Simmering tensions between NHS Trusts and policy-makers bubbled over in October with NHS Providers Chief Executive Chris Hopson going public on the financial crunch point facing hospitals.
Giving evidence to the Commons Health Committee the leader of the English Trusts body cast doubt on the viability of the 44 Sustainability and Transformation Plan (STP) footprints.
These, alongside regional devolution, have become the focal point of policy impacting on the shape of hospital services and their integration with primary and social care.
Parties brought under the STP umbrella filed their plans at the end of October – but MPs on the committee pointed to public concern that the motivation was more about meeting stringent budgets than their higher stated priorities of closing gaps in quality and care.
The plans are being drawn up against a backdrop of “frontloaded” additional Treasury funding that the committee has previously warned is far short in real terms of the amount requested by NHS England.
“What worries us is if you look at the funding increases that are coming over the next few years,” said Hopson.
“Cost and demand, as we know, in the NHS rises by 4 per cent a year, and we are going from a 3.7 per cent increase this year to a 1.3 per cent increase next year, 0.3 per cent the year after and 0.7 per cent the year after.
“We are struggling to make the numbers add up this year. I think all of us are asking how this looks when we go from plus 3.7 per cent to plus 1.3 per cent to 0.3 per cent and then 0.7 per cent.”
Hopson agreed that there was a danger that the STP process “has become mesmerised by money” due to the “very aggressive” 2021 targets facing Trusts.
“People have been told specifically that they cannot submit a plan unless it balances to this very aggressive 2021 figure, and then when people look at their 2021 figures, to be frank, they are mesmerised because they are being asked to create plans that talk about identifying hundreds of millions of pounds of efficiencies.
“We have not found anybody really yet who says to us they can, with complete confidence, get all the way there.”
In the same session NHS Clinical Commissioners Chief Executive Julie Wood echoed this concern, admitting that the “predominant focus of STPs has been on closing the financial gap. We need to make sure that we are putting emphasis on the care and the quality gap as well as that so that we then make the right level of investment.”
Hopson also complained of a skills shortage at the top of Trusts. “We recognise there is more to go at in terms of efficiencies, but we simply do not have the capacity and capability at the moment to do that because we are so busy keeping this very wobbly day-to-day system upright.”