NHS reforms

Final June STP deadline watered down to ‘work in progress’

In another damning revelation about what had originally been hailed as a game-changing NHS scheme, life sciences minister George Freeman admitted yesterday (13 June) that sustainability and transformation plans (STPs) have no legal basis and plans submitted in June will only “form the basis for discussion”.

The 30 June deadline was originally meant to mark a submission date for final STPs, with each footprint handing in a full plan of how they would revolutionise regional care until March 2021. These final plans held enough weight to symbolise providers’ “single application and approval process” for gaining access to a £1.8bn bailout fund.

Last week, however, London Councils flagged emerging obstacles in the STP drafting process, just two weeks after NHS England had determined few plans were “at the degree of scale and pace” required.

The body, which represents the capital’s boroughs, also said recent communication from NHS England seemed to have “softened the original expectation of the nature of the 30 June submission”. Instead of submitting full plans by then, it now appears that this deadline will be more of a “staging post” rather than a “cut off in the development plans”.

And just yesterday, in response to a parliamentary question from shadow health minister Justin Madders MP, Freeman said “any plans submitted will be proposals that will form the basis for discussion” – apparently watering down the original ambition behind STPs.

“Depending on the level of local and national agreement, they may form the basis for further plans and actions that will be subject to the same legal and best practice requirements that govern the NHS,” he added.

“The June STP submissions will be work-in-progress, and as such we do not anticipate the requirement for formal approval from boards and/or consultation at this early stage. Plans have no status until they are agreed. When plans are ready, normal rules around engagement and public consultation will apply.”

Noting that plans have no legal basis, the life sciences minister also said meetings booked to discuss STPs did not inherently have to be open to members of the public.

“We have made clear that the on-going engagement of patients and the public is part of good planning. However the STPs are not statutory boards,” he said.

“Rather they are meetings attended by representatives of the wider health system, and are not required to meet in public as are formal boards. The local, statutory architecture for health and care remains. As such, the local governance for STPs will ultimately be through individual organisations. Public access to Board meetings of their local organisations will be unchanged.”

According to Freeman, no STPs have been submitted yet and expectations for each footprint will vary. Footprints will enter STP discussions with NHS England and the government in July.

“Footprints are at different starting points, and so the degree of detail that will be provided by 30 June will vary. Therefore, rather than expecting to have one ‘sign-off’ moment for all 44 plans, it is anticipated that this will occur in a series of waves over the coming weeks and months, with those areas who are more advanced achieving earlier sign off than those who will require more work,” he concluded.

In a separate question from Madders, the life sciences minister provided a list of the 44 leaders nominated to oversee the STP process. While this may have been a dated list, three leaders had not yet been confirmed or were in position.

Overall, the STPs have been an area for concern across both the capital and the rest of the country, with ongoing issues including challenges with capacity and scale and “significant difficulties” in galvanising agreement over the plan to “meet the financial challenge”. There is also variation in the maturity of relationships across the system, despite strong collaboration being a “critical factor” in developing the plans.

Collaborations also appear to be weakened in terms of local government involvement, with a recent investigation by NHE’s sister title, Public Sector Executive, finding that over two-thirds of councils were shut off from discussions to nominate an STP leader.