Service Reconfiguration

Election result means STP legislation now due only after Brexit

Given the result of the latest general election and with the negotiations around Brexit due to start later this month, it is now unlikely that the government will be able to introduce legislation for sustainability and transformation plans (STPs) in the next few years – if at all.

Speaking at NHS Confederation yesterday, health secretary Jeremy Hunt argued that the legislative landscape has changed after a hung Parliament was declared last week. Because of this, it is unrealistic to expect the government to enact legislative health changes before the Brexit process is finished.

“We said [in our manifesto] that we would legislate to give STPs a statutory underpinning if that was felt to be necessary,” he said. “To be clear, we’re expecting to be in power until 2022 and deliver a stable government to make that possible.

“But obviously, the legislative landscape has changed, and that means that legislation of this nature is only going to be possible if there is a consensus across all political parties that it’s necessary. I don’t think that is in any way impossible, but it’s realistically not something we would do while the Brexit process was carrying on.”

Post-Brexit, he added, the government will have “a lot better understanding” of the legislative changes required by STPs. But even then, changing the law would require cross-party support – a much greater challenge now that the Conservatives no longer hold the majority in the House of Commons.

Responding to audience questions after his keynote speech, Hunt – who survived Theresa May’s recent political reshuffle – also hinted that the NHS could be in line to receive some more transformation funding.

Asked by a West Hampshire GP about the possibility of supporting transformation with ringfenced investment in order to enable new models of care elsewhere in the country, the health secretary argued “that is what the STP plans are about”.

But the biggest risk to pouring in more capital funding, he noted, is “if we don’t maintain the financial rigour and discipline that we started to see coming back into the system in the last year”.

“That was really what slowed down this process in the 2015-16 financial year, when we would’ve liked to put a lot more money into transformation,” the health secretary said. “But I think now we’re in a much, much better position to do that. We absolutely want to make sure that money is not an impediment to the rolling out of the STPs, because they are central to our vision.”

In fact, the recent NHS response to the horrific terrorist attack in Manchester, which saw staff working around the clock to cope with the unexpected demand, is a “very good reason for exactly what we’re trying to achieve with the STP process”, Hunt argued.

“The interesting lesson for me about the response in Manchester was how joined-up it was as a result of the terrific progress, under Jon Rouse’s leadership, that trusts have made in coming together as part of their STP,” he added. “I think they’ve probably gone further and faster than anywhere else in the country. I know it’s not been easy to do that, but it was extremely streamlined and effective.”

He also suggested that the government would be prepared to boost the region’s cash pot “if there are specific aspects of the response to those terrible events where there have been unexpected costs that the NHS incurred that wouldn’t be part of its normal response to emergency situations”.

STPs need local support

Asked by another audience member to explain the importance of bringing all local communities together into designing and delivering change, Hunt emphasised that the reasoning behind STPs is to bring about “fantastically beneficial” changes for patients.

“It’s a transformation that is wholly positive for the public,” the secretary of state said. “But people are passionate about their NHS and they obviously worry about any change that happens, and that’s why we have a responsibility to communicate that change. And that change is usually best not communicated by politicians, but by clinicians, because frankly you guys are trusted a lot more than we are.

“That’s why I think it’s really important to have that local engagement, and that’s why, when it comes to the big transformation plans, Simon Stevens and I are supporting them with every fibre in our bodies at a national level.

“But at a local level, we need you to be making the arguments. The evidence is that when you do that, even with potentially controversial changes, it’s quite possible to win the case to do them. But it does involve a lot of local engagement and I think that’s going to be one of the central challenges for the next few years.”

(Top image c. Neil Hall/PA Wire)