Round two for STP plans: a fresh start or a dangerous distraction?

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In a recent letter to Trust chief executives and clinical commissioning group (CCG) accountable officers, NHS England and NHS Improvement confirmed that they ‘expect all sustainability and transformation partnerships (STPs) and integrated care systems (ICSs) to develop and agree new strategic plans for improving quality, achieving sustainable [financial] balance and delivering the long-term plan’. These will be developed during the first half of 2019 and submitted for sign-off in the summer. Meanwhile, one-year organisational plans will be submitted for 2019/20.

If ICSs and STPs are to succeed, national leaders must ensure local systems have the time, resources and flexibility they need to develop credible plans. It is also essential that the process proceeds in a spirit of genuine partnership and that local authorities are fully involved from the outset. Done badly, the planning process could be a significant distraction, or worse, could destabilise relationships and undermine progress. Done well, it could strengthen local partnerships and enhance their efforts to improve population health and wellbeing.

There is a good case to be made for creating new system-wide plans. NHS planning needs to be based on a realistic assessment of the resources available, and it is logical to do this at the level of local systems rather than individual organisations to align priorities and spending decisions. From a transparency and accountability perspective, it is far from ideal that many STPs have moved away from their previous plans without a clear public narrative about how their agendas have moved on. Updated plans could help to address this.

But the announcement has received a mixed reaction. There is understandable cynicism about new five-year plans being developed just over two years since the last set of five-year plans. Concerns have also been expressed that their development will repeat the mistakes of the previous STP planning process, which was widely criticised for failing to engage key partners and proposing unrealistic financial savings.

Our work with local systems has highlighted the value of local authority involvement and leadership, including a stronger connection with local communities, closer working across health and social care, and opportunities to act on the wider determinants of health. ICSs and STPs will only be able to realise the ambition of integrating care and improving population health if their primary focus is outwards towards local partners and residents, rather than upwards towards the asks of national NHS bodies. While the letter communicating the plans highlights the importance of developing plans with ‘the proper engagement of all parts of local systems’, its origin and tone are firmly NHS-focused. Let’s hope this is not a sign of things to come.

Since STPs submitted their initial plans in 2016, their focus has shifted away from the production of nationally mandated plans, towards building partnerships between NHS organisations, local authorities and wider partners. Progress varies widely across the country, but those that are furthest ahead have developed new ways of collaborative working and have begun to put in place new service models to strengthen and integrate primary and community services.

Local systems have achieved this by giving priority to strengthening relationships and trust between partner organisations and their leaders, and the leadership of local authorities has often been key. Areas leading the development of ICSs have benefited from an unusually permissive approach from national policy-makers, giving them significant latitude to shape their systems and priorities locally.

The risk in developing new plans is that these become a ‘tick box’ exercise focused on meeting the requirements set out by national bodies, rather than a meaningful exercise in identifying and agreeing local priorities. To avoid this, local leaders need to be given flexibility to develop the plans their local populations need. Our work with ICSs underlines the value of local leaders undertaking focused work to agree key issues and priorities in order to establish common cause among partners organisations and a shared commitment to change.

This will require national bodies to continue with the permissive approach that ICSs have benefited from, and to adopt a more realistic timescale and financial envelope than the last round of STP planning allowed for. It will also require much greater engagement of key stakeholders, including involving people and communities to design services that meet their needs and reflect their priorities. While it is primarily in the hands of local leaders to get this right, the national process is important in setting the right expectations.

With the NHS long-term plan and national planning guidance fast approaching, the direction of travel for local systems of care is likely to become clearer. The key question to be resolved is how STPs and ICSs can balance their role as NHS planning structures responsible for manging money and performance, with their wider role as partnerships that reach beyond the NHS to bring about improvements in population health.


Richard Spicer

NHS retired but interested,
Comment date
18 November 2018

Let's hope this time there is proper consultation with the right people in the front line and it is not viewed as largely another opportunity for 'efficiency savings'

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