STP success will be ‘extremely challenging’ to achieve on time and to budget

Delivering STPs under the current timeframe and to financial targets will be “extremely challenging,” president of the Royal College of Physicians (RCP) Professor Jane Dacre has warned.

Speaking to NHE, the RCP leader said that whilst STPs represented a good opportunity to drive reform in the NHS, delivering them to time and achieving targets looks set to be an uphill task.

Prof Dacre’s warning follows a number of other health leaders revealing their scepticism about STPs. Dame Ruth Carnall, a trustee of The King’s Fund, last week stated that STPs represented a “workaround” to serious deficiencies in health and social care, although she added that STPs were also “the only show in town” with regards to effective integration.

And chair of the College of Medicine Dr Michael Dixon also said at the beginning of the month that STPs were “totally aspirational,” and needed to be backed by proper funding and corporate governance to be successful.

“STPs present well-evidenced cases for change, and propose novel and appropriate methodologies for achieving this,” Prof Dacre said. “However, the pace of change required and the financial expectations are extremely challenging.”

Prof Dacre added that STPs were more likely to be successful in some parts of the country compared to other parts due to differences in financial risk, engagement, urgent and emergency care targets and the scale of change needed.

“The problems arise when the issue of meeting the funding gaps in health and social care are discussed,” she added. “Most plans have, to put it mildly, aspirational plans for this as they rely on savings created by reductions in A&E attendances, bed numbers, non-elective admissions and out-patient appointments (often in the 10–20% region).”

The RCP president argued that bed numbers could not keep being reduced at the current rate without compromising quality of care for patients.  

“We cannot possibly reduce the number of beds by 30% over a few years without lengthening waiting lists for outpatient and inpatient procedures, and damaging patient care – unless there are enough beds provided elsewhere,” she said.

“I am pleased that Simon Stevens, the CEO of NHS England, has made it clear that mass bed closures will not be permitted unless alternative arrangements for patients are put in place first.”

And it’s not just leaders of health organisation who have warned that STP success will be difficult to achieve. Last month, MPs in the Public Accounts Committee said that STPs were unlikely to successfully integrate health and social care where the Better Care Fund had failed.

At the start of May, CIPFA told STP leads that a “reality check” was needed to come up with realistic targets for what can be achieved in the timeframe set out by NHS England.

Prof Dacre will be writing on STPs in the May/June edition of NHE, hitting desks at the end of the month. 

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John King   15/05/2017 at 15:40

Surely it is what you are trying to achieve (ie place based transformation) that than the organisational construct (ie STPs) that is important. We are co-developing an enterprise scale STP offer which uses simulation to provide whole system decision making, a collaborative working space and integrated care evidence based on local validation. In my view, we should not be focusing on the ‘why’ behind place based transformation (in the modern vernacular a 'no brainer') or the said organisational construct but the HOW TO for local transformation teams. Have a look at a Proof of Concept demo Welcome your views. John King

Anon   15/05/2017 at 15:42

I think that this is a fair observation but fails to suggest what the alternative is? That is assuming that even if funding does increase by a generous amount it is still likely to be enough to cover the "do nothing" gap. Keep with them, acknowledge they are flawed in delivering the whole amount but they represent our best chance of getting anywhere near to where we need to be.

Rational Medicine   15/05/2017 at 22:44

Good and relevant observations. Given the demographics and nature of NHS resource consumption, physicians are likely to play the leading role in any community-based intervention as proposed in the new ways of working. Would be interested in Prof Jane Dacre's views in how she envisages UK physicians can be led into reforming their outmoded means of healthcare delivery like many useless clinics which utterly fail to keep people well in the community and/or stem the rising A&E attendances.

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