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Revealed: Health devolution could be better for care integration than STPs

Health devolution could be a more effective solution to place-based health and social care integration than sustainability and transformation plans (STPs), despite the latter being hailed as the ideal solution to regional health systems, answers to Freedom of Information (FoI) requests have shown.

In an investigation carried out to analyse local authority involvement in STPs – created in December as part of NHS England’s 2016-17 to 2020 planning guidance – NHE’s sister title, PSE, found that councils based in Greater Manchester reported greater amounts of involvement, participation and general enthusiasm towards regional healthcare planning than most other councils.

Since April this year, Greater Manchester has begun to take control of its healthcare system through a devolved £6bn deal – the first health devolution in the country, followed only by London and currently being considered more informally elsewhere.

As part of the package, the 10 councils in the region, along with CCGs and trusts, are currently developing ‘Locality Plans’ rather than STPs – making the situation in the region “somewhat different to the other footprint regions”, according to Trafford Council.

Despite this, the Greater Manchester councils that responded to PSE’s FoI requests on time – all of them but Wigan and Rochdale – reported large and continued amounts of local authority involvement in local health and care planning, which is in itself one of the main ‘pillars’ in the STP process.

In its response, Stockport Council explained that their local take on the STP, or the Stockport Locality Plan, feeds into the wider Greater Manchester health and social care plan.

“This locality plan has been created in partnership by Stockport Together, in which the partner organisations across Stockport (Stockport NHS Foundation Trust, NHS Stockport CCG, Pennine Care NHS Foundation Trust, Stockport Metropolitan Borough Council and Stockport’s GP federation, Viaduct Health) are working alongside GPs and voluntary organisations to develop a single strategic plan to improve health and social care services across the borough,” the council said.

“The five organisations have committed to make this work a top priority, and have developed a strategic plan for the borough with professionals and leaders across Stockport to create tailored strategies for the four workstream areas. Stockport Council, and in particular Adult Social Care and Public Health have been integral to the process of creating the locality plan and in designing the delivery of this plan.

“The initial strategic planning work was underpinned by a health and social care Congress in January 2015. It was attended by around 100 leaders from the partner organisations, bringing them together to secure sign-up from all attendees for the outline plans for the four programmes.

“Since then, the Stockport Together team (which is formed from staff from each of the organisations) has been working hard to agree what the future could look like, and are formulating options to help deliver major changes to improve the way in which health and social care is provided across Stockport.”

It emphasised that the council has been “fully involved in designating the leadership for Stockport Together”, where there are two joint senior responsible officers: a CCG chief operating officer and the council’s own director of people’s services.

All other councils said similarly positive things about the Locality Plan process taking place in Greater Manchester, with Oldham Council saying its plan was “developed in large” between the council and the local CCG, with Alan Higgins, the director of public health, leading on the programme.

“The development of the Locality Plan also had extensive input from other stakeholders (including housing, NHS providers, police, and the community & voluntary sector) through the Oldham Health & Wellbeing Board,” it added.

Salford City Council said the region’s Locality Plan also seeks to address the three ‘gaps’ that STPs were created to address and is supported by “health and care transformation and a robust financial plan”.

“Salford City Council has had a strong presence locally and at a Greater Manchester level in this work,” the authority added. “The local senior responsible officer is the director of public health, and senior officers have been actively involved in the development of details of the Locality and Strategic Plans. The city director and city mayor are members of the Strategic Partnership Board which leads this work.”

However, of the other 114 councils located across the country which responded to PSE’s FoI requests at time of publication, just 36– or less than a third – reported having participated in STP leadership nomination discussions, held at one or more joint NHS meetings. Many councils were even informed this “was not a discussion” or said the leader was named “almost exclusively” by NHS England.

And while many footprints did enjoy positive engagement between all regional health and care bodies, some local authorities heavily criticised how the process had been taken forward from the start, with several saying councils they weren’t consulted on the plan and others criticising how footprint catchments had been designated.

Other councils also expressed concern that STPs could undermine the success of existing local strategies, slow down the health transformation momentum or even create another tier across the NHS and local government.

STPs were also brought up in NHS England’s latest board meeting, during which they circulated a report saying few plans are currently “at the degree of scale and pace” required before the final 30 June deadline, despite “lots of good initiatives”.

And while Greater Manchester’s health devolution has not been without difficulties and challenges, the whole country is currently keeping an eye on ongoing plans to bring together all of Manchester’s trusts into one single provider for all services. The three trusts in the city supported the plans, which seek to address an “unacceptable level of variation” amongst Manchester’s health services.