Separating the noise of contract negotiations from the signal of STPs

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NHS leaders across England are working with local government leaders and other partners to prepare sustainability and transformation plans (STPs). A total of 44 areas of the country have been identified for planning purposes with populations ranging from 300,000 to 2.8 million.

STPs have the potential to be a real game-changer by shifting the focus from organisations to place-based systems of care in which decisions are taken collectively about the common pool of resources available.

I’ve been working in a number of these areas recently and have witnessed the work taking place to develop STPs for submission by the end of June. My impressions are that the concept of STPs has been widely welcomed, albeit with concerns about how some areas were defined and STP leaders identified. I have also heard concerns that local authorities were included in the STP process as an afterthought, and that the timetable for submitting plans precludes genuine community engagement.

Despite these concerns, there is widespread recognition that STPs could play an invaluable part in enabling organisations to collaborate with a view to tackling the growing pressures in health and care, and developing new care models for the future. Of course, the work to do so will not be complete by the end of June, but at a minimum the requirement to submit STPs is bringing leaders together around the same table. More positively, it is beginning to fill the gap in system leadership left when strategic health authorities were abolished.

Work on STPs is taking place in parallel with negotiations between commissioners and providers on contracts for 2016/17. These negotiations appear to be more difficult than usual, with few contracts yet signed and many issues still to be resolved around activity levels, funding and payment systems. I’ve also come across examples of providers being put under pressure to hold out for agreements that will address their performance challenges. Worryingly, this creates a real risk that conflicts over contracts will undermine efforts to collaborate on STPs.

Not for the first time, the fault lines between commissioners and providers have been exposed in an NHS that is struggling to deal with the competitive legacy of Andrew Lansley’s 2012 Act. All the more important, therefore, that national bodies are consistent in their commitment to STPs as the main hope for the NHS and its partners to overcome the unprecedented pressures they face. As well, the commitment of leaders of national bodies must be reflected in the actions of their staff at all levels if the noise around contract negotiations is not to drown out the signal around STPs.

If this is to happen, then the yawning chasm in planning at a national level should be filled by the development of a 45th STP, covering the whole of England and setting out how national bodies plan to sustain and transform care. Based on the NHS five year forward view, the national STP should spell out how organisational performance, particularly among providers in difficulty, will be tackled without derailing nascent efforts to collaborate and establish system leadership. A good start would be to require system-wide recovery plans in which organisations are held to account collectively, in place of organisational recovery plans.

None of this will be easy at a time of heightened anxiety in Whitehall about deteriorating NHS finances and declining performance. All the more reason, therefore, for the leaders of national bodies to present a united front to ministers and to offer a clear and coherent plan not only for 2016/17 but for the rest of this parliament. They also need to present a united front to the NHS if STPs really are to be a game-changer in the development of place-based systems of care and collaborative working. We are tracking progress on STPs in four areas and will be reporting the results later in the year.


Anita Randon

Strategy & transformation director,
Comment date
28 April 2016
Your leadership over the 'why' and 'how'' of integrated planning, & it's coherence & alignment is a welcome response to one of many voids in the current system.
I'm reminded of the 'earned autonomy' currency of a previous era & efforts to reduce the constraints on public service organisations to enable them to act with accountability to meet local need in the context of local conditions.
Challenging the design & application of a raft of constraints and rules within discrete systems as well as nationally, in the context of clear outcomes, is a path I'd value debate over.
Conversations I've recently been engaged in include creative ways & means to sustainably secure additional training /trained resource / workforce solutions outside nationally determined / funded limits & models; 'business' growth in parallel to cost efficient & effectiveness ... 'Right sizing' according to who & why (& the contentious issues the Kings Fund chooses to confront around future operating models & funding); & you've recently heard me challenge the dialogue around population health when the 'why' is tilted more towards monitoring, control & resource allocation (whose 'why').

Tom Lake

Comment date
03 May 2016
As Chris Ham says imposition of cost cutting and relocation are the opposite to the development of quality "from within" that is the only way to preserve the NHS short of massive extra funding. Unfortunately, jamming together the unnatural region of Western Berkshire, Buckinghamshire and Oxfordshire looks like a power grab by Oxford Hospitals in the emergency care reorganisation so that we have wrecked things from the start.

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