The vast majority of agreed STP (sustainability and transformation plan) proposals should be implemented by 2021, NHS leaders have said, but no formal plans for the necessary capital funding are in place.
NHS England will outline the latest details of agreed plans and some explanation of capital funding available at the end of this month in the Five Year Forward View Delivery Update – five months after the STP plans were initially supposed to be submitted by each of the 44 footprint area, BMA News has learned.
In the chancellor’s budget last week it was revealed that £325m would be made available for the first, and most successful, STPs to get started – an amount that could be swallowed up by the capital requirements of a single STP, in south-west London. England has 44 STPs.
The chancellor said more capital may be made available in the Autumn statement but did not clarify how the £9.5bn capital costs identified by the BMA would be funded.
It is understood that NHS Improvement and NHS England are working with the Department of Health to identify priority expenditure for 2017/18 and the need to develop further proposals for consideration for the Autumn statement.
BMA council chair Mark Porter said: ‘What are people supposed to start working with this year if most projects are only to be funded by 2020/21?
'These plans require significant upfront capital with new facilities in place, if they are to achieve their aims. NHS England’s welcome new patient care test for hospital bed closures should be extended to all service reconfigurations.'
NHS England said each area should be conducting local engagement with clinicians and members of the public and that feedback will help to ‘revise’ the plans.
It has also suggested – despite previous reports that national leaders would sift through the plans and pick and choose acceptable projects – that local areas would take decisions on which parts to go ahead with, but national agreement would be required. Any decisions on specialised commissioning would be taken by NHS England.
Each of the 44 areas have also been written to by NHS England chief executive Simon Stevens and NHS Improvement chief executive Jim Mackey – with next steps outlined in the letter.
It says a formal process to appoint official STP leads will take place, that stronger STPs will be given the right to second staff from clinical commissioning groups and NHS England, options for new governance models will be sent to each area and that each STP has been allocated between £175,000 and £360,000 in operating costs.
BMA council chair Mark Porter said that the plans would need genuine engagement with clinicians and patients and a much better outlining of available capital funding if they were to have any impact.
He said: ‘While some clinicians have been involved in STPs, they haven’t been clinically led in terms of using the breadth of clinical expertise in each area. The plans should be guided by primary care, community care, public health and hospital staff, involving doctors in their expert fields. This must not just be a case of clinicians fronting the plans; clinical engagement needs to increase radically.’
It is understood that up to 10 STPs are in the running to take on extra powers and could make steps toward integrated funding. These details are likely to be outlined in the Five Year Forward View delivery update.
Find out more about STPs
Read more from Peter Blackburn and follow on Twitter.