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.

Sustainability and transformation plans in the NHS - How are they being developed in practice? | by Hugh Alderwick, Phoebe Dunn, Helen McKenna, Nicola Walsh, Chris Ham

Print copy: £10 | Buy

No. of pages: 88

ISBN: 978 1 909029 69 9

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.

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#548587 Brian Hodge
Canada Water Campaign

Interested in provision of services in growing area

#548589 Will Austin
Town Clerk
Barnstaple Town Council

In Devon there is widespread concern about our the STP drafting process. The 'Success Regime' set up here has been very specific in referring to its limited work with the public as 'engagement', rather than consultation, and the published STP makes no reference to the outcome of the 'engagement'. The STP report itself is unbelievably vague for the amount of work that is supposed to have gone into it, and it studiously avoids making firm proposals. Instead it mainly recommends a series of further reviews, which leads to concerns that the process is just trying to hide the outcomes from public scrutiny.

In addition, a Freedom of Information request I submitted six weeks ago has received no reply despite two reminders! No wonder people consider that they're withholding information!

#548592 George Houston
IT Project Manager
Private Company

The Kings Fund is wrong. Any attempt to "gently" reform the NHS is certain to fall victim to populist politics and the very many people who have a vested interest in keeping things as they are.

What would work would be to start a new, lean and efficient NHS to work in parallel with the current one, and to steadily move resources from the old one to the new one.

#548601 Janice Clark
unpaid carer

Te STP footprint covers 4 Boroughs in 2 counties and 3 Unitary Authorities; and stretches from Farnham in the South to Windsor in the North. The only thing that is common to this not so local community is the Acute Hospital community of Frimley Park, Heatherside and Wexham Park! Its an absolute nonsense for this to be considered as a local community to people like me who are subject to this almighty muddle. My county is split between 3 STP regions - Top down or what! Absolutely no engagement with my community at all.

#548603 George Coxon
Various portfolio roles in H&SC

Let me start by repeating what I am saying often at the moment on various podiums, platforms, in meetings and in conversations. "No one likes a whinger"
So my position for what it's worth on STP evolution, construction and ambition feels that they are far too heavily health dominant. Don't get me wrong a budget close to 8x greater wil give the NHS a sizeable edge on meagre social care. But that perhaps is part of the issue here! I've read and re read the Devon STP and feel sad (read - frustrated / disappointed)) that social care again has only tokenistic mention and care homes not at all or perhaps I've missed the mention?
My history and to some extent present has been and is health. I have a clinical, managerial, commissioning past with lingering involvements in H&SC work. Care home owning, commissioning advisory work, mentoring, training, supervising, chairing events, presenting - I won't go on.... so my key point is about genuine collaboration, connectivity and a commitment to getting beyond the bulky reports of at best 'same old same old' - At worst an 'economic with the truth' deception to cut services. As said however no one likes a whinger so I'm saying. We are in it together, must unite against the common enemy - not acute secondary health funding dominance or an ageing population living longer with complex health care needs relying on elderly spouses or inadequate care packages if they are lucky but the inability for those with power and many of the rest of us to grasp the nettle and priorities health and care as the greatest issue of importance for now and the future

#548604 Don Illman
Co-Chair Surrey Mental Health Partnership Board
Mental Health Activist and Volunteer in Numerous MH roles

As Chair I have tried to hold a meeting with all parties involved in MH in the East of Surrey re the forming of the East Surrey CCG and All of Sussex in one STP33. We managed to get good representation from all MH and Social Care org's but failed to get the leaders of the STP33 and our East Surrey CCG, that's despite giving plenty of notice.
We have had one central MH Trust in Surrey since 2005 and the idea of having 3 STPs covering Surrey will just create Postcode lotteries. We are already seeing one STP going in an independent way relative to the other two Surrey STP's

#548718 Ilfryn Price
Professor of FM (semi retired)
Sheffield Hallam University

I have been researching with, and educating, Facilities / Estates managers in the NHS for more than 20 years. The messages presented in this study are distressingly familiar.

"A number of interviewees commented on the large proportion of their time that seemed to be spent responding to requests from national NHS bodies rather than focusing on the detail of developing their plans. STP areas were asked to complete and submit various draft plans and templates throughout the STP process. This consumed staff time and effort. As one leader said: ‘the risk is that you start to manage a process rather than develop a meaningful plan’. Another leader – echoing the comments of others from different footprints – thought that time and energy was being wasted ‘feeding the beast’:"

It is getting on for 25 years since the creation of trusts, and the supposed encouragement of local initiative yet the NHS has never escaped the top down hands on the detail.

"They simply felt the process had been poorly managed – or, as one leader said, ‘the right thing being done badly’."

Plus ca change.

"One interviewee described how there seemed to be two narratives about the STP process from national NHS bodies: the formal narrative set out in the planning guidance, focused on a wide range of services and priorities; and the informal ‘messages’ to local areas, focused on saving money and making changes to acute hospital services."

The perception I hear from middle managers is that the second narrative is more than simply informal

#548731 HannahB
Health professional

Perhaps, many are not happy with with their local plans due to the amount of wishful thinking in them based on unevidenced plans and further contracting of services at huge expense, creating services to undertake tasks that established services used to do at no extra cost, when they had looser remits. Perhaps people are unhappy that their STPs are full of unproven IT projects. Perhaps people are unhappy that the majority of involved have not even see the plans they are going to sign off.

#548754 F.Mary Cooke
Retired nurse
National Pensioners Convention

My concern is the use of lean thinking, you can recognise it in all of Cambridgeshire and Peterborough CCG STP The next big change will be Strategic Estates Partnerships with the 50%/50% partnership between Private and Public. We need to grasp the nettle now, rid ourselves of the market, the hundred and one groups, and directorships set up, the million £'s worth of courses to train senior management to train and be educated in the Toyota lean production and WASTAGE ! Put the funding actually into caring and integrate Health and Social Care and tax paid funding. Get back to what the NHS was renown for before Simon and his mate Jeremy and their 5 year thinking finish it off !!

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