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Adebowale: STP integration players must lead, follow or get out of the way

Players across a health and social care integration patch should either be leading, following or getting out of the way, Lord Victor Adebowale has told NHE during an exclusive interview about STPs and place-based commissioning.

Lord Adebowale, who chairs the Place-Based Health Commission, argued that STPs will “act as a springboard to achieve more effective collaboration”, especially by helping organisations build the right relationships with commissioners, providers and partners.

“At the end of the day, relationships trump objectives every time,” he argued. “If you don’t have the right relationships, then you’re done. And STPs could start to build those relationships.

“There must be a notion of looking at the players across a patch and saying: ‘well, what is your contribution?’ In a nutshell, you’re either leading, following, or you should get out of the way.”

Asked how STPs can ensure all players feel like they have equal say in decisions, Lord Adebowale said it’s key that organisations are “orientated to the situation, to what they are there for, and what the current status of the health and social care system is and the impacts on the population it serves”.

“The NHS can take a lead in certainly pulling together that data alongside the local authorities, because in a sense they’re on the frontline in terms of not only having access to the information, but also leading,” he said.

“But they’re not the only people that contribute to health and social care – so the question is: how do you design intervention that brings all the players together to agree to orientate themselves around the challenge that’s facing them?

“Once people are orientated to that, it’s very difficult for people to say ‘it’s not to do with me’. You’re either leading, following, or you need to get out of the way – and once you’ve done that, you can then set objectives collectively that are actually meaningful to all the players in the room.”

Lord Adebowale, who also recently helped write the Five Year Forward View for Mental Health as part of his role in the mental health taskforce, acknowledged this process does take time.

“But it’s worth doing,” he added. “It’s a bit like, if you have 10 minutes to do something, it’s a good idea to spend the first four minutes, at least, planning what you’re going to do in the next six – as opposed to just diving in and setting objectives.”

He did also point out that, despite the potential, collaboration across the NHS and local authorities “is happening, but it’s just not happening fast enough”. There are “notable exceptions” where it’s moving at speed, but these exceptions “were always there, regardless of STPs, because they have the relationships in place”.

“I think it’s perfectly possible to move faster,” Lord Adebowale continued. “Of course, it doesn’t help that the financial positon provides a tendency for people to resort to short-term financial fixes rather than medium-term relationship building.

“It’s all done at a hell of a pace in terms of time, and it seems to me that one of the issues is that we need to be able to learn from where we are, and pick up that learning and repeat it.

“So, yes, I think some will fail, some will be challenged by the sheer speed at which we’re going – some would say necessarily so – and, of course, not having time to form the relationships necessary to set credible objectives means that the strategy is weakened.

“But that doesn’t mean to say that we can’t learn from every one of the STPs and use that learning to strengthen the relationships and develop the plans.”

Learning from failures

There have been several criticisms to the STP process since its genesis, most recently including concerns that plans could have a “catastrophic” impact on emergency care after a survey revealed a third of CCG leaders are consulting on shutting down emergency departments. Of the plans published so far, South West STP includes proposals to close an acute hospital, and North West London noted that it is considering “challenging” service consolidations.

Speaking at a Health Select Committee inquiry, Simon Stevens and Jim Mackey both accepted that STPs would take time to deliver – but Chris Hopson, the CEO of NHS Providers, warned that the time-consuming process to develop seemingly undeliverable plans “risks blowing up and destroying a process that actually seems to have a huge amount of fundamentally positive benefits”.

Speaking to NHE, Lord Adebowale did agree that it’s a major shift, but one that “places are demanding” as they start to realise integration is indeed possible.

“We need to not kill them just because they haven’t delivered everything instantly; we need to learn from them, we need to reiterate their importance, invest in the learning and the leadership, and press on,” he added.

“Learning is something you do consciously; you can decide not to learn, and that would be truly a waste of the time and effort by some very talented people. We have to learn from them because we’ve invested a lot of time and effort.

“I think it’s dishonest to say that with one leap we’ll be there. This is a complex system in a highly complex political and financial context, and it’s going to need us all to show some humility to the need for us all to learn.”

The upcoming November/December edition of NHE will feature a full-length interview with Lord Adebowale.  

(Top image c. Ian Nicholson, PA Archive)

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