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Doctors ‘horrified’ by STP staff costs

LUCRATIVE CONTRACTS: At least 158 full-time equivalent roles created by STP process

– ‘Eye-watering’ salary bill for new health managers pushing controversial STPs

– More money haemorrhaging from NHS to private consultancy firms and agency staff

– Vast differences in STP process across country could create a ‘deepened postcode lottery’ for patients

A vast cohort of operations managers, communications executives, administrators and financial analysts has been created to drive forward controversial STPs (sustainability and transformation plans) – taking millions of pounds out of the frontline NHS.

A BMA News investigation has revealed that health leaders have created more than 150 jobs, with annual salaries of at least £8.5m, despite funding on the front line being scarcer than ever before.

In some areas new roles have been created for external applicants – but some STPs are using costly agency staff or seconding senior staff from other NHS organisations. One ‘financial lead’ bills the NHS for a pro-rata salary of nearly £500,000.

The investigation has also revealed a major disparity in the processes being carried out across the country. In some areas, such as Lincolnshire, health leaders said they were using the resources already at their disposal to move the STP process forward – but in others, such as North East London which has employed 37 staff, whole ‘project management teams’ have been created and swathes of analysts, press officers, and programme directors appointed.

BMA council deputy chair and STP policy lead David Wrigley said: ‘Doctors and patients who are now all too accustomed to seeing the strain placed on hospitals, GP surgeries, social care and public health by the wilful lack of health service funding from successive governments will be horrified to see the amount of money being spent on another layer of potentially wasteful bureaucracy in the NHS.

‘These STP plans hide £26bn worth of health service cuts, as revealed by the BMA earlier this year, and are already falling apart – with the Treasury coming up with only a tiny percentage of the capital they need to get started.

‘These revelatory figures show the worrying lack of consistency across the country – with some footprint areas hiring scores of staff at vast costs, some turning to private consultants and some making the best of the management structure already operating in their local area. The result of these plans will be more inconsistency, a deepened postcode lottery and, ultimately, both doctors and patients will suffer.’


Tip of the iceberg

In total the BMA has found that 158.6 FTE (full-time equivalent) roles in the STP process have been created – costing around £8.9m. But the figures are actually likely to be much higher with only around half of the 44 STP footprints responding to the request and others unable to give detail of remuneration for staff, including very senior roles expected to be filled at director level.

Many STPs will have created more detailed plans and created more jobs during the period of responses being supplied – and some of the footprint areas were unable to give full financial details of created roles, including some senior positions.

It comes after concerns about the STP process, and particularly a lack of engagement and STPs having no formal legal or governance structure, have been raised by health leaders and politicians – with the Labour Party recently calling for a halt to the process in its general election campaign.

Dr Wrigley said: ‘Some of these STPs seem to be ballooning into governing health and social care ...
... structures with no mention in law and no proper governance – making a mockery of the pernicious legislation enforced on the health service in 2012. Doctors and patients deserve a properly structured, transparent health service with strong governance and a consistent structure across the country. The NHS needs more GPs, more junior doctors and more consultants – it already has business managers, finance directors, and communications and engagement managers. It is about time the Government woke up to the crisis facing our services.’

Eleven of the STPs that responded told the BMA that they had created teams of 10 people or more to take the process forward. And just five areas accounted for more than £5.5m of the spending:

– Cambridgeshire and Peterborough created 28 job roles at a cost of £893,000 annually

– Milton Keynes, Bedfordshire and Luton created 12 jobs at a cost of £920,000

– North Central London created 19 job roles at a cost of £974,000

– Leicestershire and Rutland created 22 job roles at a cost of £673,000

– North-east London created 37 job roles at a cost of £2.3m.


Falling apart

Tower Hamlets GP Jackie Applebee said the ‘astronomical’ figures in north London were ‘shocking’ and that the STP is creating another level of NHS bureaucracy which ‘overwhelms’ patients and doctors.

She added: ‘I’m appalled. The NHS is falling apart and the NHS in our area is falling apart. We are being told that the number of GPs in our number is being cut drastically but they are prepared to spend all this money on people who aren’t even necessarily tied to our area.’

Some of the STP plans advertised jobs for agency staff, or private consultants to take, with at least £1.1m of NHS money haemorrhaging to external firms.

In North Central London – an STP now rebranded the North London Partners in Health and Care and facing ‘challenging’ finances –  a ‘financial lead’ from an external consultant was hired with a day rate of £1,500 – costing the taxpayer £199,000 for a part-time job. Earlier this month a job with the same title, but covering an entire acute NHS trust in the North West was advertised with a day rate of £250 to 300.

Camden GP Farah Jameel said: ‘It is rather ironic that an STP plan which is struggling to meet financial balance is haemorrhaging monetary resources in this manner.

‘These are eye-watering sums of public money being paid to private firms for expert management advice, while we already have NHS Improvement whose job it is to provide such support.’

The vast differences in the process across the country is highlighted particularly in the East Midlands where, along with the vast expenditure in Leicestershire, Nottinghamshire’s STP has already put together a team of 10 staff costing £385,000 – but Derbyshire’s STP had only employed two staff at the time of asking at a cost of just £68,000.

See the 'eye-watering' costs

Find out more about the figures

Find out more about STPs


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