Consultant Medical Interview

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

It sets out how NHS Improvement will oversee NHS trusts and NHS foundation trusts, helping them to determine the level of support they need.

The Single Oversight Framework is designed to help NHS providers attain, and maintain, Care Quality Commission ratings of ‘Good’ or ‘Outstanding’. The Framework doesn’t give a performance assessment.

The framework applies from 1 October 2016, replacing the Monitor ‘Risk Assessment Framework’ and the NHS Trust Development Authority ‘Accountability Framework’.

How it works

The Framework will help NHS Improvement identify NHS providers’ potential support needs across five themes:

• quality of care
• finance and use of resources
• operational performance
• strategic change
• leadership and improvement capability (well led)

NHS Improvement will segment individual trusts according to the level of support each trust needs. NHS Improvement can then signpost, offer or mandate tailored support as appropriate.

Ref: http://tinyurl.com/jd6mwn8

It came into being on 1^st Apr 2016. It is the operational name for an organisation that brings together:

• Monitor
• NHS Trust Development Authority
• Patient Safety, including the National Reporting and Learning System
• Advancing Change Team
• Intensive Support Teams

NHS Improvement is responsible for overseeing foundation trusts and NHS trusts, as well as independent providers that provide NHS-funded care. It offers the support these providers need to give patients consistently safe, high quality, compassionate care within local health systems that are financially sustainable. By holding providers to account and, where necessary, intervening, it help the NHS to meet its short-term challenges and secure its future.

Currently, NHS is under severe pressure. More is asked of NHS every year as the population grows and changes. The public funding for NHS is not growing so fast.  A lot of NHS trusts and foundation trusts are facing big challenges. Their task is to meet the nation’s healthcare needs within the NHS budget. How can they extend services and maintain or improve the quality of what they do and at the same time keep a lid on the cost. The answer is to work together with the local communities, other NHS and social care organisations in remodelling local health care systems. With everyone’s input systems can be designed to deliver high-quality affordable care indefinitely but none of this is easy.

NHS improvement works alongside NHS trusts and foundation trusts to help them overcome these challenges. NHS Improvement supports their efforts to

1. Care quality
2. Operational efficiency &
3. Financial management

NHS improvement also holds trusts to account in meeting national standards in all these areas. NHS improvement as part of their statutory duty intervenes in Trusts which can’t meet these standards to protect and promote the interests of people who use health care services. As sector regulators, NHS improvement also sets the rules determining the tariffs for NHS services and make sure that procurement, choice and competition operate in patient’s best interests.

NHS Improvement helps the trust help themselves in 3 main ways:

1. First, they provide the board members and managers with more of the skills, systems and information they need to prevent, pre-empt and tackle their particular issue and to continuously improve.
2. Second, they give trusts practical evidence-based help. They advise on how to make services more efficient without eroding quality for instance by managing waiting list differently. They can suggest on how to improve clinical quality without overspending. NHS improvement tries hard to avoid duplicating. Their first instinct is to check what expertise is out there and link people together so they are a hub for sharing existing good practice and knowledge across the sector
3. Third, NHS Improvement spells out what success looks like for the trusts so that everyone knows what they are aiming for and how to measure progress.

NHS improvement work with other national partners at the centre of the health system like NHS England and the Care quality commission to make sure they all speak with one voice to the sector and the individual messages and actions are consistent.

Ref: https://improvement.nhs.uk

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