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Strengthening STPs Through better engagement

Sarah Hutchinson, policy advisor at National Voices, on the need for sustainability and transformation plan (STP) leads to ramp up engagement as they develop their plans.

It has been just over a year since STPs were announced, and they have gone from being a deeply technical process only understood by policy wonks, to becoming a politically thorny issue, via some serious public scepticism. 

The concept of bringing together all of the people involved in health and care in local areas to set out what the ideal system would like is eminently sensible. Why has it been such a rocky ride? 

Filling a vacuum 

When STPs were announced local areas were told they should be “developing a shared vision with the local community”. 

It was always going to be difficult to deliver effective engagement with local people given how quickly STPs had to be developed. This was exacerbated by the decision not to publish drafts. If you leave a vacuum, someone will fill it, and in this case suspicion of STPs quickly grew. Before we knew it STPs were being portrayed as ‘secret plans to cut the NHS’. This has muddied debate even though all plans have now been published. 

The level of engagement carried out whilst developing the plans has been patchy, and voluntary sector groups have told us that the extent of their involvement is variable. NHS England’s guidance on engagement came too late in the process. 

As the plans are further developed and move towards implementation, there is an urgent need to strengthen engagement. That means not only engaging communities in the planning, but also ensuring that the plans set out how local areas will continue to engage the communities. 

Crucially, we need wider recognition that engagement is inherent to improving quality and experience. It is not an add-on or ‘nice to do’, it is core business. It cannot be seen as less important than financial stability – it is a key tool for achieving this. Surely the least efficient service is one that does not meet people’s needs. 

What’s the big deal with engagement? Put simply, more engaged services are better services. 

Firstly, services are delivered for patients and carers, so we should find out what they actually want and need. Patients and carers hold unique insight into how services work (or don’t work), how services interact, what it feels like to use them, and how this affects health outcomes and experience of treatment. 

Secondly, true engagement and involvement builds legitimacy for a plan. In NHS England’s own words, engaging people and communities will “help to build ownership and support for proposals” and will “help identify potential areas of concern”. 

This isn’t about engaging because someone has told you to engage, or because there is a legal duty. This is about engaging people because it will lead to a better plan that comes with greater legitimacy. It is pivotal to realising the Five Year Forward View. 

Getting the engagement right 

Although all 44 STPs have now been published, it is fair to say that much of the details are still to be worked out. This means local leaders still have the opportunity to engage their communities in how the plans are delivered. Luckily, there is guidance available. 

The ‘Six principles for engaging people and communities’ give a practical steer to local planners by providing a framework for engagement. They were developed by the People and Communities Board working with the New Care Models Team, and help leaders to understand and measure the impact of engaging with local people and communities. 

NHS Clinical Commissioners has published a useful checklist for STPs (backed by National Voices), which includes a section on engagement, encouraging leads to ask whether “plans clearly communicate what changes mean for patient experience and outcomes and help explain how efficiency savings will be made and the impact on patients”. 

NHS England’s STP engagement guidance for local areas sets out the legal duties and how to carry out engagement. NHS Networks’ Smart Guides to Engagement are useful, concise guides dealing with the different elements of engagement. NHS England’s ‘Transforming Participation’ guide – currently being refreshed – sets out best practice in meeting statutory duties around involving people in their own healthcare and in service redesign. 

‘Changing care, improving quality’ is a report from National Voices, the NHS Confederation and the Academy of Medical Royal Colleges. It uses evidence from previous reconfiguration projects to provide advice and tips on engaging communities in challenging service redesigns.

What next for STPs? 

The STP process has been far from perfect and it now carries some reputational issues, but the concept is sound, and many people across the country are working hard to get them on track. STPs are our best hope of creating a sustainable health and care system that provides the support that communities need. 

At the national level, health and care leaders need to create an environment more conducive to transformation by making the case for change and giving STP leads the freedom to be more transparent. 

In turn, STP leads need to ramp up engagement as they develop their plans. 

The NHS needs to evolve to meet people’s health and care needs and to become financially stable. Patients, carers, and citizens hold the vital insight that will help the system achieve this. Why wouldn’t you engage them?

For more information

W: www.nationalvoices.org.uk

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