Sustainability and transformation plans - governance arrangements

03 May 2017


Sustainability and Transformation Plans (STPs) were announced in the NHS planning guidance published in December 2015.

There are significant challenges facing the NHS, particularly for providers of healthcare, as organisations look to find more opportunities to reduce costs, whilst maintaining quality services. This means that the organisations need to look at ‘service transformation’ and much closer working together across health economies.

STPs provide an opportunity to drive system wide collaborative working. They provide a means of challenging local NHS leaders, clinicians, local government leaders and communities to look at the changes within the 'funding envelope' as Simon Stevens, the chief executive of NHS England, has commented. NHS organisations and local authorities across England have come together to develop ‘place based plans’ for the future of both health and social care services. The STPs are five year plans which cover geographical footprints and as a result an organisation can be in more than one STP footprint.

The challenge

STPs offer an opportunity to improve the health and social care services in England; they are not just a ‘plan’ but a different way of working; they are large and complex, with a number of stakeholders. However, this presents a challenge and this degree of change requires collective decision-making, across all partner organisations but does not change the statutory responsibilities of the individual organisations. So, how can they be governed and how can engagement be maintained to enable the delivery required to be deemed successful?

Organisations can also have a footprint in more than one STP, and each STP has different challenges; building trust and working relationships which may not have always worked well in the past will be an important factor in STPs. There are also the conflicting needs to deliver as an individual organisation, various internal reporting requirements and statutory duties to deliver.

Following the development of the STPs and their publication between October and December 2016, there has been an insight into what the governance arrangements may look like. This is, however, going to require time to change and leadership to develop to no longer secure an organisation’s individual future at the expense of the impact on others in the STP. The future is now to collaborate rather than compete.

Why are the governance arrangements important?

Governance is the established system whereby organisations are directed and controlled. This is led by the Board who set the strategic direction for the organisation, who then manage, monitor and report on organisational delivery.

Whilst this is often well-established and regularly reviewed in individual organisations, bringing together a number of organisations presents a new challenge of how the governance will work. Whilst views on the governance arrangements have started to emerge, the details of how these will be applied in practice, and how successful the arrangements will be, are yet to be seen.

Download the full report where we've identified the key questions for your Board to ensure that strong governance arrangements are set up from the outset.