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Sustainability and transformation plans in the NHS

How are they being developed in practice?

Sustainability and transformation plans (STPs) have been developed by NHS and local government leaders in 44 parts of England. The plans offer a chance for health and social care leaders to work together to improve care and manage limited resources. But will they succeed where other initiatives have failed?

Despite the importance of STPs for the NHS and the public, little is known about the process of developing the plans and how the initiative has worked in practice. Based on a series of interviews with senior NHS and local government leaders which took place throughout 2016, this report looks at how STPs have been developed in four parts of the country.

Key findings

  • Local context and the history of collaboration within STP footprints have played a major role in determining the progress of the plans.

  • Despite the focus on local ownership, key elements of the process have been ‘top-down’.

  • National requirements and deadlines for the plans have changed over time, and guidance for STP leaders has sometimes been inconsistent and often arrived late.

  • The approaches of national NHS bodies and their regional teams have not always been aligned.

  • Tight deadlines have made it difficult to secure meaningful involvement in the plans from key stakeholders, including patients and the public, local authorities, clinicians and other frontline staff.

  • Organisations face fundamental policy barriers to working together on STPs; existing accountability arrangements focus on individual rather than collective performance.

Policy implications

Based on these findings, the report makes a number of recommendations for the future of the STP process. It argues that STPs offer the best hope to improve health and care services despite having been beset by problems so far, and calls for a need to:

  • secure the meaningful involvement of patients and the public in the plans, alongside clinicians, other frontline staff and local authorities

  • develop governance arrangements that allow organisations to make collective decisions and share accountability

  • improve national co-ordination and leadership of the STP process

  • ‘stress-test’ STPs to ensure that the assumptions underpinning them are credible and the changes they describe can be delivered

  • focus on the skills and resources needed to implement STPs, as well as the cultural aspects of making change happen.

Video presentation

Hugh Alderwick, Senior Policy Adviser to the CEO at The King's Fund, shares findings from our report on how sustainability and transformation plans have been developed in four parts of the country.

This presentation was filmed at our conference, Sustainability and transformation plans: from planning to implementation, on 17 November 2016.