STP savings plans are “not credible,” think tanks warn

BMJ 2017; 358 doi: (Published 13 September 2017) Cite this as: BMJ 2017;358:j4270
  1. Tom Moberly
  1. The BMJ

Plans to reduce NHS costs in London are “not credible,” and more radical cuts to services may need to be considered to deliver savings, leading healthcare think tanks have warned.

As part of work commissioned by the London mayor Sadiq Khan, the King’s Fund, and the Nuffield Trust analysed plans published by the five London based sustainability and transformation partnerships (STPs). The think tanks concluded that, without appropriate action, the NHS in London would face a gap of £4.1bn (€4.5bn; $5.4bn) by 2020-21 between the funding it receives and the money it needs to deliver services.1

The two organisations warned about a lack of detail in the STPs’ proposals as to how to deal with this shortfall. Closing the gap would require the NHS in London to deliver savings of around 3-4% a year, they concluded, saying, “This is unlikely to be achievable.”

Speaking at the launch of the report, Chris Ham, King’s Fund chief executive, said that the plans to overhaul acute services did not offer a plausible way of delivering the suggested savings.

“The proposed changes to acute services and specialised services—especially where there are plans to reduce bed use or indeed reduce the actual number of hospital beds—are not credible as they stand, even with a prior investment in primary care and community services,” he said. “We’ve also questioned the financial plans and the financial assumptions on which the STPs are based, and whether in fact they will fill the £4bn.”

Nigel Edwards, Nuffield Trust chief executive, cited “an issue” with the scale of investment and rate of change that would be required to deliver the savings set out in the plans. “I think you come to the conclusion that, to close this gap, there’s probably less palatable measures [that are] not in the plans that might need to be considered,” he said.

Speaking to The BMJ after the event, Edwards said that such “less palatable” measures could include the closure of some services, with patients being redirected elsewhere. He added that a key challenge for STPs was to ensure that NHS staff have the necessary time available to deliver service redesign while also meeting current delivery targets.

“The STPs themselves are actually full of lots of really good ideas,” he said. “The real issue for me is the bandwidth of people in terms of their ability to deliver this stuff. How many of these things can you do simultaneously while running the organisation, meeting all of the short term targets?

“One is left with a general feeling that, not just in London but across the STPs, we’re missing a powerful enough change model to make these things happen within the timescales that have been set.”


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