20.06.16
STPs need more ‘central permission’ to focus on local relationships, NHSCC co-chair says
For sustainability and transformation plans (STPs) to flourish, they must be allowed more central permission in order to build strong local relationships and share the direction of travel, Dr Graham Jackson, co-chair of NHS Clinical Commissioners, said.
Speaking during a breakout session on place-based planning at last week’s NHS Confederation conference, chaired by the Confederation’s director of policy, Dr Johnny Marshall, Jackson said there is currently a “permission issue” with STPs.
He argued that we’re still “in that mood” where STPs have “constituent components” rather than a collective drive because the process has moved very rapidly – meaning people “had to just work on the technicalities” of finalising plans and didn’t have “a chance to really build the relationships in their locality”.
“We need to be more permissive to allow the system to build those relationships and share the direction of travel,” he added.
“There are numerous STPs across the country that have been defined centrally, not based on local relationships. I think we need to understand that we need to allow them to grow. But we don’t have any time – that’s always an issue – we don’t have the time to do that.”
The co-chair also named processes such as mutual assurances and mutual governance as ways of “overregulating” the system, ultimately creating an “over over over oversight” with the potential of hindering local plans.
“To me it’s all about permission, really: being allowed, centrally, the permission for STPs. If the central situation believes the STPs are the way forward, and I think there’s a very strong argument that it is, then give it some time and give some permission to let them grow,” he said.
Speaking from the audience, the Confederation’s chair, Stephen Dorrell, also emphasised the importance of local relationships with councillors in each STP footprint.
He argued civic leaders need to be consulted on, adding: “That’s one of the bits of learning in the STP process that the NHS needs to get comfortable with – that actually, in a place, the most authoritative political leaders are the council leaders and their council members.
“They also are an indirect way into changing the opinions of MPs, because very often they’re in the same party process.”
Ultimately, the chair said, the NHS must learn to see civic leaders – particularly council leaders, but their backbench members as well – as important components of their communities, “and not as problems, which has been the traditional place in which the NHS has put them”.
But Jackson raised the difficult nature of these relationships in the context of current Health and Wellbeing Boards (HWBs), designed to bring together leaders from the health and care spheres.
He said he has been working with the Local Government Association in the last two to three years to carry out HWB development work, during which he noticed there are still areas across the country that are “really struggling to have a HWB that is in functional nature, which is a shame”.
“There are some that are flying and relationships are very strongly built, but I do worry that, if the HWBs exist for three years and they’re still struggling with relationships at that level in a statutory organisation, how can we now make that work?” he asked. “Because actually, three years should’ve fixed that.”
The STPs were one of the centrepiece debates across all three days of the Confed conference, touching on issues such as mental health, new council powers and relationships within the NHS itself. The most simplified of these debates actually came from health secretary Jeremy Hunt, who argued the plans are “very simply” about reducing hospital bed days and reducing emergency admissions.