Swindells: Time to collaborate as legislative change for STPs not on horizon

An influential NHS England director has this week told trusts to not hold out on legislative change for STPs, and instead push forward into more collaborative ways of working.

Speaking to health leaders at Health+Care Show, Matthew Swindells, NHS England’s national director for operations and information, urged trusts to get on with essential work optimising care pathways and not wait for legislation for STPs to be pushed through Parliament.

During his keynote address, which focused on strategies to optimise care through collaborative working and improving the STP process, Swindells was asked whether he felt legislation was needed for STPs to be successful and encourage trusts to continue with the STP agenda.

“STPs can’t have legislative change to make it work because I don’t see it coming in a hurry,” he told the audience. “At the moment, I don’t see any possibility that the clause that was in the government’s manifesto about bringing forward legislation being implemented.”

It comes after Jeremy Hunt said that STP legislation would only be acted on after Brexit, although Swindells argued that trusts could be waiting even longer than that for change to arrive.

He also warned that if the government did act and draw up legislation for STPs, it was likely that the law could considerably change the appearance of STPs.

“Any legislation might get snarled up in the House for so long that we don’t recognise it when it comes out,” he explained.

This led Swindells to encourage delegates present to instead look to working collaboratively within their STPs to overcome the challenges.

“The challenge for statutory organisations which are CCGs, acute trusts and foundation trusts is about saying to themselves that the challenges that we face cannot be solved in our silos and therefore the right thing to do is to partner and share decision-making,” he said. “It isn’t a ‘wouldn’t it be nice if…’ scenario, it’s far more, ‘the best interest of the population that we serve requires us to act differently to achieve better results’.”

Legislation needed to make success of STPs, think tank argues

The NHS England director’s message comes just as a new report by the influential think tank IPPR revealed that new legislation was vital to ensuring that STPs could drive better care and efficiency savings in England.

In their report called ‘Sustainability and Transformation Plans: What, why and where next?’, researchers argued that many of the challenges facing STPs was due to a lack of legislation in how budgets were pooled and how commissioning functioned locally.

IPPR also said that doing this would give regional bodies a formal role in the system and put placed-based health and care policy in place in their areas.

The report also called for the introduction of a new ring-fenced ‘NHS tax’, which would involve rising national insurance to raise £16bn to be put back into the health service over five years.

It also stated that national leaders, in particular the prime minister and health secretary, needed to lead a visible and high-profile public engagement exercise to make a case for NHS reform.

“The 2012 Health and Care Act created silos through the dissolution of primary care trusts and the strengthening in legislation of the provider-commissioner split which have not made reform easy,” said research fellow at the IPPR Harry Quilter-Pinner.

“IPPR is arguing that part of the solution to the problems preventing STPs from driving real change in the system must involve wrapping governance around STPs both to give them real power but also to make them more accountable for how they use this power,” he added.

“Amending existing legislation and creating new national legislation would move away from competition to collaboration.”



Dr Prasanna De Silva   05/07/2017 at 13:36

1. I think Foundation Trusts (FTs) will think twice about persusing STPs without a legislative back up, as this opens them up for costly legal challenges. So, our Jeremy will have to wait until Brexit is sorted out before pushing FT's to do this (which they were never happy about). 2. In any caseCompetitive local FTs (acute and MH) need a legal framework to collaborate. It always gives confidence to work together. 3. The general principle that if you give organisations freedom to operate, it is never easy to order them to do your bidding afterwards (especially those who are financially viable, so no leverage is possible) 4. When do NHS England / DOH / treasury realise it is better to follow public wishes on accessibility to form care pathways? There is no point in telling the public to not misbehave re hospital attendance. So, it is more sensible to have a Primary Care centre next to A&E in order to triage the 'walking wounded' to then pass on (if needed) to Psychiatry or focussed A&E? So out of hours should be 24/7. 4. This would allow Primary Care to be businesses dealing with cold and planned work, for example chronic disease management and cold surgery.

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