More detail on the process has been promised later this month, but the initial guidance gives NHS leaders plenty to think about in the meantime. After agreeing the right geography for their plan – their ‘transformation footprint’ – health service leaders are asked to develop five-year plans covering all areas of NHS-commissioned care in their area (including by working closely with colleagues in local government). These plans will then become the new assessment process for accessing NHS transformation funding, with the best plans set to receive funds soonest.
What should the plans include? Annex 1 of the guidance helpfully reminds local leaders just how many ‘national challenges’ there are to keep them awake at night, setting out more than 60 questions (counting those containing multiple questions separately) for the plans to respond to. These questions (very) broadly fit within three themes: improving health and wellbeing; improving quality and developing new models of care; and improving efficiency. The guidance also asks that sustainability and transformation plans describe how they will deliver the objectives in the NHS Mandate – so there’s a lot to cover.
Taking a place-based approach to planning and delivering health and social care services is the right thing to do. As Chris Ham and I argued in our recent report, Place-based systems of care: a way forward for the NHS in England, the challenges facing public services in England can only be met by collective action across local areas. Put simply, this means organisations working together – in partnership with patients and the public – to govern the common resources available for improving the health of the population they serve. We set out ten ‘design principles’ for this approach in our report.
But developing sustainability and transformation plans will not be simple. The first task facing local leaders is working out how to define the ‘place’ that their plan relates to. Is their local system defined by the boundaries of the clinical commissioning group, the local authority, NHS England’s local area team, the area covered by a major local provider, or in some other way? In some places, say, the Isle of Wight – the answer to this question will be pretty simple. But in others – say, London – it won’t be. The added challenge is that leaders have been asked to submit proposals for their ‘transformation footprint’ by the end of January. So the clock is already ticking.
A related task will be defining the relationships between neighbouring and overlapping ‘places’ in England. Take an organisation like the Royal Free London NHS Foundation Trust, whose footprint spans the London boroughs of Camden, Barnet and Enfield and extends into Hertfordshire. How many plans will the trust end up being involved in? And where will the lines between them be drawn? In cases like this where the boundaries between places are blurred, it is likely that different sustainability and transformation plans will need to be knitted together – or at least closely co-ordinated.
And all of these questions come before the real task of developing the content of the plans themselves, which need to be submitted by the end of June this year. While the guidance focuses mainly on NHS services, developing a credible plan will require the NHS to work closely with social care, public health and other local government services, as well as third sector organisations and members of the local community. It’s odd that the meat of the guidance doesn’t focus on these aspects of integration in more detail.
This is where the big problem lies – namely, that doing all of this properly within the timescales provided will be difficult even for those areas with a long history of working together. For others, simply developing the co-operative relationships needed between leaders more used to competing than collaborating will be a challenge in itself. Either way – and as the planning guidance itself hints – the right answer won’t be to outsource the problem to external consultants.
Instead, the requirement to write these plans should be used as an opportunity for local organisations to invest time in working together where this isn’t happening already. The task here isn’t simply to write a good enough plan to pass muster with NHS England and the other national bodies in the summer. Done well, the process of developing these plans could provide the right stimulus for long-term collaboration based around places and populations – things that really matter. If this doesn’t happen, the risk is that NHS organisations revert to an all-too-familiar ‘fortress mentality’, fighting for their own survival regardless of the impact on others. The ultimate losers in this scenario are NHS patients.
- Learn more about our event, Moving towards place-based systems of care