‘Significant difficulties’ in capacity and collaboration flagged in London STPs

A series of emerging obstacles in the sustainability and transformation plan (STP) drafting process across London means that fully formed plans might not be achievable by the end of June, despite a firm deadline pre-determined by NHS England.

In its board papers from a meeting held yesterday, London Councils also said that recent communication from NHS England “appears to have softened the original expectation of the nature of the 30 June submission”.

While footprints were meant to submit their full STPs by then, it now appears that this day will be more of a “staging post” rather than a “cut off in the development plans”.

Ongoing issues across London, which comprises five sub-regional footprints, include challenges with capacity and scale – mirroring the current situation nationwide – and “significant difficulties” in galvanising agreement over the plan to “meet the financial challenge”.

The pace of the STP process, which has moved relatively quickly since its creation late last year, is also “creating tensions in the system”, especially in areas where sub-regional working is in its infancy.

And there is still variation in the maturity of relationships across the system despite strong collaboration being a “critical factor” in developing the plans.

“Clearly, given the nature of some of these themes, and the relatively imminent deadline, questions arise regarding the level of development which can be reasonably expected as of the 30 June deadline,” the London Councils board said in a paper penned by Clive Grimshaw, the strategic lead for health and adult social care.

Despite this bleak picture, Freedom of Information (FoI) requests sent out by NHE’s sister title, Public Sector Executive, revealed that London is actually working in a more integrated fashion than a large proportion of other footprints countrywide.

For example, London councils responding to the FoI requests largely indicated that they have been closely involved in the STP process, whereas nationally, over two-thirds of local authorities have been shut off from important leadership discussions. Grimshaw also noted in his report that NHS England’s planning guidance “falls short in setting out detailed expectations in terms of local government engagement in the STPs and processes for sign-off”.

“In terms of enhancing the voice and influence of local government, boroughs may wish to consider the options for ensuring that Health and Wellbeing Boards and Chief Executive and Director leads are supported to maximise their involvement local and sub-regional STP partnerships,” Grimshaw added.

Strong ties with devolution

London also has the advantage of its health devolution package which, according to an investigation into Greater Manchester’s councils, could be better for effective care integration than STPs.

Grimshaw recognised this advantage during the board meeting, writing in his report that “there are clear overlaps” of the STP process with the goals of London’s devolution pilots.

“As a consequence it will be important to ensure that pilots and STPs support each other rather than one undermining the impact of the other,” he added.

“The interplay with devolution merits further exploration. Firstly, the devolution agreement was reached prior to the publication of NHS Planning Guidance, and yet a great deal of the aspiration for transformational change expressed in the Planning Guidance overlaps with the bold aspirations of the devolution agreement.

“It is therefore critical for devolution propositions to feature, where relevant, in STPs. To assist with this, officers in London Councils and the London Partners are working with pilot areas to develop materials which can assist with enhancing the profile of devolution in London STPs.”

He also admitted that the delivery of “credible and convincing” STPS can attract financial support, which could in turn accelerate devolution planning.

“In contrast, in a position where STPs do not meet the expectation of the national system, questions remain over how any subsequent intervention would work for or against the transformation planning in pilot areas. For these reasons, a strong STP is in the interest of borough devolution pilots,” Grimshaw said.

Finally, in his final recommendations to the board, the strategic lead said leaders from London Councils must recognise the “importance of strong and credible” STPs to the success of health and care devolution in the capital, and agree to “support local and sub-regional working which ensures devolution pilot visions, plans and strategies feature prominently in STPs”.


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