Kings Fund Conclude STPs Represent a Positive Step Forward for the NHS

The King’s Fund has been examining the usefulness of the government’s Sustainability and Transformation Plans (STPs) for the NHS and has concluded that they offer the best hope for improving health and care services in the NHS, despite having been beset by problems so far.

STPs are currently in development in 44 areas of England but have not been fully embraced, meeting strong local criticism in the areas in which they are being developed.  Many of these criticisms are shared by the Kings Fund and have been highlighted in their report:

• The regulatory environment, informed by the Health and Social Care Act 2012, in which collaborative working is made more difficult, due to the focus on competition, is severely hampering progress and innovative thinking.
• Involvement of local government has been patchy.
• There has not been enough time to adequately involve clinicians and frontline staff.
• With huge pressure on NHS finances, some plans are being based on assumptions and projections that local leaders lack confidence in.
• Patients and the public have been ‘largely absent’ from the process.
• STP leads are struggling with a confused process, with unclear or changing deadlines and instructions from national NHS bodies.
• There is a lack of governance structure or formal authority for STP leaders that has led one STP lead to describe their role as being like ‘operating in a sea of fog’.

Despite these problems, the King’s Fund urges the government and the NHS to continue to back STPs as they believe they offer the best hope for delivering long term improvement in health and social care.

The report made the following recommendations for making them work better.

• all parts of the health and care system, as well as the public, should be involved in the plans;
• improved governance is needed, with the role of STP leaders strengthened and clarified, and NHS regulation changed to make it easier for organisations to work collaboratively;
• national bodies in the NHS need to ‘stress test’ STPs to ensure the assumptions behind them are credible and the proposed changes realistic.

Chris Ham, Chief Executive of The King’s Fund, said: ‘The introduction of STPs has been beset by problems and has been frustrating for many of those involved, but it is vital that we stick with them.  For all the difficulties over the last few months, their focus on organisations in each area working together is the right approach for improving care and meeting the needs of an ageing population. It is also clear that our health and care system is under unprecedented pressure, and if STPs do not work then there is no plan B.”