Analysis: STP digital plans need a major reboot

Sustainability and transformation plans have fallen well short of their overall goal, so it is not surprising that the digital elements in the plans are also largely undercooked.

There are tricky questions about the huge gap between available and required funding

Indeed, the consensus among senior figures working in digital health is that, while there are notable exceptions, very few areas have spelt out a compelling narrative for how they will deliver a digitally mature STP.

The approach taken in the bulk of the STPs is a cobbling together of previous initiatives and cookie cutter style statements about integrated patient records, e-prescribing and patient access to records, designed to tick the local digital roadmap guidance check list, rather than tangible delivery plans.

A muddled starting point didn’t help: Areas were first told to produce local digital roadmaps and set a headline target for a paperless at the point of care NHS by 2020; this was confusingly translated into the STP process and official acceptance that ‘paperless’ was the wrong focus and 2020 was the wrong target. This added to a lack of joined up thinking.

Some observers are concerned that some of the stronger parts of LDRs have not been carried over into the STPs – efforts are being made to correct this.

Funding running short

Even the more advanced plans which do set out cost forecasts raise tricky questions about the huge gap between available and required funding.

The handful of STPs which produced forecasts both revenue and capital requirements for their digital plans included north central London (total cost of £180m), Hampshire and Isle of Wight (£70.8m) and Frimley Health (£71m).

This small and obviously unrepresentative sample suggests an average of around £100m – and a hypothetical total of around £4.4bn for all 44 areas. Some STPs indicated funding for at least some of their plans was already earmarked (Frimley, for example, only requires £33m of new money), while capital receipts and other efforts to raise funding locally were also cited.

But most plans are dependent on securing central funding from the £900m estates and technology transformation fund or the £1.3bn to help fund the Paperless 2020 programme. These funds will be heavily oversubscribed, so significant questions remain about what can be achieved with funding running short.

There is no easy answer to the lack of funds, but with many STPs now being asked to sharpen up their plans, there is at least the chance to look again at the LDRs and attempt to better integrate them into the STPs.

This in itself will not solve the problem because many of the LDRs are weak on how they will deliver their visions, but making the most of what areas already have would be a good place to start.

Plundered cash

System leaders also need to set out how they are going to support digital development beyond the small number of trusts which will receive a share of the £100m digital exemplar programme funding.

It would be easy for local NHS leaders to push technology projects on to the backburner

Uncertainty about NHS England’s approach to the rest of the system, and to allocating the bulk of the £1.3bn of paperless 2020 funding, is further undermining confidence in delivery of the centre’s worthy but ambitious digital aims.

System leaders will have to resist increasingly strong temptation to raid the insufficient but not insignificant amount of funding allocated for the digital agenda to address other pressing concerns – winter pressures being an obvious example.

Every previous technology fund held by NHS England has been plundered to address short term problems, and this has contributed to the lack of progress made on the agenda since the national commissioner took on its full responsibilities in 2013.

With day to day pressure only likely to rise in 2017, it would be easy for local NHS leaders to push technology projects on to the backburner to avoid the cost and short term disruption implications. This will only contribute to an even bigger mess to deal with at a later date.