Sustainability and transformation plans (STPs)

Sustainability and transformation plans (STPs) are five year plans detailing how local areas will work together to implement the ‘Five Year Forward View’ and achieve financial balance by 2020. STPs will be the main gateway to funding from 2017/18.

For these plans to be developed, England has been divided into 44 STP geographic ‘footprints’ made up of NHS providers, CCGs, local authorities and other health and care services. These organisations will work together to create a plan based on local health needs.

The average population size for a STP is 1.2 million people (the smallest area covers a population size of 300,000 and the largest 2.8 million). A named individual has been chosen to lead the development of each STP.

The proposed scope of STPs is broad, however, there are three headline areas: improving quality and developing new models of care; improving health and wellbeing; and improving efficiency of services. The timelines for developing STPs and the process for approving them have been somewhat fluid.  The plans are likely to be assessed and approved in phases, depending on their quality. From April 2017, STPs will become the single application and approval process for accessing NHS transformation funding, with the best plans set to receive funds more quickly.

What do the STP mean for NHS?

STPs represent a shift in the way that the NHS in England plans its services. While the Health and Social Care Act 2012 sought to strengthen the role of competition within the health system, NHS organisations are now being told to collaborate rather than compete to respond to the challenges facing their local services. This new approach is being referred to as place-based planning.

This shift reflects a growing consensus within the NHS that more integrated models of care are required to meet the changing needs of the population. In practice, this means different parts of the NHS and social care system working together to provide more co-ordinated services to patients – for example, by GPs working more closely with hospital specialists, district nurses and social workers to improve care for people with long-term conditions.

It also recognises that the growing financial problems in different parts of the NHS can’t be addressed in isolation. Instead, providers and commissioners are being asked to come together to manage the collective resources available for NHS services for their local population

But developing STPs is not a simple task. STP footprints are often large and involve many different organisations, each with their own cultures and priorities. Perhaps the biggest challenge facing leaders is that STPs are being developed in an NHS environment that was not designed to support collaboration between organisations. Leaders of NHS providers, for instance, find themselves under significant pressure from regulators to improve organisational performance. This means focusing primarily on their own services and finances rather than working with others for the greater good of the local population.

 Will STP be beneficial to local population?

This will depend on finalised STP plans. However, the aim to integrate health and social care services more closely and to provide a platform for improving population health is laudable.

There are some reasons to be cautious about the kind of benefits that will be delivered. For example, concerns have been raised that leaders have focused their efforts on plans for reconfiguring acute hospital services, despite evidence that major acute reconfigurations rarely save money and can fail to improve quality too (and in some cases, even reduce it).

However, STPs could provide a foundation for a new way of planning and providing health services based around the needs of local populations. While STPs are primarily being led by the NHS, developing credible plans will require the NHS to work in partnership with social care, public health and other local government services, as well as third sector organisations and the local community.

Ref: Kings Fund

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