Delivering sustainability and transformation plans: from ambitious proposals to credible plans

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This report examines the content of the 44 sustainability and transformation plans (STPs) that were submitted in October 2016. STPs are the main vehicle for transforming health and care services in England in line with the NHS five year forward view. The report discusses the main challenges that lie ahead in implementing STPs and realising the opportunities they identify.

Key findings

  • STPs offer the best hope for the NHS and its partners to sustain services and transform the delivery of health and care.
  • STPs are wide-reaching and propose changes in a number of areas – from prevention through to acute and specialised services.
  • A high priority for many STPs is to redesign services in the community to moderate demand for hospital care.
  • Proposals to reconfigure hospitals could improve quality but need to be closely scrutinised and considered on their merits.
  • Proposals to reduce capacity in hospitals will only be credible if there are robust plans to provide alternatives in the community.
  • Cuts in social care and public health and a lack of earmarked funds to support transformation will affect the ability of NHS organisations and their partners to implement STPs.

Policy implications

  • The proposals in STPs now need to be developed into credible plans, with clarity about the most important priorities in each footprint.
  • The NHS should engage meaningfully with staff, patients and the public, local authorities and the third sector in discussing the proposals.
  • The governance and leadership of STPs needs to be strengthened and more realistic timescales adopted for implementation, given the time it takes for innovations in care to become established and deliver results.
  • National bodies should work together to support the NHS and local authorities to implement the plans and send out consistent messages on what they now expect.
  • The government should reiterate its commitment to STPs and support their proposals where the case for change has been made. It should recognise the need for additional resources for the NHS and social care if the STPs are to deliver the proposed transformations in care.
  • Changes to the law are needed to amend aspects of the Health and Social Care Act 2012 that are not aligned with the Forward View, particularly in relation to market regulation.

Comments

michael foulkes

Position
consultant psychotherapist (retired),
Organisation
Sussex Defend the NHS
Comment date
21 February 2017
I am shocked by the partial position adopted by the King's Fund in relation to STPs, a government 'reform' that will prove to be the final nail in the coffin of the NHS. You are acting as nothing more than the mouthpiece for the government, a government that has made abundantly clear its visceral hatred of the welfare state. Shame on you

jo

Comment date
21 February 2017
Can we really cope with even fewer beds? Already we have less than almost any comparable country. I fear the narrative of cutting beds is fine so long as we have more /better community services will prove to be a false proposition in time

Sean Aspin

Position
Healthcare,
Organisation
Philips
Comment date
21 February 2017
The challenge is, doing nothing will not help the NHS reform enough to meet the needs of the future population. Throwing money at it (although admittedly we do need a little more!) will not solve the challenges of tomorrow - transformation is the key.

Una-Jane Winfield

Position
NHS campaigner,
Comment date
21 February 2017
From KeepOurNHSPublic press release today (https://keepournhspublic.com/news-events/press-release-stps-will-not-work-kings-fund/):

"The report does not point out that a growing number of local authorities are rejecting the STPs as impractical, including Conservative-held areas such as Oxford. There simply is no capacity to support people in the communities where the planned hospital closures are to take place. And there is a disturbing trend to make people travel further and further for essential services, as these are cut instead of receiving the further investment they desperately need."

John Toby

Comment date
23 February 2017
I do not find any evidence of a detailed critique of STPs’ proposals for the development of primary and community care nor any recognition of the need for such an analysis to precede proposals that make assumptions about the capacity, capability and desirability of reliance on these areas of healthcare. I speak as a general practitioner who is entirely supportive of the role of primary care (and general practice) but is looking for reassurance that policy, funding and commissioning will enable the delivery of care at an appropriate level outside hospitals but within institutions such as care and nursing homes as well as within the wider community. I recognise that part of the problem here lies in the artificial distinction between local and national responsibilities for funding primary and community care and I believe that this is an important issue for the Kings Fund to address

mike letton

Position
admin,
Organisation
aspen
Comment date
07 March 2017
Thanks for this comment, I look for such reasoned exposition, rather than the avalanche of shouty complaint

Karen Upton

Position
Clinical lead for children's services and anmed GP for safeguarding,
Organisation
Bexley CCG
Comment date
20 March 2017
A move to more community based services is welcome, but is only appropriate if there is sufficient funding. Also I am concerned that the plans are being made without taking into account fully the changes occuring in services. I think particularly about the move of public health to the remit of councils and away from health, which has lead to a large cut in funding. In various plans the role of health visitors and school nurses is required to be enhanced, while they have systematically been cut and also suffered the change to 0-19 public health nursing with large and varying changes from borough to borough in the role that they can take, so we get a requirement of provision, which relies on school nurses providing a service according to NHSEngland which will not be available potentially.

Sheeba Jobanputra

Position
Honorary consultant AMU,
Organisation
Good Hope Hospital
Comment date
30 March 2017
Has anyone looked at a working model for e.g.in Europe or elsewhere which might serve as a guide to all concerned to see what the end result would look like for the patients and providers

Adrian Hale

Position
Chairman,
Organisation
Trigeminal Neuralgia Association UK
Comment date
12 August 2017
The inadequate guidelines to enable the leaders of the 44 areas to produce cohesive STPs has resulted in a variety of opportunities and challenges which made it difficult to assess and implement an holistic approach to a new NHS. Whilst the NHS has committed itself to working closely with supporting organisations such as charities, there is little evidence that this has or will take place. Whilst collaborating with – but independent from – the NHS, health-related charities (such as ours for example) provide an essential support and sometimes a lifeline to sufferers. Many of us are unpaid volunteers who work tirelessly for those in need and, without us, the NHS would be in an even more parlous state. The NHS needs to recognise our place in STPs – but will it?

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