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Are the NHS' foundations flawed?

Can the NHS’s transformations plans work? Some FDs have serious doubts

January 2017

The foundations and frameworks of the sustainability and transformation plans (STPs) introduced to transform services and help re-balance NHS finances may be fundamentally flawed, according to finance directors working in the service.
In the latest NHS Financial Temperature Check from the Healthcare Financial Management Association (HFMA), most finance directors see STPs as a cornerstone of reducing the deficit – but an overwhelming majority also voiced concerns about the way they are set up, with nearly three-quarters (72%) concerned about their governance.
It appears finance directors have limited confidence in the simultaneous delivery of both STP and organisational financial objectives – with only 6% of trust finance directors and 17% of CCG chief finance officers (CFOs) believing that they are both deliverable.
Across STP footprints, emergency care demand, social care budgets and an increasing demand on services are the biggest threats to a financial balance. Worryingly, only 54% of finance directors believe that risks associated with STPs have been recognised, and just 5% believe adequate risk management arrangements are currently in place.
Paul Briddock, Director of Policy at HFMA, said: “Although STPs were met with enthusiasm and positivity when they were introduced, there is scepticism from FDs that the STP frameworks can work in practice. It is encouraging to see reported improvements in collaboration and some strong leadership in place, but when operating in a ‘club versus country’ framework, where there are conflicting priorities between individual organisations and footprint areas, the lack of clear governance is causing some angst.”
This rings true, as 62% of NHS finance directors say they will still prioritise their organisational objectives rather than their STP objectives. On reflection, 82% of finance directors believe that the regulatory regime needs to change to support the delivery of STPs, and 79% believe the financial regime needs to change, too.

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