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Stevens confirms up to 10 STPs will be ACOs in string of major revelations

The leads of England’s 44 STPs, who are due to be formally appointed soon, will be given a range of governance rights over the organisations within their geographical areas, including the ability to “marshal the forces of the CCGs and local NHS England staff”, Simon Stevens has revealed.

Although NHS England will set out a lot of detail about STPs in about four weeks’ time, its chief executive decided to “give some clues ahead of then” during a Public Accounts Committee hearing held earlier this week – including an indication that there will be no new money injected into the process.

Pressed by Anne Marie Morris, MP for Newton Abbot, whose many questions about the STP process left Stevens “lost for words”, the NHS England boss also revealed that between six to 10 of the STPs are “going as accountable care organisations (ACOs) or systems, which will for the first time since 1990 effectively end the purchaser-provider split, bringing about integrated funding and delivery for a given geographical population”.

“This is pretty big stuff, and people are pretty enthusiastic about it,” he told MPs.

Morris said delivering that would be “quite something”, but emphasised the need for leadership if that is to be realised – to which Stevens confidently invited her to a ‘field visit’ in some parts of the country to speak directly to frontline staff about this.

But despite his confidence, he urged MPs not to sugar-coat the situation, stressing that “these are a very difficult set of circumstances for different parts of the country to have to resolve”.

“The STP process is simply saying that the best way of resolving a shared and unified plan of action is to ensure that there is no bickering locally as to what that should be,” explained Stevens.

“Instead people should unite around a plan to make the best of the funding envelope that they have got. That is what we are supporting them to do. There are certain changes that we have got to make to help them get that right, and we are going to be setting those out at the end of March.

“We are going to set out at the end of March which parts of the country are going to move first and fast on that, but the whole country obviously has to make the next two years and beyond work within the budgetary envelope that the NHS has.

“Since the STP proposals were originally drafted, there has been a chance to kick the tyres on those and refine them in the light of the contracting round between different parts of the health service going into next year. That is the basis on which we will set a clear operating plan for the NHS for the next year.”

He then added: “What we are going to be doing at the end of March is setting out quite clearly the NHS delivery plan for the next couple of years. That will be very explicit about what the integration will look like in each of the 44 STPs and about the move towards accountable care systems in key parts of the country. That is in part about the health and social care interface, but it is not just that; it is also about join-up of physical and mental health services, primary care and hospital services.”

The NHS England chief was being grilled by MPs who presented proof from a National Audit Office report that concluded the Better Care Fund (BCF) did not make the savings it was set out to make. The committee’s chair, Meg Hillier, argued that the BCF was set up with “very specific targets”, none of which were met or delivered on funding.

But Stevens reassured that the same situation would not be extrapolated to STPs, answering: “The indicators in the BCF mark 1 were there to correspond to the net budget transfer that was coming out of the NHS cost to social care. That is not what we are doing now going forward with the STPs or the BCF mark 2.”

NHS priorities

Asked where NHS England’s priority lies – if it’s within STPs and the vanguards, integration or looking at deficits – Stevens said: “If we take as given the funding envelope available to the NHS for the next several years – which clearly is a very demanding set of circumstances that we have discussed previously – to succeed, there are three sets of things we’ve got to do.

“First, we’ve got to focus quite relentlessly on a smaller group of priorities and demonstrate that the NHS can bring about improvement on those areas. Cancer, mental health and the strengthening of primary care would be among those areas.

“Secondly, we’ve got to streamline the governance and support local implementation of some of these new care models, including changes to the way the urgent and emergency care system responds, to help offset the pressures we have seen showing up in the system this winter.

“Thirdly, there is a set of big-ticket nationally co-ordinated efficiency programmes that we have to put more muscle into, to create some of the headroom to allow those first two things to occur. That is what the delivery plan will set out.”

With relation to vanguards specifically, the NHS England CEO said there have already been “some encouraging news”: based on the first 18 months of their existence, the GP-based vanguards have seen their emergency admissions go up a third slower per person than the rest of the country. Similarly, the fully integrated hospital vanguards saw their emergency admissions go up by around half the rate of others.

“The vanguards that have been working in care homes have seen a marked difference as well—there has been a marked difference in the growth in emergency admissions between care homes that are part of the vanguard programme and those that are not. What we have to do is accelerate the roll-out of these kinds of approaches, and we have to use the STPs as a vehicle to do that,” he added.