The NHS shared planning guidance 16/17–20/21 set out a new approach to ensure that health and care services are built around the needs of the local populations. 44 geographical footprints were identified across the country with each footprint tasked with producing a Sustainability and Transformation Plan (STP) with a view to enabling more rounded and effective models of care. Leaders were named in each of the 44 footprints and in each instance they were charged with bringing together leaders from across the health and care spectrum to develop their Sustainability and Transformation Plan.
The intentions behind these STPs are clearly good. They aim to get providers and commissioners together to review problems, put the patient at the centre and design the most efficient and effective services to meet the local population’s needs. The plans are also supported by a number of powerful partners including national health and care bodies such as NHS England, NHS Improvement, the CQC and Public Health England. What the STPs importantly though will not do is take away any of the accountability or responsibility from any individual NHS bodies such as a CCG or provider Trust, from delivering their objectives and statutory duties on behalf of their populations and Governors etc.
Herein lies potentially a large obstacle to the achievement of dynamic and transformational change. Plans will need to be drawn up, research conducted, time committed and meetings held. Who is going to pay for this? Is it fair that a CCG and Trust pays the same and how are the individual bodies going to be able to hold anyone spending this money to account for the outcomes?
As the STP footprint is not in itself a statutory body it does not have a control total and therefore accountability. In the past where CCGs have been required to fund something specifically, there has been the opportunity to top-slice CCG monies and allow a central fund to be created. However, in this instance if this is to be a true provider / commissioner partnership then it will not work unless all parties (and increasingly this will need to include the local authorities) are investing similar amounts of money and facing similar risks. It would seem that to achieve this there will need to be some central regulation and potentially a change in the law.
Stalwarts of the NHS have been known to comment that if you stay working in the NHS long enough the systems will revert to those that were in place when you started. Whilst recognising the flippancy of such statements, the move towards STPs brings to mind the Regional Health Authorities and Direct Managed Units of the 1990s. Taking a system wide approach is to be applauded and is to our mind the best way to break down some of the artificial barriers between commissioners and providers, which can at times forget that the NHS is there for its patients. However, to be truly successful it may need some central drive and imposed changes to structure and accountability which are not yet in place.
For more information, please get in touch with Nick Atkinson.