A leaked document has indicated that a major transformation plan in the north west is significantly underfunded.
Over £750 million of investment is required to drive a sustainability and transformation plan for Cheshire and Mersey.
This is revealed by the STP submission for the region, led by Louise Shepherd, chief executive of Alder Hey Children’s Foundation Trust.
The document which is to be submitted to NHS England outlined the extent of understanding in the region.
“We recognise that these plans are heavily dependent upon capital – up to £755m additional funding requirement in current plans. However, we recognise there is still significant work to do before these high level requirements are turned into robust business case ready solutions. In particular to fully articulate the cost/benefits associated with the proposed investment. We also understand that capital funding is extremely limited and that we will need to focus investment in those schemes that provide the most beneficial impact on our STP plans.”
NHS England has requested for leaders of trusts to refrain from publishing STPs at this juncture.
The Cheshire and Mersey document also suggests that there is a fundamental lack of contingency funding.
“The size of the current gap is an estimate and more work to agree the future assurance framework is yet to be completed. However, two dimensions can be described in that: firstly, the current level of planning has no level of contingency (indicatively 25-50 per cent) that would normally be associated with programmes of this size and complexity. Secondly, the robustness of the ‘plans’ and associated risks regarding measurability, capability and deliverability all serve to make us discount the current value of the whole by a figure of 30 per cent equating to some £300m.”
And there are clearly issues related to capacity and capability, with the document indicating that questions raised by the organisation have yet to be satisfactorily resolved.
Staffing problems are particularly rife, with the authors of the document noting that delivering a change program of this magnitude without freeing up key members of staff from other departments is simply impossible.
“The lack of transformation capacity and expertise released from within the system will result in momentum being lost. We are at a watershed moment and the membership group has recently agreed to consider all requests for capacity and skills in the light of insufficient progress being made to exploit the goodwill and discretionary efforts of all those contributing to this plan to date,” the document asserts.
The government body Monitor has announced that is it to undertake an investigation into the financial conduct of Mid Cheshire Hospitals NHS Foundation Trust.
Finances at the trust have deteriorated significantly, and the regulator will examine the reasons for this, and also attempt to establish an approach that will lead to an improvement.
Monitor intervened after it became evident that the trust was experiencing financial difficulty.
The Mid Cheshire Hospitals NHS Foundation Trust had, in fact, reported a surplus during last year’s accounting period, but its financial position has since declined significantly. Reports suggest that the trust will accrue a £5.4 million deficit for the 2015/16 financial year.
The trust is responsible for Leighton Hospital and the Victoria Infirmary, and plays a major role in one of England’s largest and most prosperous counties.
Speaking on the issue, Paul Chandler, Regional Director at Monitor, stated that the government body is concerned about the financial health of the Mid Cheshire Hospitals NHS Foundation Trust.
“The trust’s finances have deteriorated and the most recent projections show that things could get worse over the coming year,” Chandler warned.
“Patients in and around Crewe, Northwich and Winsford rely on the services this trust provides, so we’re investigating to find out more about the problem and what can be done to improve the situation,” Chandler continued.
Chandler emphasised that no decision has yet been made on whether regulatory action would be necessary, but he did indicate that such a decision could be expected imminently.
Independent NHS trust are intended to provide care on a sustainable basis, and it is a major part of Monitor’s duties to ensure that this remit is being met adequately.
In the case of the Cheshire trust, the degrading financial position of the trust has been a massive red flag to the government body that further investigation is vital.