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King’s Fund: If STPs do not work ‘then there is no plan B’

Despite being plagued by problems in their infancy, STPs offer the best chance of improving health and care services, a new report by the King's Fund has revealed. 

STPs have faced strong criticism by politicians, local authority leaders and patient groups. The think tank’s new report, based on interviews with senior leaders in four STP areas, echoes many of these criticisms, especially for the scant engagement with local government, clinical staff and patients and a lack of governance for STP leaders. 

However, it also recognised that the backdrop against which STPs have been introduced – in a time of tight NHS finances and the greater competition sought by the Health and Social Care Act 2012 – is a difficult one, and it has therefore urged the government and the NHS to continue to back STPs. 

“It is clear from our research that STPs have been developed at significant speed and without the meaningful involvement of frontline staff or the patients they serve,” the report concluded. 

“But collective action through STPs still offers a preferable alternative to the ‘fortress mentality’ whereby NHS organisations act to secure their own future regardless of the impact on others.” 

While supporting the principle of STPs, the King’s Fund’s report made clear suggestions for patients and all parts of the health and care system to be involved in the STP consultation process, along with improved governance supported by changes in NHS regulation. 

In response to the report, an NHS England spokesperson said that by the end of this week, at least half of the STP reviews would be published. In recent weeks, a number of the draft STPs have been made available to the public, but serious reservations have been made about the process and the plans. The King’s Fund also noted that officials leading the development of STPs are “struggling with a confused process”, with changing or unclear deadlines and guidance from national NHS organisations. 

“I am sure there are things that could be learnt about the process,” said Prof Sir Bruce Keogh, NHS England's medical director. “But when you are trying to improve care across a whole system, things are never going to be straightforward.”

Recently, the Royal College of Emergency Medicine (RCEM) warned that STPS could have a “catastrophic” impact on emergency care, after a survey revealed that almost a third of CCG leaders are considering closing emergency departments. Shortly after this, the Health Select Committee recommended that the process must include an assessment of the infrastructure investment needed to ensure type 1 emergency departments – or major consultant-led A&E departments open 24 hours a day, seven days a week – are fit for purpose.

The latest King’s Fund report also advised that STPs be ‘stress-tested’ by NHS national bodies in order to ensure that the changes they propose are realistically achievable. 

Chris Ham, chief executive of the King’s Fund, accepted that the introduction of STPs has been “frustrating” for many in the health service, but stressed that it is vital to stick to them.

“For all the difficulties over the last few months, their focus on organisations in each area working together is the right approach for improving care and meeting the needs of an ageing population,” Ham explained. “It is also clear that our health and care system is under unprecedented pressure, and if STPs do not work then there is no plan B. 

“The progress made so far has only happened because of the hard work of local leaders who have been prepared to work around the difficulties. It is vital that NHS national bodies learn the lessons so far, so that we can see STPs fulfil their potential.” 

The Health Foundation recently called for the NHS accountability framework to be revised to accommodate new models of care such as STPs. 

Jeremy Taylor, chief executive of National Voices, the coalition of health and care charities, said: “The NHS’s own guidance to STP areas states that ‘involving people, communities and stakeholders meaningfully is essential to effective service improvement and system transformation’. 

“While some areas are trying to put these principles into practice it is very variable. We agree with the King’s Fund’s analysis that lack of engagement creates risks. We recommend the Six principles for engaging people and communities, developed by the People and Communities Board, which offers  practical guidance on meaningful engagement. 

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