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STP rescue plans ‘can’t be delivered’

SRM 2016
Dr Anthea Mowat
MOWAT: Tight timescales mean decisions may be made without full consideration of the implications for patients and staff

The Government’s plans for pulling hospitals out of deficit are ‘completely undeliverable’, and subject to a timescale that may not enable them to be properly checked.

These are just two of the multiple warnings – of apparent increasing urgency – issued by hospital representatives, the NHS agency that oversees trusts, and the boards that scrutinise STPs (sustainability and transformation plans).

The BMA believes that STPs raise opportunities for collaboration and longer-term planning, but have concerns in areas such as funding and accountability.

According to ministers, hospitals will be pulled out of deficit next year by rolling out STPs, which are being put together by local health leaders, commissioners, and councils in 44 areas across England.

But the credibility of the rescue strategy is now being called into question – most recently last week in Parliament, but also in official papers released by councils and NHSI (NHS Improvement), which oversees both foundation and other NHS trusts.


‘Completely undeliverable

Last week, NHS Providers chief executive Chris Hopson told members of the Commons health select committee that unprecedented financial deficits faced by many hospitals risked ‘blowing up’ STPs.

Hospital leaders were being forced to agree plans they knew would bust future budgets, he added. 

‘Funding is going to drop, so they’re now looking at a set of figures that, to be frank, just look completely undeliverable.’

Mr Hopson’s warning comes after NHSI indicated its own timetable for checking STPs was too tight.

According to NHSI board papers, the agency and NHS England have less than a month to assess, offer feedback, and sign off all 44 finalised STPs.


Concerns across England

Last year, officials had three months to check and approve NHS plans. ‘The timetable [for checking STPs] is extremely challenging,’ the papers state.

Warnings about STPs have also been flagged in papers produced by HWBs (health and wellbeing boards), the groups of health and local authority leaders who scrutinise STPs in town halls across England. 

A review of HWB papers from the past few months reveals a litany of concerns about STPs:

  • Lancashire HWB pointed last month to ‘significant concerns’ about the time it had left to get feedback from doctors on its plan. 
  • Papers from the HWB in Solihull warn its joint STP with Birmingham – one of the largest in England – missed by three months a June milestone to submit a ‘financial template’. While their joint plan had not yet proposed ‘significant closures or changes’ to healthcare, NHS England had suggested ‘significant efficiencies’ must be found, while patient care and outcomes were improved. 
  • York’s HWB said in July that the ‘nationally’ driven agenda of STPs ‘might not be what the community wants’ and that there had been ‘little time for public engagement’.


Need for full consideration

BMA representative body chair Anthea Mowat said there is ‘great concern that STPs are not financially viable’. 

‘In order to maximise the benefits from STPs, the NHS, public health and social care functions need to be adequately resourced, she said.

‘The tight timescale to sign off STPs risks decisions being made without full consideration of the implications for patients and for staff, and without proper governance procedures being in place.’ 

NHSI said the STP process was led ‘locally’ and ‘built on months of collaboration between clinicians, patients’ representatives and other partners’.

‘Local STP teams have to be sure that their plans are deliverable, robust and meet the needs of their local population,’ the spokesperson added. 

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