Sustainability and Transformation Plans (STPs) require at least £9.5bn of capital funding to be delivered successfully but NHS leaders don’t have the cash to do so.
A BMA investigation has revealed the vast sums needed just to create the infrastructure to deliver the projects, with costly building projects and investment in community facilities vital to the plans.
Responses to FOI requests from 37 of the 44 footprint areas show that the projected capital demands for these STPs totalled £9.53bn
More than half of the STP footprint areas have told NHS England they would need more than £100m of up front funding to make changes and a handful have quoted capital needs of more than £500m, including Manchester, Cambridgeshire and Peterborough and West Yorkshire.
Figures also suggest hospitals alone need more than £2bn to pay for outstanding ‘significant’ or ‘high risk’ maintenance needs.
NHS leaders are unlikely to have anything like the capital required to deliver the projects, with budgets under significant pressure. In the spending review the Department of Health was given an annual capital allocation of £4.8bn from 2016/17 to 2020/21 – but that money is being transferred to cover vast hospital deficits and will be soaked up by other demands.
At a Public Accounts Committee hearing last month NHS Providers chief executive Chris Hopson said a quarter of the capital budget (£1.2bn) 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.
If the costs of the repairs and maintenance were paid and health bosses continued to raid capital budgets, the capital budget – without taking into consideration any of the vast costs of ‘business as usual’ projects like building new facilities – would stand closer to £1.6bn for next financial year.
National staff are now sifting through the plans to work out which ‘small to medium scale’ projects can be funded and implemented over the ‘next few years’ – and are working with local areas to ‘review’ and ‘refine’ capital demands.
Dr Mark Porter, BMA chair of council, said: “From its very beginning this process was carried out largely behind closed doors, by rushed health and social care leaders trying to develop impossible plans for the future while struggling to keep the NHS from the brink of collapse.
“These figures are especially concerning given that everyone can see a huge crisis unfolding within our NHS, with record numbers of trusts and GP practices raising the alarm to say they already can’t cope. 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.”