Delivering STPs will need capital funding of £9.5bn, says BMA

An analysis by the British Medical Association has concluded that the NHS will need at least £9.5 billion of capital funding to pay for sustainability and transformation plans (STPs), which are currently being drawn up in 44 'footprint' areas with the aim of transforming and integrating health and social care services.

Eventually, these plans are to be produced by every health and care system in England to show how local services will evolve and become sustainable over the next five years, pursuing the 'triple aim' set out in the NHS Five Year Forward View of improved health and wellbeing, transformed quality of care delivery, and sustainable finances, according to NHS England.

An STP fund of some £2.1 billion has been set aside for the financial year 2016/17, which will rise to £2.9 billion in 2017/18 and to £3.4 billion in 2020/21.

However, the BMA says its analysis - based on a series of Freedom of Information requests - has revealed the "vast sums" needed just to create the infrastructure to deliver the projects, and that "NHS leaders are unlikely to have anything like the capital required to deliver the projects".

National staff are now assessing the plans in order to weed out those 'small to medium scale' projects which can be funded and implemented over the 'next few years', and are working with local areas to 'review' and 'refine' capital demands, it found.

BMA council chair Dr Mark Porter argues that the process was "doomed to failure" all along because of "inadequate funding and a lack of political will to transform services properly", while the clinicians "expected to deliver this flawed revolution were not engaged and many staff have had little or no involvement".

"The BMA has been saying for some time now that the STP process could have offered a chance to change some of the problems that hang like a millstone around the health service's neck: unnecessary competition, expensive fragmentation and buildings and equipment often unfit for purpose.

Covert savings
"The reality, however, is that these plans have become a vehicle for £26bn of covert savings – yet another crippling blow dealt by a Government with a vicious austerity agenda and lacking the gumption to come up with properly funded solutions for a health service in crisis," he argues.

"There is clearly nowhere near the funding required to carry out these plans and it appears that NHS England and NHS Improvement have probably known that for quite some time."

In November last year a report by health think-tank the King's Fund concluded that STPs offer "the best hope to improve health and care services" despite widespread criticism of the initiative.

But it did stress that the whole process is confused, muddied by unclear or changing deadlines and instructions from national NHS bodies and a lack of governance structure or formal authority for STP leaders.

"The introduction of STPs has been beset by problems and has been frustrating for many of those involved, but it is vital that we stick with them," Chris Ham, chief executive of The King's Fund, said at the time.

Ending in tears?
However, BMA north-west regional council chair Kailash Chand said while the aspirations may be good the plans are not deliverable.

"I think the future of STPs will end in tears. They will slowly be shelved. NHS England and NHS Improvement need to take this more seriously and look at the problems properly".

In response to the analysis, a spokesperson for NHS England said: "Rather than just commenting from the sidelines, local health and care leaders and clinicians are coming together to actually try and solve some deep-seated problems by identifying practical ways to improve services.

"Yes, there are well known pressures and constraints facing the NHS, but for patients' sake we should obviously all try and make the best of the situation, rather than just stand to one side and say 'well I wouldn't start from here'."