‘Scandalous’ savings: £61m demand on STP a threat to care

CREDIT: This story was first seen via the BMA

Further savings cannot be made without ‘major’ changes to access, range and the quality of services offered to patients, NHS leaders have been warned, the BMA writes.

Staff involved in the North London Partners in Health STP (sustainability and transformation plan) were told to find £61m more savings by March next year – despite having already produced a 78-page plan detailing major efficiencies – as part of the so-called CEP ‘capped expenditure process’, but have said further cuts would significantly affect local healthcare.

The CEP is an NHS England and NHS Improvement initiative where 14 areas already unable to meet ‘control totals’, or financial targets, have been told to make ‘difficult choices’ and to ‘think the unthinkable’ to save more cash.

The ‘basic’ analysis included changes in major areas of spending

Health managers in North Central London, which includes the five boroughs the STP covers, Haringey, Barnet, Enfield, Camden and Islington – reviewed their existing plans and analysed possible measures, including reductions in treatments or services, to attempt to meet the demands but have told the BMA they do not support the proposals or actions they were forced to draw up.

The ‘basic’ analysis included changes in major areas of spending – including hospital care, mental health, community services and primary care but it is understood that health leaders felt the process was purely a ‘hypothetical exercise’ designed to show what would have to be done to achieve financial balance locally.

The analysis included possibilities of waiting times being lengthened, less money for doctors to spend on drugs – and could even have meant emergency departments and maternity units closing.

The plan was discussed at a joint health scrutiny committee meeting – featuring representatives from the five councils – on 7 July and it was revealed that local health leaders are ‘frustrated’ and concerned by the short-term nature of the demands for savings.

Speaking at the meeting, University College London Hospitals NHS Foundation Trust finance director Tim Jaggard – who also fills the finance lead role for the STP – said the STP’s leaders had told NHS England and NHS Improvement they did not support the project.

He said: ‘We are holding our ground but we are finding quite a lot of pressure because that leaves us with a budget gap. The obligation to balance [the finances] is still there but we are confident we will be given a lot more time.

The plans have been criticised for a lack of transparency – with no public or clinical engagement having taken place

‘We’ve been very clear with NHS England and NHS Improvement that this is not realistic without some of those really unpalatable implications on patient care. We have, I think, convinced them to accept that is the case.

‘We are a little bit frustrated by CEP, I think it’s fair to say.’

The plans have been criticised for a lack of transparency – with no public or clinical engagement having taken place.

Camden GP and local medical committee chair Farah Jameel said neither local nor national leaders had discussed anything with her organisation, despite the process having been ongoing for some time.

She said: ‘It is concerning that our LMC has not been provided with more information on the cuts proposed by the CEP, which could have a major impact on the whole health and social care system in north central London if implemented.’

The North Central London STP has been told to find a total of £61m to save through the CEP and still needs to find £52m to meet savings pledges already made. Local leaders said discussions with NHS bosses were continuing.

An STP spokesperson said: ‘We are focusing on delivering the plan which we have published and we don’t believe there is scope for us to find a further £61m of savings in 2017/18, without major changes that would affect access to services, the range of services [or] the quality of services.

The CEP has caused controversy in parts of the country, with health leaders in some areas suggesting the project was carried out in secret

The absolute priority for North London Partners is to maintain the quality of patient care and services to the residents of north London,’ she added.

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The CEP has caused controversy in parts of the country, with health leaders in some areas suggesting the project was carried out in secret, and some local leaders suggesting serious changes would need to be made, including extending waiting times and rationing treatments.

BMA deputy council chair and lead on STPs David Wrigley said the secrecy surrounding the CEP – as well as the potential content of local plans – was scandalous.

He said: ‘It is clear this area in north London cannot continue with the savage cuts forced on them by the Government without making  further fundamental cuts to the NHS offer; cuts which will affect doctors and patients. And that is a situation replicated across the country.

‘Commissioners, managers and clinicians have already delivered remarkable and painful cuts over the past few years. NHS Improvement chief executive Jim Mackey recently said the savings delivered were “near-impossible” – but managers are being asked to do more and more with less and less, and doctors in hospitals and GP surgeries across the country are feeling the strain every day. Our workforce is stressed and demoralised, our buildings are not fit for purpose and our patients are going to suffer.

The spokesperson said the STP did not include any major service changes

‘The BMA has long warned that STPs would mean nothing but another £26bn taken away from vital health services unless the necessary capital is made available to deliver them. Our own research earlier this year revealed that at least £9.5bn of upfront funding would be needed to make these changes yet so far local areas have only seen pennies.

‘There is nothing sustainable about running a health service on fumes, and there is nothing transformational about starving the NHS of the cash it needs to take care closer to people’s homes and improve crumbling local facilities.’

A spokesperson for North Central London STP said any ‘significant’ plans to change health services beyond the projects in the STP document would not be made without an equalities impact assessment and formal public consultation.

A spokesperson for NHS England’s London team said STP leaders would be expected to take their plan to ‘partner boards’ during July together with a ‘more detailed analysis’ of their financial position.

All plans must be signed off by provider or CCG boards, she added, saying that meant they would have ‘clinical involvement’.

She said: ‘Health organisations across North London are working with NHS England and NHS Improvement to make sure commissioners and providers deliver safe and effective patient care within budget.

‘This is not about cutting existing budgets, but about living within the budget allocated and making sure all organisations deliver the best service for patients from the money they receive.’

The spokesperson said the STP did not include any major service changes – but did not comment on the content of the analysis of what would be needed to provide more efficiencies, whether it would be carried out or what decisions national leaders had made in response to the STP, saying they did not support more savings.

She said: ‘The STP is prioritising robust stakeholder, patient and public engagement on their operational plans, and support for patient choice as well as clarity on the clinical evidence base.’

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