Anne Rainsberry: Planning for 2016/17 and beyond - what are the opportunities for commissioners?

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Anne Rainsberry

Speaking at our breakfast event on 22 March 2016, Anne Rainsberry, Regional Director for London, NHS England, considers the opportunities and challenges for commissioners in light of the NHS shared planning guidance.

Transcript

So obviously 16/17 is very challenging planning round, it’s challenging on the commissioning side as well as the provider side and in an ideal world you would do the STP planning process and then 16/17 would nestle within that but we inevitably are needing to manage those two things concurrently and that's a complication. But in relation to the STP process, so in terms of what they are, as Bob says, they are plans which are about local determination to implement five year forward view talking about how in that place people will come together to close the health gap, the care gap and the efficiency gap.

And it’s important to say that they are what I would describe as umbrella plans so not everything is to be planned an STP footprint and certainly in London of the 44 we have five in London, there would be no prizes for people in the re-infer … I think you all could have said what number we would have come up with in London. But it’s important to sort of say what were the considerations across the country when STP footprint were being formed and, as Bob said, it was left to the local determination, but what sorts of things did you need to consider if what you were trying to do is to say success looks like clinical and financial sustainability in 2020/21.

So having a footprint that allows you to drive change, that allows you to think about how you have resilience in relation to implementing things like the urgent emergency care review, to be able to move back to play space, to commissioning not only primary care but also specialised services and to be able to develop a financial strategy and resilience to implement that vision, all important considerations in terms of where the footprints land. And they are just footprints because none of the plans will be an island on their own really because particularly for us in London if you look at our flows we have about two billion pounds worth of activity that comes into London, coming from populations that are outside of our STP planning footprint. So there's lots of things to think about in terms of the development of the STPs from a technical perspective.

But what I wanted to focus on today was really what was different about it because we’ve had, certainly in London, lots of strategic planning processes, the last one similar to this was CSPs, if any of you remember that, commissioning strategy plans, in London which, if I cast my mind back, was about 2010 when we were doing that. And what’s different about this is the emphasis on place. And I don’t think any of us should underestimate what that signal was in the planning guidance. And a very clear intention to move away from planning on a footprint of individual institutions and moving to a sense of place. And that is very welcome in a place where we’ve got huge challenges but also significant fragmentation of the system and for us in London we went from six PCT clusters and a health authority to 32 CCGs, 32 health and wellbeing boards, NHS England, ATE, NHSI, you can count it up.  Nobody is arguing, and I would not be arguing for any form of reorganisation, we’ve got much more to do than to argue for that.  But a greater alignment of those bodies around a sense of place to me feels like a really important thing for us to take forward.

And underpinning all of that then if we’re going to move to a sense of place there's also a theme in the planning guidance, but also the guidance that came out last week on STPs about encouraging the dialogue in those places to name what the issues are and to have those honest conversations. Now, I could trot around London, as some of you will know, I've been in London for quite a while, and so I could say what the wicked issues are in each of the places that have been discussed by individual parties behind closed doors. But what the STP process is saying, if you look at the guidance, is saying we actually need to have an honest conversation in that place about what are those issues and to understand collectively how we’re going to finally tackle those because they need to be tackled if we’re going to deliver what is promised for 2021.

And so I think there's something about what is the nature of that dialogue and the openness and honesty that will be needed by leadership and I’ll come back to leaders. For providers, clearly there are implications in terms of them starting to think through about different forms of collaboration across providers, I’m sure David will say more about that so I won't touch on that other than I can already see across London certainly in North West, South East, North Central, different types of dialogue happening with providers about forms of collaboration. So that is happening, it’s not something that is waiting to happen as part of the STP process already under way.

And for commissioners it would suggest a greater degree of joining up commissioners and that's something I think CCGs in London have embraced over the last two years and so there's quite a well articulated commissioning architecture now in terms of what do we do 32 times, what do we do in SPGs, strategic planning groups, which are groups of CCGs coming together and what do we do once and an expression of that is the Healthy London Partnership which CCGs have formed with the support of NHS England but also now increasingly with other parties like NHS Improvement, NHS England, PHE and importantly local government and the GLA.

And so that would need to develop as those conversations take forward but we’ve got a platform for greater collaboration on commissioning. The most significant thing, I think, to make STPs work is the style of leadership and how we move to a different tone of leadership compared to where we have been, what it really, really means to transcend institutional interests and to accede authority to other parties in order to get to a plan for a place. And one of my observations would be that when we have done really fantastic transformation in London those conditions have been met and when I say leadership I don’t only mean chief executives and chairs and their boards, I'm meaning clinicians in that space. So when we think about what were the conditions that led towards stroke, or trauma, or the fantastic work that UCLP lead on cardiac transformation in London that sense of place, that sense of transcending institutional interests, acceding authority etc.  They were all present to drive that forward so we know it works.

So, lastly, all of that means we need to redefine what success means and Bob touched on that. I think that's something we’re working through and I think there are important implications for all of the regulators in terms of how we move forward with the STP process, how we reinforce that sense of place and judge success in relation to what these plans deliver for the populations in that place as distinct from assessing purely on the success of the individual institution.

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