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Better connection needed between STPs and BCF, argues ADASS

While some sustainability and transformation plans (STPs) have considered the financial impact on social care in the changing landscape, many have not, Grainne Siggins, national policy lead & trustee at the Association of Directors of Adult Social Care (ADASS) has told NHE.

Rising social care costs, she argued, are one of the by-products of the STP process, which aims to get patients out of the hospital environment faster, even though many of them will have higher levels of care.

Speaking to us after the NAO’s recent report into health and social care integration, Siggins said: “This is where the connect between the Better Care Fund (BCF) and STP needs to be better, because if your STP is your place-based footprint and then your local delivery arm is your local areas through your BCF, there should be a direct link between the BCF and STPs.

“We are expecting to see in the next BCF planning framework a greater connectivity with the narrative of the STPs. The STP plans are very high level and it would be quite difficult to understand what the BCF is delivering in any of these areas on the ground. It is difficult to tell because they are so high level.

“Some plans have considered this, but there does need to be better connectivity.”

Local government representation has been described as ‘patchy’ in the development of the plans, and Siggins noted that “there hasn’t been a balance in terms of influence on STP boards”.

“In the initial focus, everybody bedded down and tried to establish programme structures for their STPs; there was lots of work filling in the plans. There were some people [in local government] involved, but there is a difference between being involved, invited and engaged,” she said, adding that while people were involved it has been very much an NHS-led initiative.

“In many areas, you have your STP boards which involve 20-25 people and often one or two local authority representatives as part of that. You have these large footprints including the CCGs, for each of them, the different providers and then a couple of voices from local authority,” noted Siggins.

“STPs are about health financial sustainability, and a significant impact of STPs, slightly touched on in the NAO report, is about the impact on social care of increased out of hospital care.

“What we do know is that if people are coming out hospital, and they are more poorly than they were before, you have an enhanced level of care and support. You have to put higher packages of care in initially as people improve. There is always going to be some level of cost across to social care. Some of the STPs have, but others haven’t considered the financial impact on social care in that change in shape of the landscape.”

Reflecting on the current composition of STPs, Siggins argued that they are planning areas that are working up governance arrangements, “but CCGs could, potentially, delegate some level of power for STPs”. She added that ADASS is fine with that from an acute planning perspective, but asked: “What happens to the out of hospital care?”

“We still need to have a mechanism to plan and deliver out of hospital care at a borough level, which is what BCF gives us,” concluded Siggins.

A full interview with Grainne Siggins will appear in the May/June edition of NHE.


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