The 'Next Steps for the Five Year Forward View', published at the end of March 2017, has made it absolutely clear that Sustainability & Transformation Plans (STPs) are now the only game in town for tackling the quality and efficiency challenges faced by the NHS.
Better A&E performance, reduced delayed transfers of care and meeting control totals are now in the mix as much as improvements in prevention, mental health support and older people’s care. Early concerns about timelines and process have largely faded. Criticisms around secrecy and lack of engagement are being addressed as local systems gain confidence in working together and find their public voice. Whilst many footprints may drop the formal STP ‘brand’ in order to demonstrate more local ownership (a position palatable to an increasingly pragmatic NHS England) the underpinning strategy and expectations will remain the same.
What is the true role of STPs?
Some experienced NHS-watchers, seeing the growth in STP responsibilities, have commented that the plans are a way of re-creating mini-SHAs, filling the system leadership gap left by their abolition in 2013 under the Health & Social Care Act.
Whilst understandable, this is not strictly accurate, as STPs vary greatly in form and geography - and many are led by local authorities. There is also the endpoint for STPs which are - as well as closing the care, quality and efficiency gaps - expected to evolve from transitional collaborations into accountable care systems, dissolving many of the NHS and council-led care barriers in the process.
The real issue is not what STPs were designed for, or may become, but how rapidly and effectively they can move from vision into implementation and into tangible results on the ground. Ambition needs to be firmly sense-checked against the achievable. Tough decisions on prioritisation need to be taken. Systems need to be clear on what they can do by pooling limited local resources; and when compelling cases for national support will be required.
Will STPs survive post General Election?
Ahead of the General Election on 8 June, political parties are taking distinct standpoints on the future of STPs. Party manifestos have not been published at the time of writing, however it is assumed that the Conservative Party would continue to support their implementation, whilst the Labour Party has committed to scrapping STPs. This raises the question: ‘if not STPs, then what?’. Indeed, Simon Stevens has stated: “there is no version of reality where we don’t need stronger primary care; no version of reality where we don’t need more expansive and resilient mental health services; no version of reality where we don’t need better health and social care integration – to name just three.”
From our work with STPs we know that there is wide variation in maturity, with some clear on the answers and some still honing the questions. What is also clear is that wherever they are on this spectrum, all footprints face similar challenges around form, governance, leadership and engagement; and indeed planning. Moorhouse has been supporting STP clients to move forward confidently with the right practical steps, rather than spending more time redefining issues and challenges. These steps have included investing in organisational development to put workable structures in place, bringing together different working cultures (NHS and local government) and supporting leadership and staff engagement. With more mature systems, the establishment of clear delivery plans is now essential to support maximum and rapid traction for the priority workstreams. It is this focus on structure, tactics and implementation which will drive delivery, and ultimately the quality and efficiency improvements that patients and the health and care system need.
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