Rocky finances threaten West Yorkshire & Harrogate Sustainability & Transformation Plan

West Yorkshire & Harrogate Sustainability and Transformation Plan – which aims to cut nearly £1bn of NHS and social care services by 2020/21 compared to what the budget would be if services were to be provided at the current level –  includes  a bar chart showing the expected financial position in 2017/18,  if  2016/17 finances don’t screw up too badly.

Things aren’t looking too good on that front.

This chart (below) shows that the “template deficit” for 2017/18 (where is the template? nowhere to be seen in the published STP) is around £130m. I am assuming this is the level of underfunding if NHS and social care services were to be provided at the current level, without any of the measures in the STP being taken.

It also shows that the Actual position for 2017/18 is underfunding of around £70m. This assumes the whole area collectively meets both the anticipated and increased financial control total (ie the spending limit imposed by NHS England on all the hospital trusts, the ambulance trust and Clinical Commissioning Groups);  and that it gets all the planned Sustainability and Transformation Funding – although this depends on NHS organisations achieving targets set by NHS England and the hospitals regulator NHS Improvement.

And it depends on investment in the GP Forward View – proposed changes to primary and community care – and the Mental Health Forward View – proposed changes to mental health services.

screen-shot-2016-12-18-at-23-15-21

These STP finances are based on the assumption that in 2016/17 the NHS organisations in the area will  meet their “control totals”

The STP  says if that doesn’t happen, this will “bring significant risks in the outer years” ie towards 2020/21 – and that at the moment the NHS providers are £36m from break even.

This means they need £39m more to meet NHS Improvement’s control totals. They say they think they will be able to sort this through discussions with NHS Improvement and through receipt of transformation funding from the Sustainability and Transformation Fund.

Mid Yorks hospitals Trust to forfeit some Sustainability and Transformation Funding this year

But at its 3.11.16 Board meeting, Mid Yorks Trust predicted the loss of some of its planned £16.7m Sustainability and Transformation funding this year,  for failing to meet its access targets eg the 95% A&E target, and others.

The Mid Yorks Trust Sustainability and Transformation Fund offer for 2016/17 is £16.7m. With that the Trust is planned to make a £4.2m surplus

. Instead, the predicted loss of Sustainability and Transformation funding because of the Trust’s failure to meet Access Targets means the forecast surplus is £606K.

The paper presented to the Mid Yorks Trust 3.11.16 Board meeting said that at month 6 (September) most Divisions are struggled to identify and deliver the required Cost Improvement Plan targets (ie spending cuts).  £2.434m “savings” have been made compared to a target of £7.536m.

Calderdale Clinical Commissioning Group will be in financial turnaround soon

Calderdale Clinical Commissioning Group (CCG) Governing Body heard at its meeting on 8.12.16 that the CCG will be in turnaround soon. The Chief Officer Matt Walsh said,

“NHS England will have conversations about this.”

This probably means NHS England will take control and probably parachute in KPMG or another consultancy/accountancy company to tell them what to cut.

The risk that the CCG fails to deliver the 2016/17 planned financial surplus has gone up to 20, critical.

The CCG has developed a recovery plan to try and deal with the problems that have derailed the 2016/17 financial plan. It  forecast a £4.6m surplus but the CCG is facing “cost pressures” of £11m; the recovery plan can reduce  some of that, but the CCG is reporting to NHSE a reduced surplus of £3.7m.

Matt Walsh, Calderdale CCG’s Chief Officer, told the meeting:

“We need to bring the recovery plan into the public forum and talk about how we make challenging decisions about how to use resources.”

He added,

“Resistance and suspicion of the STPs nationally is based on fairly solid ground. There needs to be a conversation about working within resources allocated by Parliament. It’s not happening at the West Yorkshire level but we have tried in Calderdale.”

His concern is: how will all this be stitched together nationally when the answer comes back [from NHS England] – eg about capital ask?   West Yorkshire and & Harrogate STP’s capital requirement is £1bn – multiply that by 44 (the number of STPs in England.  He added,

“The  country hasn’t got the money the STP is driving us to need.”

He said there is a need for a  better conversation with West Yorkshire – presumably he means the West Yorkshire & Harrogate STP joint committee which is being set up? –  and a need “to move at pace” on primary and community services.

The knock on effect is a  reduced surplus next year, when there is a huge increase in effiency cuts to £6.4m 2017/18 – up from £2.5m+ so far this year.  

The CCG officers reported that this  has brought “challenge” into the 2017-19 STP contracting round that is due to be signed 23.12. If can’t they achieve efficiencies,  the finances deteriorate fast.

Calderdale CCG’s biggest risk is the acute contract with Calsderdale and Huddersfield hospitals Trust  (CHFT), where there is an overspend of around £8m. Other hospitals have increased too, but not at same rate as CHFT.

In West Yorkshire at least 3-4 other Clinical Commissioning Groups are in a similar position. That means most of the area’s CCGs. Calderdale CCG is planning for breakeven if not deficit next year & overspend in the acute hospital.

There is more info about the West Yorkshire and Harrogate Sustainability & Transformation Plan finances – and its missing financial information-  here.

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