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Developing sustainability and transformation plans

Lisa Robertson, HFMA research manager, discusses the emerging governance arrangements being developed to support the delivery of sustainability and transformation plans (STPs).

STPs are the current focus for those working in NHS finance. There is a broad consensus that the NHS needs to transform service models and patient pathways to provide sustainable services that are integrated around patient needs. STPs should provide the route maps for this transformation. 

Although STPs were met with enthusiasm and positivity when they were introduced, there is scepticism over whether or not the frameworks can work in practice. Most finance directors see STPs as a cornerstone of reducing the deficit but an overwhelming majority also voiced concerns about the way they are set up, with nearly three quarters (72%) concerned about their governance. Finance directors have limited confidence in the simultaneous delivery of both STP and organisational financial objectives, with only 6% of trust finance directors and 17% of CCG chief finance officers (CFOs) believing that they are both deliverable. This is understandable given finance directors will have different pressures coming from different directions.

While STPs carry a big burden of expectation, they also represent a huge change in working practices. They mark a move away from a focus on individual organisations and market competition towards system working. Complex, with a large number of stakeholders, each STP also starts from a different point in terms of local relationships. 

Since the announcement of STPs in December 2015, there has been much activity in establishing relationships and plans for each footprint. With plans completed by the end of 2016, the focus is now on implementation and action. During 2017 there will be a huge shift in effort as areas turn their visions into reality and transformation plans take shape in a financial and care context that is already very demanding.

Given the concerns about governance arrangements we heard from finance directors, HFMA has been exploring the emerging arrangements in this area and how they support the delivery of financial sustainability and transformation in the NHS. Our recent HFMA briefing, Developing sustainability and transformation plan governance arrangements, explores the emerging governance arrangements being developed to support the delivery of STPs.

We hope it will be a useful tool for finance staff and others to use in developing their own robust governance arrangements. In order to maintain momentum, STP models must be clear, robust and flexible to support the fundamental changes required. It is clear that each governance model will be developing at its own pace, with tailored arrangements that suit the footprint community and organisations. However, there are specific aspects that need to be considered when developing these arrangements such as leadership, resource, engagement and risk management. Finance directors can use our online checklist to make sure they have considered all the key areas.

Visions need to turn into practical reality as STPs take shape in a financial and care context that is already very demanding. Some arrangements will stand up to this test better than others. However, the prize – more integrated and sustainable services – is so important that the NHS will need to learn fast from these early forays into system-wide governance. If we identify governance models that work well, we will need to replicate this across the country. At the same time, we will need to be vigilant for any barriers in the way of system-level working becoming business as usual.

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