Mike Gill 07 November 2016

Are STPs achievable?

As I write this blog, another local authority has commented on it’s published Sustainability and Transformation Plan (STP). Hartlepool Council has apparently written to NHS England raising concerns about the lack of involvement from Health and Wellbeing Boards, echoing calls made by other local authorities last week.

So is there something going wrong with STPs and are they heading in the right direction? Leaving aside the obvious question of plans being ultimately achievable.

Let’s first remind ourselves what STPs have set out to achieve with a short step back in order to remember the aims of the STPs.

They set out to:

• Help ensure that health and care services are built around the needs of local population and to improve health and wellbeing;
• Deliver the Five Year Forward View vision of better health, patient care and improved NHS efficiency; and
• Show how local services will evolve and become sustainable over the next five years.

So STPs are the sharp end of the NHS Five Year Plan and will perform an extremely difficult task. Made particularly difficult in the current financial climate and with the pressures and challenges already facing our health and social care services.

Only last week, we have the Health Select Committee writing to the chancellor to say using the figures being used (by the government) gives the 'false impression that the NHS is awash with cash'.

Sarah Wollaston MP, Chair of the Health Select Committee, has published this letter to the Chancellor ahead of the Autumn statement. In the letter she does acknowledge that the STP process is producing some good early results, demonstrating more joined up planning. However, she also comments that: 'Financial constraints of the spending review settlement are forcing some local leaders into producing STPs which are unrealistic and zoomed to fail.'

It’s all sounding very familiar….

She concluded with three questions, the first being: 'Will the Government support the long-term sustainability of the NHS by making available the further capital resources required for the success of the Sustainability and Transformation Plan process?'

I would start by saying I agree wholeheartedly with many points of the overall vision and intent of STPs. Facilitating local government and NHS services to work in partnership, forward planning, and reviewing costs and making efficiencies and savings is what I believe in. And yes, I also believe in taking account of all factors including need and quality. The scale of change is huge clearly begging the question, is actual delivery of these plans possible? And in such a short timeframe? So far several areas have stated that they have submitted ‘draft plans’ which is a start, despite the rather later issuing of the detail monitoring plans. STPs involve complexities of often competing performance targets, outcomes and measure. So bringing the management of those different regimes together will not be easy.

However, there is a much louder noises than that starting to emanate from industry figures asking if STPs are ‘undeliverable’. Is that to be expected given such pain and such scale of change? Is there an organisation in Britain going through quite so much change (aside from that pesky Brexit thing of course!). And ahead of the Autumn statement, it is usual to witness commentators and pressure groups talking about areas that are facing a ‘funding black hole’.

Fundamental changes are needed

Unfortunately, I don’t think STPs are the sole answer, certainly not in isolation. I do think they will achieve some things, such as more collaborative working, reviewing of services and how we can deliver more for less - but not to the extent that is needed to reduce the largest ever deficit faced by the health service. However, I do believe that the draft plans submitted will highlight just how much more investment is needed. There are fundamental changes that need to take place and those changes need to be made at Government level.

With that Autumn Statement just weeks away Hammond has a lot of work to do and I hope that the Health Select Committee’s question is addressed.

Mike Gill is a partner at management consultancy Libre Advisory and author of the best-selling book, How to Survive Austerity.

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