts of the NHS must live within the resources that it has allocated.

“Taking the total local funding envelope as the fixed point, the shared task is therefore to ‘reverse engineer’ a pragmatic set of funding decisions between programmes of care and individual services. It is important that this is supported by clear plans that manage cost and risk, not just shift them between organisations.”

Mr Stevens spoke to HSJ last week, setting out the next steps for STPs, and stating that: “The NHS’s budget settlement in the spending review was not intended to, and obviously cannot absorb, all the pressures in the local authorities [and the] financial pressures on their side. That fact should not be used as a reason for individual councillors or NHS bodies taking issue with the broad direction being set out in the STP.”