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Date(s) - 10.04.2017


Broadacre House


A discussion about whether Sustainability and Transformation Plans will solve the NHS’ problems or not led by John Kennedy and David Taylor-Gooby from the SHA.

All welcome, but please let David Taylor-Gooby know at 0191 5870008 or David.Taylorgooby@btinternet.com if you can come.

What is a Sustainability and Transformation Plan?

To understand what an STP is we need to go back to the Five Year Forward View, published in October 2014. It mapped a way forward for the NHS up until 2020/2. The point it made was that the NHS had to change, to adapt to a situation where many people have long term conditions and bad lifestyles contributed to ill health, away from an emphasis on curing illness, to prevention and long term care.

It makes the following points:

  1. The first argument we make in this Forward View is that the future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health

2 Second, when people do need health services, patients will gain far greater control of their own care

3 Third, the NHS will take decisive steps to break down the barriers in how care is provided between family doctors and hospitals, between physical and mental health, between health and social care.

The future will see far more care delivered locally but with some services in specialist centres, organised to support people with multiple health conditions, not just single diseases.

In addition, as is well known, the NHS undertook to make considerable efficiency savings in return for additional funding from the Government. These were far tougher than any made before. There had previously been the Nicholson Challenge. In particular many Trusts were running deficits.

The STPs were a response to this document. NHS Guidance stated

We are asking for every health and social care system to come together, to create its own ambitious local blueprint for accelerating its implementation of the Forward View.

As a truly place-based plan, the STPs must cover all areas of CCG and NHS England commissioned activity irrespective of delegation arrangements. The STP must also cover better integration with local authority services, including, but not limited to, prevention and social care, reflecting local agreed health and wellbeing strategies.

But we cannot lose sight of the need to return the provider sector to financial balance in 2016/17

What the STPs mean for the North East

There are 44 “footprints” for the whole country, with 2 in the North East They are based round the Tyne and the Wear in the north, and the Tees in the South. Patient flows tend to follow rivers. The big issue is rationalising the hospital sector and transferring resources into community care. Hospital provision in the North East is regarded as the best in the country, but there is 20% higher use than in the rest of the country. The STPs are looking at concentrating expertise on particular sites to ensure the efficient use of consultants. The controversial aspect of this is that it means concentrating a full Emergency Service in a reduced number of “Major Trauma Centres” so that not all hospitals can provide a full range of A&E services.

Cooperation between the different sectors is not always easy, particularly because of the competition provisions of the 2012 Act. It can be done at the grassroots level by the establishment of “Primary Care Hubs” where social services and clinical staff work together based on groups of GP practices. These would provide “wrap around care” for those with long term conditions.

It is the CCGs, who control the funding, who have to drive this.

Another issue which inhibits cooperation is the absence of an effective regional sector. Many of the achievements of improving public health were done through bodies such as ANEC which no longer exist. It would help all this if there was a regional body such as the old Strategic Health authority, with the power to pull the now fragmented nhs and local government together. That would be the only way to ensure effective cooperation and ensure the transfer of resources which is needed. It is very difficult under the present structure and rules to initiate “Place Based Commissioning”

Note BHPs and STPs

The BHP, (Better Health Programme) was an NHS initiative to rationalise hospital provision. The STPs require the agreement of local authorities before they can be finalised. The BHPs have now been subsumed into the STPs.

STP plans, particular hospital reorganisation, will be controversial.


Betts: STPs will only work if all players are involved

Sustainability and transformation plans (STPs) are only going to work if all players, including local government and the voluntary sector, are involved, the chair of the Communities and Local Government (CLG) Committee has told NHE.

Speaking to us shortly after the chancellor’s Spring Budget, where he unveiled an extra £2bn for social care funding, Clive Betts MP said that the STP model can’t be purely health-driven. The problem is that the health service has got most of the money, and it is so short of money that it doesn’t have the flexibilities it might need to implement the STPs,” he argued.

During last week’s Budget, Philip Hammond revealed an extra £325m to support “a small number of the strongest STPs” that are already in a position to implement their plans.

Responding to this news, Betts said: “It [the funding] might be interesting in kicking some of them off, but nobody I speak to thinks the level of efficiency savings can be delivered at the same time as transforming a service.”

Discussing council involvement in STPs, which he described as patchy, the CLG Committee chair argued that “in some areas local government has been pushed aside and ignored”. In others, like Sheffield, which I represent, the STP has involved the council and voluntary sector. An effort has been made there and it was apparent,” he added.

Prior to the chancellor’s STP funding allocation, BMA analysis suggested that an estimated £10bn will be needed to get STPs off the ground, and Betts said he was not surprised at those figures. The simple reason is that, if you are going to do major transformations to service delivery, you can’t stop what you are doing and deliver something new,” he said. There is almost always a period of dual running and reorganisation while you change things. If you are going to reduce the amount of provision in acute hospitals, and get more in the community for prevention, you need a period of transition. Prevention is great, but it takes time to have an impact.”

Reflecting on the extra funding for social care, Betts, whose committee is conducting an inquiry into this area, said: “Obviously, we are pleased that the chancellor has recognised that the problems of social care need more money, but are disappointed that he hadn’t gone as far as the committee asked.”

His committee had also requested a National Audit Office review to establish a figure that everyone could agree on with regards to the social care funding gap, but “the government didn’t even mention that”. To pluck another £1bn over two years and say that is enough misses the point,” said Betts. “The chancellor can’t be certain it is enough; he has no credible evidence to back it. And we could be back here in a year’s time having the same argument.”

While admitting that health and social care integration can go some way to reducing the stress on both systems, the committee chair noted that as NHS England’s chief executive, Simon Stevens, told them, “integrating health and social care will bring benefits, but it won’t solve the problem of social care funding in the long term”. The Sheffield South East MP added: “If anyone thinks all we have to do is get social care and health to integrate and then everything will be fine, then they are missing the point. We are still going to have a continuing need for extra funding for social care, simply because of demographics.”

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