Sustainability and transformation plans for the NHS in England: what do they say and what happens next?

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Planning guidance produced by national NHS bodies in December 2015 asked NHS organisations to work together to make plans for the future of health and care services in their area.

The plans – called sustainability and transformation plans (STPs) – needed to cover all areas of NHS spending up to 2021 as well as how NHS services work with social care and other local authority services. NHS organisations were asked to describe how improvements would be made in three areas: population health and wellbeing; quality of services; and healthcare efficiency.

The plans are based on 44 areas of the country, with an average population of 1.2 million (range: 300,000 to 2.8 million). STPs are the local plans for delivering the NHS Five Year Forward View, which is the strategy for transforming NHS services closely associated with Simon Stevens, the chief executive of NHS England.

STPs are based on the idea that collective action is needed to improve care and manage resources. This represents a major shift in the approach taken to NHS reform in England, embracing collaboration rather than competition as a means for driving health service improvement. This shift is taking place without changes to legislation, causing a tension between the statutory framework for the NHS, created by the Health and Social Care Act 2012, and the direction being set by STPs.

The process of developing the plans has not been simple and was criticised by some council leaders for taking place behind closed doors and not involving relevant stakeholders, such as patients and the public, NHS staff, and local authorities. Despite these difficulties, all 44 STPs have now been published, and work has begun on implementing their proposals. Here we describe their content and the challenges they present.