Don’t let old-style contracting hinder your STPs, leaders told
NHS England is hoping to get all 44 STP plans assured by the end of the year, at which point they would be turned into contracts and implemented regionally over four years, its national director for operations and information said – adding that footprints should not let old-style contracting stop them from “doing the right thing”.
Speaking during the second day of NHS Expo last week, Matthew Swindells ran through the expected timeline for assuring STP plans throughout the next few months. In what he argued was a “normal distribution”, he revealed that around 10 plans are nearly ready to go; a big chunk in the middle is making “real progress” but has work left to do; and some at the far end, which did not have a history of working well together, still have a lot to do.
This follows on from the “fantastic” range of responses received when NHS England carried out the first set of reviews in April, which varied from “at last we’ve got someone to talk to about the sort of planning we’ve been trying to do for the last 10 years” right down to “it’s been really nice to meet the social services lead for the first time”.
“I personally saw all 44 footprints in July,” Swindells added, “and they have moved to ‘we’ve pretty nearly got a plan’ – and we were testing those plans: will they really improve health inequality, will they improve quality, do we believe it can solve the money – through to ‘we have a plan for a plan, we’re moving forward, we know where we’re going but we haven’t solved it yet’. We’re expecting the financial analysis to come up in mid-September, and we’re expecting final plans to come through in mid-October.”
At that point, he said NHS England is hoping to find that as many plans as possible are already ready to be turned into an action plan, with others still needing some help – as previously indicated by Simon Stevens.
“That’s the point where it rolls into the contracting process, so we will be putting the planning guidance out at the same time, which I’m hoping will give a lot of flexibility which says: if you have a plan that works, go in it together and don’t let old-style contracting stop you from doing the right thing,” he continued.
“We are looking to get all the contracts for the whole of the system signed off by December. What we should be able to say in the middle of October is how many can just get on an do it, and how many will need more support to get them to the right place so that come December, we get as many – preferably all, but as many – plans turned into contracts and ready to go.
“The task will be to get them all done by the end of the year; if any fall over the edge, that is not what we’re planning for. After that, you have a two-year contract and you have four years’ worth of implementation to deliver the trajectory, during which consultation will need to happen over some of the changes.”
Limited time to sort things out
Speaking as part of a roundtable discussion next to two prominent STP leads, Amanda Doyle and David Pearson, Swindells added that it’s “really up to local leaders” in the meantime to manage how they engage with their communities with respect to ongoing plans – but said NHS England would “discourage” people from publishing plans they’re still working on.
Adding to this, Doyle, who is the CCO at Blackpool CCG and STP lead for Lancashire and South Cumbria, clarified that what her footprint has so far is “not a plan, a complete narrative that describes everything we’re going to do and what healthcare will look like in five years’ time”. Instead, it is a series of templates, government information and finance templates, most of which would be “almost meaningless” to the wider public.
Doyle, who is also the co-chair of NHSCC, argued that the STP ask is “really, really, difficult”, but necessary: “We’re not making any bones about that, and the message back to Matthew, Simon [Stevens] and Jim [Mackey] is that this is really hard to do in the time we’ve got.
“But we have got unlimited time to sort this out. We are not sustainable as we are. We do not have the luxury of two years to nail down every detail of everything. We have to get on and deliver, we have to improve health, we have to improve outcomes, and we have to be able to afford what we’re doing.”
Swindells agreed, adding that every day NHS leaders “decide to have another committee meeting” rather than “getting on and making a hard decision”, the system is “not delivering the optimum NHS and social care with the money that’s available”.
Pearson, who is the director of adult social care at Nottinghamshire County Council and the STP lead for that footprint, also argued that while his region is currently “grappling with a tiger” in terms of getting the plan where it needs to be and making good use of available capacity, he does believe it is the right thing to do.
“We have to be good enough to make a start and to take the next step, but be wise enough to continually evaluate how it’s doing and make adjustments,” he continued. “Change needs to happen at every level. We’ve got to have an alignment of the expectations across the regulators in terms of making sure that the messages being given are consistent right throughout the process.”
As expected, STPs were a major point of discussion during this year’s NHS Expo, including Simon Stevens telling health leaders to get behind the process; the chief nursing officer making the case for a central leadership role for nurses; and Swindells himself stating technology must be a centrepiece feature in all plans.
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