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STPs ‘will meet opposition’ due to lack of council involvement

The controversial STPs would be more likely to succeed if there was proper engagement with local councils and communities, the chief executive of the Local Government Association has claimed.

In a Communities and Local Government hearing, Mark Lloyd said there was a “spectrum” of STPs, from areas of “outstanding practice” to areas where councils were “refusing to support the plans”.

A recent report from the Chartered Institute of Public Finance and Accountancy (CIPFA) revealed that the STPs lack robust plans to deliver savings and should make more use of councils’ involvement.

Lloyd added that the principle of integrated care “could make a big difference”, but that draft STPs so far had a mixed record in delivering them.

“Where they’ve not worked are where plans have been introduced in secret,” he said. “Where they’ve not worked are where communities have not been engaged. Where they’ve not worked are where politicians are not at the table and, in some areas, as a consequence of those failures, plans will meet opposition as they’ve been made public.

“In areas where councils have been inside, communities have been involved, plans have been evolved in a way that’s right for local circumstance, it will make a big difference in solving the dilemmas we face in social care, health and wellbeing more generally.”

Two Shropshire councils recently refused to endorse their region’s STP, saying that it was insufficiently developed.

Lloyd described STPs as “at least a start” that would “nudge” the social care sector towards greater sustainability.

Jon Rouse, chief officer of the Greater Manchester Health and Social Care (GMHSC) Partnership, said he agreed that there was a need to make councils “full and active partners” in STPs.

He added that the acute funding crisis in social care is creating “artificial barriers” by making the NHS reluctant to take on the financial risks of partnering with councils.

Lloyd noted that there was an “overwhelming” case for more social funding and the government’s failure to address the issue in the Autumn Statement had been “a mistake”. “The foundations are not solid and the future looks grim unless we get an injection of further resources,” he told MPs.

However, he said he hoped the issue was something the government would “come back to” in the local government finance settlement, which is due next week.

‘Jury is out’ on savings benefits of integrated care

Rouse told the committee that the “jury was out” on whether integrated care could deliver savings, because the “systemic place-based integration” currently being introduced in Greater Manchester, which gained devolved powers over healthcare in April, was on an unprecedented scale.

He did indicate, however, that a crucial measure of successful care integration is the ability to move care from acute to community services. “If you don’t do that, you can’t save money,” he said. “You do that by reducing demand for those services, which means it is safer to reduce some of the supply.”

Rouse also warned that the GMHSC Partnership would be affected because it hadn’t been able to secure baseline protection for social care funding.

“I think in Greater Manchester we know how to deal with the NHS gap for the next four to five years, I don’t think we know how to close the social care gap,” he said.

Board papers from the GMHSC Partnership also indicated that the lack of social care funding could “undermine” the integration initiative.

Furthermore, Rouse called for localities to be allowed to “make the judgements” on how much of the Sustainability and Transformation Fund should be distributed to social care and acute care. In addition, he said the fund needed to be aligned with other incentives to improve care.

Professor Gerald Wistow, visiting professor in social policy at the London School of Economics and the third witness at the hearing, claimed that there “wasn’t a hope” of achieving integrated care by the target date of 2020.

“Broadly speaking, to achieve large scale cultural and systems change, you are looking at a minimum of five, probably 10 years to be able to do it,” he said. “If we’re setting people unrealistic goals, you are almost setting them up to fail.”

He also argued that the health and care system had “lost an opportunity” by not giving Health and Wellbeing Boards the power to make decisions about the commissioning budget when they were established.

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