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Dixon: The jury is out on ‘totally aspirational’ STPs

Sustainability and transformation partnerships (STPs) have been described as “totally aspirational” and, at the moment, the jury is out on them, according to the chair of the College of Medicine.

Speaking during a panel session on place-based commissioning at UK e-Health Week, Dr Michael Dixon OBE, who sits on NHE’s Editorial Board, said that STPs are only just at the beginning of their journey.

“They don’t have any real, if you like, ballast yet and certainly don’t have any budgets. They certainly don’t have any corporate governance,” he said. “To me, they seem totally aspirational.”

He added that STPs, provided some structure and funding was put around them, could work. “But, at the moment, the jury is out,” Dr Dixon concluded.

Since their inception, STPs have divided opinion in the health sector. And earlier this week the Labour Party stated that, if elected on 8 June, it would impose a moratorium on STP hospital closures.

Dr Dixon isn’t the first person to raise concerns about STP funding, as the BMA said recently that an extra £10bn would be needed in capital funding for them. CIPFA also stated that the potential success of the 44 plans hinges on health leaders setting realistic targets for what savings can be achieved within set timeframes.

However, NHS England’s Five Year Forward View (FYFV) progress report stated that from April this year all NHS organisations will form part of an STP in order to ensure a basic governance and implementation “support chassis”, which will include an STP board and greater flexibilities.

On top of this, accountable care systems (ACSs) will now be considered an ‘evolved’ version of an STP that is working as a locally integrated health system. This will come paired with much greater freedoms for local organisations.

NHS doctor and global healthcare IT strategist, Dr Saif Abed, told the e-Health Week audience: “STPs, as it stands today, are documents. It is about people, processes and execution to make them work. And to give them the time to actually work.

“There will be hiccups, there will be challenges; we have to expect those and get through with them.”

This was similar to what Lord Victor Adebowale told NHE last year: “We need to not kill them just because they haven’t delivered everything instantly; we need to learn from them, we need to reiterate their importance, invest in the learning and the leadership, and press on.

“Learning is something you do consciously; you can decide not to learn, and that would be truly a waste of the time and effort by some very talented people. We have to learn from them because we’ve invested a lot of time and effort.”

The peer added that players across a health and social care integration patch should either be leading, following or getting out of the way.

The e-Health Week panel was also asked about the role of incentives and the NHS tariff. Dr Abed, also the medical director at Imprivata, said: “It is one thing to incentivise for the adoption of digital, it is something else for the optimisation of it and leading to outcomes that are measurable. We don’t want to incentivise for the wrong behaviour, because incentives can become perverse. I think coming together, as a combination of providers, technology providers and government, we can ensure it is the right type of incentive.”

Dr Justin Whatling, VP for population health at Cerner, told delegates he thinks the challenge is that “we are not getting the pace of change on the incentive models and empowering them locally fast enough with the ambition of new care models”.

“I think a lot of people are designing new care models, but they are being held to account in the old way of working while being asked to do the new way of working,” he said. “The answer to that has to be local innovation, but they need to be supported on that journey. The next step of the FYFV is trying to make that a bit clearer, and as we move to accountable care organisations (ACOs) then the centre will help and relax some of these things.

“My view on STPs is that they are there to transition and help incubate ACOs.”

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