Where Did Half a Billion Pounds of Your Money Go? S&C Investigates the STP

In 2016, Hampshire and Isle of Wight NHS Services announced its Sustainability and Transformation Plan (STP) to generate savings across NHS spend in Hampshire and the Isle of Wight. Documents published in November 2016 set out to establish 10 major projects related to local healthcare provision. According to a discussion held in a Health Overview Scrutiny Panel (HOSP) meeting, the stated aim of the STP was to save over £300m of public money a year by 2021, later revised to a total of £577m to be saved by 2021.

But three years on, neither Richard Samuel, Senior Responsible Officer for the Hampshire and Isle of Wight STP, nor any of his colleagues have produced any evidence that these planned savings have been or are in the process of being made. Secret meetings have taken place to brief officers and councillors on progress – or lack thereof – but no record of those meetings has been made public. S&C’s new Local Democracy Reporter, Jerry Brown, has been closely following developments.

In public meetings held by HOSP since 2016, the STP team were supposed to report against the planned savings which set out the following deliverables:

• Prevention at Scale: £10m per year 2021
• New Care Models £46m per year 2021
• Effective Patient Flow £15m per year 2021
• Solent Acute Alliance £165m per year 2021
• North & Mid Hampshire £41m per year 2021
• Mental Health Alliance £28m per year 2021
• Digital £10m per year 2021
• Estates £24m per year 2021
• New Commissioning Models £104m per year 2020

The progress of initiatives like STP that aim to achieve significant savings is normally measured at certain ‘milestones’ throughout the duration of their delivery. It is customary for there to be internal reporting to show how the plan is developing.

At the most recent HOSP meeting on 13th June 2019, captured on video (see below, and original link here), the STP team were asked to provide at least the internal reporting, as that would not entail any extra work on their behalf. They are yet to respond to this request. Some at the meeting wondered whether the team were taking the proceedings seriously when Mr Samuel arrived very late after all deputations had been read out and left very early to, he said, collect his children from school. Others present stated that they thought Mr Samuel’s attitude was disrespectful.

When asked to provide more detail on the plan, Mr Samuel referred to the briefings he had given to the panel in private session – none of which have been shared with the public or the press.

The STP team made it clear that they had not achieved what was in the plan, because the plan was predicated on receiving £90m in transformation funding and £192m in capital allocation from the NHS, neither or which were fully delivered. Again, no reporting has been made about this. But despite the lack of inward investment, the STP has claimed to have made over £190m a year in efficiency savings.

In the same HOSP meeting, Mr Samuel announced that the STP would be making sweeping changes to the nature of its projects, the personnel involved and its delivery objectives. But the STP was not prepared to update and republish its plan, Mr Samuel said. This means that the original 10 projects and the nominal savings attached to them remain visible in the public domain as if they are still extant and operational, even though they are not.

The Integrated Care System (ICS) expected to replace the STP is planned to deliver on its £300m a year savings. A new ICS plan will set out fresh objectives and there are fears that the £300m will be quietly forgotten about. HOSP has yet to account for the progress it made with the original plan it published, which is still the plan being nominally worked to.

In the HOSP meeting, the STP claimed but did not evidence efficiency savings (in other words, spending cuts) of over £190m a year. This needs to be examined in the context of current problems affecting NHS services in our region that are related to spending cuts:

• Our ability to discharge patients in a timely way is amongst the worst in the country

• We are the second worst in the country for delaying transfer of care

• We are the second worst performer in the country for enabling assessments outside of hospitals

• We are not improving significantly in any of these areas

The STP now promises to provide additional reporting at the detailed level – despite claiming previously that it has already done so – at the next HOSP meeting on 21st November 2019. The timing of this is notably close to when the original STP plan will be abandoned and the ICS emerges with new, fresh savings figures.

There is a public interest need for clear reporting on the last three years of the ‘big plan’ to fix the NHS in our region. But the few briefings that have taken place have been behind closed doors, beyond public scrutiny.

When asked why there are pre-meetings for scrutiny panels featuring STP staff that the public are unaware of, are not told about and whose content is never published, a spokesperson for HOSP said:

‘[This was an] Informal briefing session with representatives of a partner organisation. A briefing helps Members gain an understanding of issues that are of relevance to the Scrutiny Panel, before they are formally asked to consider a matter in a public meeting. It also allows those being asked to present to the Panel to gain an understanding as to what they are expected to address and explain at the public panel meeting.’

Public scrutiny meetings are supposed to be open to the public. It is inappropriate for the Scrutiny Panel to make decisions in advance about what will and will not be covered at the meeting. If there are to be briefing meetings, it is customary for the public to be notified about them. They should also be provided with a transcript of what has been discussed.

I have produced a simple reporting template in Excel that highlights the ten major projects and provides empty boxes for the STP to fill in the blanks, year by year. It would be helpful if they would comply with this request. They should also report on the effect of not receiving the ‘seed money’ needed for the transformation and outline the level of capital needed to support the changes. The impact of those failures to secure funding should be mapped out across the change programmes. This and much else about the STP ought to be made visible and accessible to the public who, after all, are footing the multi-million pound bill.

Mr Samuel and his STP colleagues have so far declined to comment on the issues raised in this article, despite being asked face to face, by email and by telephone.

Update 1st August 2019

The Hampshire & Isle of Wight Sustainability & Transformation Partnership contacted S&C for comment.

‘The financial information detailed in the 2016 plan was based on our assumptions that we would receive a ‘fair share’ of capital from NHS England. In fact, NHS England chose to distribute capital using a different approach and therefore quite soon after agreeing our plan, it was identified that some of our financial targets could not be met. I cannot find reference to the £300 million savings that you describe, however can confirm that, as a HIOW system, in 2017/18 we achieved £165 million savings and in 2018/19 £190 million.

‘The financial detail above, along with progress on the plan itself has been reported through the scrutiny committees/panels across Hampshire and the Isle of Wight and the Governing Body/Board meetings of our 21 statutory organisations at regular intervals over the last two years. All of these are public meetings and papers have been made available via the various organisational websites.

‘We, along with all other areas throughout England, have been mandated by NHS England to implement the commitments detailed in the Long Term Plan. Within these commitments is the expectation that STP footprints (for us Hampshire and Isle of Wight) will evolve into Integrated Care Systems in order to better meet the needs of their population. When the Plan was published we were pleased to note that many of the circa 500 commitments were in line with the work that we are already progressing across Hampshire and the Isle of Wight. Therefore our local response to the Long Term Plan will encompass many of the original deliverables, evolved to reflect more recent feedback from the population, the current situation with regards to workforce, finances and population need, along with the national mandate. We have been discussing our plans with a variety of stakeholders over recent months and will be discussing our response to the Long Term Plan formally at the November meeting of the Portsmouth HOSP.’

S&C has been unable to find any public reporting evidencing progress of the original STP plan, nor has an updated plan yet been published.


Read more:

S&C, 2016, NHS Plans for Portsmouth Set to Pass Without Consultation

S&C, 2017, NHS Plans: A Portsmouth Doctor Questions the Cuts

S&C, 2018, Patient Activation: Personalising Portsmouth’s Healthcare or Speeding Up Privatisation?

Image ‘The New National Health Service leaflet’ reproduced from a Wikimedia Commons file whose copyright has now expired.