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Cash shortfall for NHS transformation plans

£9.5bn capital funding needed to deliver STPs

Adrian O'Dowd

Tuesday, 14 February 2017

The NHS will not have enough money to fund the often-cited sustainability and transformation plans (STPs) it has been asked to design as a way of improving the health service, according to an analysis by the BMA.

The BMA has today released details of an analysis it has carried out into STPs in England and found that the plans put forward will require at least £9.5 billion of capital funding to be delivered successfully.

For its investigation, the BMA gathered responses to Freedom of Information (FOI) requests from 37 of the 44 footprint areas that were asked by NHS England to come up with a STP.

The plans show that the projected capital demands for these STPs totalled £9.53 billion needed to create the infrastructure to deliver the projects, with costly building projects and investment in community facilities vital to the plans.

More than half of the STP footprint areas have told NHS England they would need more than £100 million of up-front funding to make changes and a handful have quoted capital needs of more than £500 million.

The figures also suggest that hospitals alone would need more than £2 billion to pay for outstanding “significant” or “high risk” maintenance needs.

The BMA said that NHS leaders were unlikely to have anything like the capital required to deliver the projects, given that budgets were already under significant pressure.

In the last spending review, the Department of Health was given an annual capital allocation of £4.8 billion from 2016-17 to 2020-21, but that money is being transferred to cover hospital deficits and will be soaked up by other demands, said the BMA.

Last month, during a parliamentary public accounts committee evidence session, NHS Providers chief executive Chris Hopson said a quarter of the capital budget (£1.2 billion) had been taken “to prop up revenue” and Department of Health finance director David Williams admitted that raids on the capital budget were likely to continue.

The BMA has calculated that the capital budget is likely to be closer to £1.6 billion for the next financial year.

National staff were now going through the plans to work out which small to medium scale projects could be funded and implemented over the next few years, said the BMA, and were working with local areas to review capital demands.

Dr Mark Porter, BMA chair of council, said: “The NHS is at breaking point and the STP process could have offered a chance to deal with some of the problems that the NHS is facing, like unnecessary competition, expensive fragmentation and buildings and equipment often unfit for purpose, but there is clearly nowhere near the funding required to carry out these plans.

“These plans are fast becoming completely unworkable and have instead revealed a health service that is unsustainable without urgent further investment, and with little capacity to ‘transform’ in any meaningful way other than by reducing the provision of services on a drastic scale.”

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.”

Picture credit: Marbury / Shutterstock, Inc.

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