Controversial Plans Right Way Forward For The NHS

Sustainability and Transformation Plans (STPs) offer the best hope to improve health and care services despite having been beset by problems so far, according to a new report from The King’s Fund.

STPs – plans for the future of health and care services being developed in 44 areas of England – have been strongly criticised by politicians, local authority leaders and patient groups. The new report, based on interviews with senior leaders in four STP areas, supports many of the criticisms. Its findings include:

Involvement of local government has been patchy.

There has not been enough time to adequately involve clinicians and frontline staff.

Patients and the public have been ‘largely absent’ from the process.

STP leads are struggling with a confused process, with unclear or changing deadlines and instructions from national NHS bodies.

There is a lack of governance structure or formal authority for STP leaders that has led one STP lead to describe their role as being like ‘operating in a sea of fog’.

The report also finds they have been introduced against a difficult backdrop, as the Health and Social Care Act 2012 has created a complex system and its focus on competition makes it more difficult for organisations to work collaboratively. It is also a time of huge pressure on NHS finances, which has led to some plans being based on assumptions and projections that local leaders lack confidence in.

Despite these problems, the report urges the government and the NHS to continue to back STPs as the best hope for delivering long term improvement in health and social care.

At the same time as supporting the idea behind STPs, the report makes recommendations for making them work better. These include the need for:

all parts of the health and care system, as well as the public, to be involved in the plans;

improved governance, with the role of STP leaders strengthened and clarified, and NHS regulation changed to make it easier for organisations to work collaboratively;

national bodies in the NHS to ‘stress test’ STPs to ensure the assumptions behind them are credible and the proposed changes realistic.

Chris Ham, Chief Executive of The King’s Fund, said: ‘The introduction of STPs has been beset by problems and has been frustrating for many of those involved, but it is vital that we stick with them.

‘For all the difficulties over the last few months, their focus on organisations in each area working together is the right approach for improving care and meeting the needs of an ageing population. It is also clear that our health and care system is under unprecedented pressure, and if STPs do not work then there is no plan B.

‘The progress made so far has only happened because of the hard work of local leaders who have been prepared to work around the difficulties. It is vital that NHS national bodies learn the lessons so far, so that we can see STPs fulfil their potential.’