Mark Cooke Defends Sustainability and Transformation Plan (STP)

Letter from Mark CookeFurther to County Councillor Brian Greenslade's email of 23rd January, Mark Cooke, Director of Commissioning Operations
NHS England South, South West, replied:

Councillor Brian Greenslade
Devon County Councillor for Barnstaple North,
2 Longpiece,
Devon. EX31 4DT
Director of Commissioning Operations
NHS England South SW
Peninsula House
Kingsmill Road
Tamar View Industrial Estate
Saltash, PL12 6LE
email: [email protected]
Tel: 0113 824 8778
Date: 30.12.16

Dear Councillor Greenslade,

Thank you for your email dated 23rd December 2016.

You may be aware that the system for allocating NHS funding was revised from the financial year 2014/15, to place greater emphasis on tackling health inequalities.

We recognise that this is a difficult area and that there will always be argument over the relative weighting of different factors, especially when money is tight.

Nevertheless, the National Audit Office has said that the new funding arrangements are more transparent, while continuing to draw on expert, independent advice from the Advisory Committee on Resource Allocation. In fact the NAO concludes that: “The Department and NHS England’s approach to allocating funding for healthcare is generally sound.

In the case of Cumbria, the CCG is some 2 per cent above its target allocation. That means it will see greater downward pressure on its allocation than will NEW Devon, which is just 0.1 per cent over target.

In that context, you will not be surprised to know that West, North and East Cumbria, which was the subject of its own Success Regime and is now covered by a single Sustainability and Transformation Plan, is also looking to make considerable savings.

Its STP explains that it will be £81m in the red this year, rising to £168m by 2020/21 if its services are not adapted. For a population of just 327,000, this means that the financial gap per head of population is actually greater than that projected for Devon (£557m against a population of 1,160,000).

You are right to state that the STPs are a key mechanism for delivering the £22bn in efficiency savings that the NHS is required to make. That is no secret; on the contrary, it is the very basis of the Five-year Forward View, which underpins each STP.

STPs are therefore designed to deliver strategic change, in accordance with the Five Year Forward View, re-engineering local systems so they can cope with rising demand and rising costs in a period of flat funding and recruitment difficulties. This will help to deliver the triple aim of delivering improved health outcomes, better quality of services for the public and reduced cost-per-head of population for those services. Characterising this as ‘cuts’ does little to take forward the debate, when the aim is to re-invest money in the best way for local patients, in line with clinical advice. Simply doing more of the same is not an option.

All this is already clear to Devon County Council as a full partner in the STP process, sitting at the top table in recognition of its vital roles in social care, public health and healthcare commissioning. The Devon STP is the county council’s STP, as well as that of the local NHS.

In this context, I would quote the respected King’s Fund, which states that “STPs offer the best hope to improve health and care services”.

It adds: “Dealing with growing financial deficits in the NHS…requires a systemic response, avoiding the ‘tragedy of the commons’ that is all too apparent in the NHS today. The same is true between the NHS and local government, as the pressures facing NHS and social care services (and their impact on the population) are closely linked.”

“STPs therefore offer an important opportunity for NHS and local government leaders to work together to address the collective challenges facing their local populations.

With regard to the position of Ruth Carnall as independent Chair, I believe it has already been made very clear that this post was recruited to via a thorough and objective procurement process.

Further change may well ultimately come to the national funding formula but that is not within the gift of NHS England, as the formula is administered by an independent organisation whose work, as mentioned previously, has been assessed by the National Audit Office. In the meantime the local healthcare deficit gets bigger and the need to bring about genuine strategic change becomes more acute. If such change cannot be delivered, then we will indeed be in the realm of short-term cuts simply to prevent overspends. That would most definitely not be in the interests of patients and public across Devon.

Put simply, the challenges we face as the NHS and as local authorities will not go away. The STP’s organisations will therefore be carrying out considerable engagement work across Devon over coming months, leading on to formal consultation as and when required.

This will help people understand more fully why change is needed, what the benefits might be, and how they can play their part in making difficult choices that cannot be avoided. Your contribution to this process will be welcomed.

Yours sincerely,

Mark Cooke
Director of Commissioning Operations
NHS England South, South West

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