25.01.16
Finding your place: What does the planning guidance mean for local leaders?
Miriam Deakin, head of policy at NHS Providers, looks at the key considerations for local leaders following the publication of this year’s planning guidance.
There has been a growing focus in recent years on a more ‘place-based approach’ to delivering health and care, reflected in the recent planning guidance, which encourages local leaders to come together and plan for a five-year period.
There is no doubt that the prize of more integrated, locally-led care is worth seizing, but the leadership challenges posed by the ‘planning guidance’ should not be under-estimated. In a more collaborative context where ‘success’ may mean ceding delivery or providing services differently, our judgements on effective leadership will change and all partners will need to find their place. So, what then are the key considerations for local leaders in the recent guidance?
What has been announced?
This year’s planning guidance was published in the context of the Spending Review and sets out expectations for the sector to deliver the Five Year Forward View by 2020, including returning to financial balance, meeting access and quality standards for patients and developing more integrated care models. Significantly, many organisations within the NHS will be required to produce two plans:
- ‘Local health and care systems’ will develop a five-year sustainability and transformation plan (STP) covering October 2016 to March 2021; and
- NHS foundation trusts and trusts will develop one-year operational plans for 2016-17 which are ‘consistent with the emerging STP’ and enable contract sign-off by end of March 2016.
Finalising the planning guidance is always a balancing act for national policymakers, who have to align a tight funding envelope with a stretching set of priorities, and the ‘ask’ of the health and care sector this year remains considerable, not least given the continued cuts to public health and social care. However, there are elements to welcome, including a multi-year settlement with a focus on local health economy level solutions and a funding settlement for ‘core NHS services’ that is more realistic and bolstered by access to a small sustainability and transformation fund of £2.1bn.
What are the immediate considerations for local leaders?
Quickly agree a footprint: NHS providers are already working with their partners to improve how health and care is delivered and the requirement to deliver an STP will allow some places to move more swiftly with existing plans. However, it will be much more difficult where local authority and commissioner boundaries do not align, where patient flows are complex or where relationships need time to develop. Whatever the local context, the task of delivering a considered footprint to the national bodies by 29 January 2016 seems incredibly tight.
Plan transparently: Local health economy partners have been asked to develop ‘open book’ plans marking the more collaborative approaches encouraged under the Five Year Forward View. NHS providers will want to work closely with colleagues in commissioning, local authorities, public health, primary and social care to develop strategic priorities and a shared evidence base for their decisions, but questions about how local plans will be triangulated and how a more collaborative approach sits with competition legislation remain. Local partners will also wish to consider at what point they involve patients and the public as well as the voluntary and independent sectors in the process.
Identify leadership capacity: The task for 2016-17 alone remains stretching but NHS provider boards will need to develop one-year operational plans which meet the ‘nine’ must dos set out in the planning guidance alongside investing time in developing relationships to craft medium-term plans at local health economy levels. The timeframe for delivery of both plans will stretch leadership capacity even in the best performing trusts and local areas.
Secure sign-off: The planning guidance includes a welcome focus on local leadership, but there are a number of requirements for national sign off with the potential for funding to be withheld from local NHS organisations if milestones are not met. It will be important for NHS Improvement and NHS England to offer support for local areas to develop STPs and to use NHS Improvement’s regulatory functions sparingly if local plans are to be developed and ‘owned’ at the frontline.
Lead locally, and collaboratively: Much has been written about the shift to more collaborative leadership styles within the NHS and it seems clear that outcome-focused discussions will support a ‘place-based’ approach to planning most effectively. We may expect leaders to champion new care models in different partnerships for patient benefit. It will be equally important that colleagues in the national bodies reflect the same collaborative behaviours to support local plans.
Local leaders in the NHS face a series of challenges to sustain and improve care in a tough financial climate, all of which is reflected in this year’s guidance. A refreshed approach to planning at local health economy levels is an important step but its success will rest on a cultural shift to invest in local determination, new forms of leadership, and relationship building. NHS providers, and their local partners, will wish to both shape and find their place in these debates.
FOR MORE INFORMATION
W: www.nhsproviders.org