King's Fund assesses STP progress and explores key themes from plans

policy digest

28 / 02 / 2017

Delivering Sustainability and Transformation plans: from ambitious proposals to credible plans
The King’s Fund, February 2017

This King’s Fund report looks at the progress made in developing sustainability and transformation plans (STPs), since their inception. It explores the main proposals in the plans submitted in October 2016 and identifies several key areas of change that are being considered. 

Key areas of change include: 

  • Changing the role of acute and community hospitals, which includes reducing hospital capacity, reconfiguring acute services and reviewing the provision of specialised services.
  • Redesigning primary care and community services, including strengthening prevention and early intervention, improving mental health services, improving productivity and tackling variations in care. 
  • Workforce, including ambitions to address recruitment and retention issues 
  • Developing enablers, with enablers identified including IT and electronic data records, with six digital roadmaps that cross STP boundaries and with proposals for more shared electronic data records. It also includes proposals for better use of estates, with some plans identifying opportunities for colocation of services with local authorities.
  • Organisational arrangements, this includes proposals for more collaborative commissioning, such as in Birmingham and Solihull STP, merging organisations and more integrated approaches to commissioning. There are also several new approaches being put forward to contracting and payment methods, such as embodies in the local care organisations being bought forward in Greater Manchester. 

Looking at the challenges and opportunities facing STPs, the Kings Fund surmises that “they are the best hope for the NHS and its partners to sustain and transform the delivery of health and care.” However, the report also recognises that the context in which they are emerging is “more challenging than when the Forward View was first published” in both a financial and operational sense. 

The report recognises that greater integration of health and care is a priority in all the STPs, building on the new models of care programme. However, the Kings Fund highlights the fact that whilst reconfiguring, integrating and moving services into the community are part of proposals, achieving financial balance is still seen by chairs and chief executives as the priority and it suggests that there is a risk that “sustainability will crowd out transformation”.

The report suggests that many STPs are clearer on what they want to achieve than they are on how the changes will be implemented. In response the report suggests:

  • STPs are encourage to produce credible and robust plans to provide alternatives in the community, before cutting bed numbers 
  • There is a call for more realistic timescales to be adopted for implementation. 
  • National bodies are encouraged to work together to support the NHS and local authorities to implement STPs. 

The Kings Fund also calls on STPs to address the question of whether it is possible to convince the public, local authorities and stakeholders to support STPs, given the controversy that has accompanied their development.

Overall it calls for the government to give clear commitment to STPs and suggests that they need to be strengthened further, including potential legislative changes, if they are to deliver what is expected of them. 

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