Comment

We must ensure every STP succeeds

Niall Dickson, chief executive of the NHS Confederation, considers what else must be done to ensure all sustainability and transformation plans across the country are supported and up to scratch.

The NHS cannot continue to provide current levels of service without further national and local intervention. Without concerted action, we will see further deterioration in standards.

First there is the perennial challenge of funding – recent research from Age UK has yet again underlined the immense forthcoming challenge of older people living with long-term conditions. There will be another million people over 65 by 2020, then another 1.3 million on top of that by 2025 and a further 1.7 million by 2030, with the over-85s set to double within 20 years. We now know that the Office for Budget Responsibility projects that meeting demand would see NHS spending in England rise in real terms by around 4.5% a year.

Secondly though, alongside making the position sustainable, it needs to be transformed.

That is the underlying message of the NHS England’s Next Steps on the NHS Five Year Forward View document and, alongside most of our members, we remain committed to this vision in England.

The local sustainability and transformation partnerships (STPs) have proved challenging in many areas. In part, this is because they require leaders to set aside organisational interests in favour of the system as a whole, a challenge that is easier to describe than to deliver.

In parts of the country it has also been made more difficult by regulatory and accountability mechanisms that have not always been aligned. At times, regulators too often have continued to be focused on organisational rather than system performance.

In reality, the S of ‘sustainability’ can simply overwhelm the T of ‘transformation’ – just trying to keep the system afloat is difficult enough without requiring it to transform. And it is made harder still because change requires clinical and public support. In hard-pressed health economies, genuine attempts to create services based on new models of care can be viewed as nothing more than cuts designed to save money.

Investing in radical change

Following the general election, we might have hoped that local and national politicians would be more willing to back radical change; in reality, given the ongoing political uncertainty we have to accept that many politicians will be nervous about supporting the case for reform if it courts local unpopularity.

Nevertheless, we desperately need constructive engagement between politicians and communities to shape the future of local services. In exchange, the NHS will continue to show commitment to reform and to work with partners, not least in local government.

In July, the government announced an extra £325m in capital funding for a few STPs which are seen as being high-performing. However, given the Conservative manifesto commitment to £10bn of extra capital for the NHS in England, we should expect a more serious capital injection in the Budget statement later this year.

Capital is certainly needed as new and different services are developed, not least through investment in digital technology – but STPs also need transition funding to move to new models of care.

Individual STP ratings

Meanwhile, the decision to rate individual STPs should be viewed with caution. While there is a case for setting for a baseline to measure future progress, the measuring process is hardly scientific. It may make sense to incentivise those who are most advanced; the bigger challenge is to support and incentivise those in the middle of the bell curve.

The usual MO of the centre to lavish praise on those they regard as high performers, castigate those who are struggling and ignore those in the middle has never been wise. It is particularly problematic for partnerships that are at an early stage in their development. There will be good reasons why some areas are progressing more slowly and it is vital we give them the support they need, rather than point the finger.

The STP model is relatively immature and fragile – this is a time to encourage and nurture partnership working and for the centre to do all it can to support those who are seeking to foster collaboration at local level. Without it, services will continue to struggle to meet growing demand and patients will suffer. It is in everyone’s interest that every STP succeeds.

As the IPPR noted recently, STPs are “an opportunity rather than a risk for the NHS”, adding: “without these fundamental changes, it seems inevitable the NHS will remain a 20th-century system in a 21st-century world”.

FOR MORE INFORMATION
W: www.nhsconfed.org