DD2211 The King’s Fund analysis of the NHS’s Sustainability

Type of decision: 
Director's decision
Date signed: 
16 February 2018
Decision by: 
Jeff Jacobs, Head of Paid Service

Executive summary

This decision form seeks approval to commission The King’s Fund to provide the Mayor with further analysis and advice on the NHS’s London Sustainability and Transformation Plans (‘STPs’).  It also requests a related single source exemption from the GLA’s Contracts and Funding Code.
This work follows on from the report on the NHS’s STPs commissioned by the GLA (approved under cover of ADD2067) in late 2016 and which was published in September 2017. It will look at how each STP has developed since that last report, and in particular The King’s Fund will be asked to assess the STPs against the six assurances the Mayor, when the original report was published, said he needed to be met before he could offer his support to them. 


That the Executive Director of Communities and Intelligence approves:

1.    expenditure of £50,000 on research and analysis services provided by The King’s Fund in respect of the NHS’s London Sustainability and Transformation Plans (noting this work follows on from earlier analysis work at a cost to the GLA of £45,000); and 

2.    a related single source exemption from the GLA’s Contracts and Funding Code to commission the above services from The King’s Fund without procuring competitively. 

Part 1: Non-confidential facts and advice

Introduction and background

1.1    The NHS developed Sustainability and Transformation Plans (‘STPs’) aimed at securing a sustainable health service in the longer term. 

1.2    The STPs attracted considerable debate throughout the latter part of 2016 and 2017 and in the light of this the Mayor, in November 2016, commissioned The King’s Fund and Nuffield Trust (two leading independent experts on these matters) to advise him on:

a)    What the plans say and mean – including an assessment of out of hospital changes and beds
b)    The credibility of the assumptions made in each STP
c)    Impact on social care
d)    Impact on health inequality
e)    How the plans can be improved
f)    How this should be implemented 

1.3    Their joint report was published on 12 September 2017.  Please see Appendix A.

1.4    The commission of further analysis is aimed at assessing the progress each STP has made against the six assurances the Mayor, when the original report was published, said he needed to be met before he could offer his support to them. 

1.5    For reference, those six assurances are: 

•    Health inequalities and prevention of ill health 
The impact of any proposed changes to health services in London must not widen health 
inequalities. Plans must set out how they will narrow the gap in health equality across the capital.
•    Hospital beds   
Given that the need for hospital beds is forecast to increase due to population growth and an ageing population, any proposals to reduce the number of hospital beds will need to be independently reviewed to ensure all factors have been taken into account. Any plans to close beds must be an absolute last resort, and must meet at least one of the NHS’ ‘common sense’ conditions.

•    Financial investment and savings
    Sufficient funding is identified (both capital and revenue) and available to deliver all aspects of plans including moving resources from hospital to primary and community care and investing in prevention work.  Proposals to close the projected funding gap, including planned efficiency savings, are credible.

•    Social care impact
Proposals must take into account the full financial impact any new models of healthcare, including social care, would have on local authority services, particularly in the broader context of the funding challenges councils are already facing.

•    Clinical support 
    Proposals demonstrate widespread clinical engagement and support, including from frontline staff. 

•    Patient and public engagement
    Proposals demonstrate credible, widespread, ongoing, iterative patient and public engagement including with marginalised groups, in line with Healthwatch recommendations.

1.6    The GLA is seeking a single source exemption from the GLA’s Contracts and Funding Code to commission The King’s Fund without procuring competitively and a single source justification (SSJ) form is attached with this report at Appendix B. The original report was granted a single source exemption (Appendix C) to appoint The King’s Fund. The GLA is seeking a further exemption to ensure that the Mayor has the best advice while ensuring continuity of approach and delivery. The King’s Fund is also the market leader in this area and enjoy considerable credibility among health sector leaders. 

1.7    ADD2067 (Appendix D) approved original expenditure of £45,000 to commission the joint analysis of the STPs as noted above. This decision seeks approval of a further £50,000 to assess the progress each STP has made.

Objectives and expected outcomes

2.1    The objective of the work is to follow up on the previous report that was undertaken with The King’s Fund & the Nuffield Trust and to assess progress the STPs have made against what they set out to do. There have been developments in national policy with the introduction of the accountable care plans and London Health Care Devolution.  

2.2    The King’s Fund’s report will include: 

•    An update on the national policy context to outline how the thinking of NHS England and NHS Improvement about STPs has moved on and an update on the work of the eight accountable care systems in England, which are the most advanced form of STPs. The King’s Fund would also outline developments in the government’s policy on devolution as relevant to this work in Greater Manchester, Surrey Heartlands and London.

•    An update of progress in all five London STPs through interviews with leaders in all areas as well as key contributors from London as a whole.  The objective of this aspect will be to assess the progress made in each area against the Mayor’s six assurances as well as highlight the challenges that have occurred with examples of work done to address those.  

Equality comments

3.1    The officers have given due regard to their duty in respect of section 149 of the Equality Act 2010. 

3.2    All the work of the GLA Health Team is predicated around the need to address health inequalities, including leading the implementation of the Mayor’s Health Inequalities Strategy. Health inequalities are experienced by Londoners with the protected characteristics of the Equalities Act and between other groups of Londoners.

3.3    The Health Team actively considers the impact of its work on health inequalities (including the protected characteristics) and works with a range of other teams within the GLA to help them do the same.

3.4    This work will enable the Mayor and GLA to better understand the impacts government policy in respect of the NHS has on those groups with protected characteristics, and so that the Mayor can “Champion and Challenge” the NHS (the Mayor’s manifesto commitment). 

Financial comments

The cost of £50,000 for this proposal will be contained within the Health Programme budget for 2017-18.


Planned delivery approach and next steps




Execution of contract

February 2018

Delivery Start Date

15 February 2018

Interim findings review

March 2018

Delivery End Date

Receive final output (in form of a report) in July 2018

Project Closure

Publication in September 2018. Project closure thereafter


Appendices and supporting papers

a)    Sustainability and Transformation Plans in London: An Independent Analysis of the October 2016 STPs
b)    Single Source Justification Form (Proposed)
c)    GLA80939 Single Source Justification (signed)
d)    ADD2067 (signed) https://www.london.gov.uk/decisions/add2067-health-team-programme-budget...