Stephen Dorrell, Chair of NHS Confederation and Independent Chair of Birmingham and Solihull STP board, reflects on the progress of the Birmingham and Solihull Sustainability and Transformation Plan so far.
This presentation was filmed at our conference, Sustainability and transformation plans: from planning to implementation, on 17 November 2016.
The first point I want to make is that although I was asked to fulfil the role of the independent chair of the Birmingham and Solihull STP I regarded it as an important objective to render myself redundant because if STPs are to work then that can’t be through a process that is ultimately attemptable through an independent outsider. That doesn’t seem to me to be a model for effective engaged governance. I am pleased to say I am no longer the chair of the Birmingham and Solihull STP and the chair of the governance structure around the Birmingham and Solihull STP is the political leader of one of the two constituent local authorities in the form of Bob Sleigh who is the leader of the Solihull Borough Council.
So we set up a structure that where there is local engagement, local ownership to carry the STP process forward. And that brings to a second point of difference in Birmingham Solihull compared with the majority of other STPs which is that the system lead appointed by NHS England was not an NHS leader but was the Chief Executive of the Birmingham City Council and they’re saying it applies everywhere and local circumstances are different but a substantial number of the STP meetings take place in the Council house in Birmingham.
By locating it in local government in that way and developing a view across the range of public services, we are in the very early stages I certainly don’t want to over sell this, but we are in the very early stages of developing a different view of how, not just the different elements of the National Health Service need to work together, but the different elements of public service seen more generally need to work together.
What we have started to develop is the sense that there is a shared agenda, and STPs are meeting, that is all it is, it’s a group of stakeholders coming together to develop within their own existing governance structures, plans for their organisations which make more sense by working collaboratively than they do by working separately. But it isn’t a new authority structure. It may need to turn into that but that is not where we are.
So to the people who ask “who is accountable, where is the governance, how do we deal with system control titles” and so forth, the answer is none of that has changed. What’s changed is that by creating a meeting place potentially developing it into a melting pot, you have a different view at statutory regulated agencies about how to deliver the outcomes for which you are responsible including the financial outcomes.
We know that it has been a process that’s been done at breakneck speed, we know that it’s a process where what we’re really about is culture change and we know we can’t do that on a spreadsheet and we know we can’t do it on a monthly cycle, it’s an investment in a changed set of behaviours and it will take longer, but it is I think, exactly the right direction of travel. The challenge therefore is how to take the kernel of the idea and to understand what the shortcomings are but to focus on how that process is moved forward and that means engagements with all the stakeholders in the broad sense of public services.
We all know that if we hear a plan first and our instinctive reaction is “what are they doing to me”, we’re lost. So engaging in a process where there’s a joint ownership of the objectives and a conclusion therefore about how those objectives are better delivered, that is the culture change into which, the territory into which the successful STP should be aiming to lead.
Final thought, and that is that one of the big dangers that we think this is the new process, a new culture, looking across all the statutory agencies, rethinking public services and therefore every element of public services that’s on the agenda. Well that’s an impossible agenda. Identify the priorities and focus on them. But for goodness sake, don’t try and do everything because if you try and do everything you’ll end up doing nothing.