Workforce and Training

New STP partnerships given raft of flexibilities in exchange for robust governance

All NHS organisations will form part of a sustainability and transformation partnership – the apparent new name for STPs – from April this year in order to ensure a basic governance and implementation “support chassis”, which will include an STP board and greater flexibilities.

In NHS England’s long-awaited Five Year Forward View progress update, otherwise known as the health service’s delivery plan, it confirmed the intention to push forward with STPs as non-statutory bodies that seek to be more than just the ‘wiring’ behind the scenes of the NHS – instead representing a way to bring together all parts of a local health system.

It promised that the way each STP works will vary according to the needs of different parts of the country, with place-based health and care systems being “defined and assessed primarily by how they practically tackle their shared local health, quality and efficiency challenge”.

But it did emphasise that, in order to succeed, the plans need a basic framework to support leadership, implementation and effective working. From April, all NHS organisations will have to join partnerships and form an STP board drawing from constituent bodies and including “appropriate non-executive participation, partners from general practice, and in local government wherever appropriate”.

These partnerships will establish formal CCG Committees in Common or other appropriate decision-making mechanisms where needed for strategic decisions between organisations. The governance arrangements in place in Greater Manchester are one example of how this can be done within the current statutory framework, NHS England said.

But the delivery plan also issued a warning to non-believers: “In the unlikely event that it is apparent to NHS England and NHS Improvement (NHSI) that an individual organisation is standing in the way of needed local change and failing to meet their duties of collaboration we will – on the recommendation of the STP as appropriate – take action to unblock progress, using the full range of interventions at our disposal.”

Where it has not already occurred, STP chairs or leaders will be appointed subject to ratification by the national oversight bodies.

The partnerships will also have to ensure the STP has the necessary ‘programme management support’ by pooling expertise and people from trusts, CCGs, CSUs and other partners. CCGs are free to decide to align their management teams or governing bodies more closely with those of the STP geography, a move which NHS England “will generally now support”.

Under a raft of greater flexibilities, footprints will be able to propose adjustments to geographical boundaries if appropriate and in agreement with NHS England. “Over time we expect these may flex pragmatically depending on local circumstances,” the delivery plan said. “In any event, patient flows, for example for specialised services, may mean planning across several STP areas.”

NHS England will be working with STP leads, NHS Clinical Commissioners, NHS Providers, NHS Confederation and the Local Government Association, as well as other appropriate bodies, to develop STPs and the policy framework under which they will operate.

“The corollary to not being prescriptive about STP structures is that the way to judge the success of STPs – and their constituent organisations – is by the results they are able to achieve,” said the plan. “We will publish metrics at STP level that will align with NHSI’s Single Oversight Framework for NHS provider trusts and NHS England’s annual CCG Improvement and Assessment Framework, which will be published in July.”

Importantly, NHS England also confirmed that accountable care systems will now be considered an ‘evolved’ version of an STP, with some areas around the country already being targeted as potential candidates for this development.

‘Pragmatic and flexible approach’

Chris Hopson, chief executive of NHS Providers, welcomed the organisation’s “pragmatic and flexible approach” to developing STPs, with the plan recognising that the Health and Social Care Act 2012 “prevents the creation of a formal ‘mid-level STP tier’ with statutory powers”.

“The plan also recognises the importance of existing governance and accountability structures focussed on trusts, but also the opportunity for shared decision making at the STP level,” added Hopson.

“Finally, it allows different STPs to move at different speeds: enabling the fastest to progress without delay but not forcing others to adopt a single uniform approach they neither want nor are ready for.”

Niall Dickson, CEO of NHS Confederation, acknowledged that the delivery plan is ambitious in its reform and transformation goals, but argued that it is ultimately asking health and care organisations to “set aside their own interests for the good of the wider system – and that will require new ways of thinking at local level and much stronger and more consistent support from national bodies”.

“The current system needs to be redesigned to meet the very different health demands of the 21st Century, but the proposed new structures and models of care will need to be tested,” said Dickson. “This will be challenging without the funds to grow them while existing services are still operating.

“There is currently wide variation across the country and it is important there is support that reflects local reality. Those areas which are most advanced should receive the backing to transform services. But we also need to support other areas where there is more to do in reshaping services, building the necessary relationships and engaging the public.”