So, the latest iteration of STPs had to be submitted by 21st October and despite – or perhaps because of – the NHS England calls for secrecy, the controversy surrounding them continues to grow.

How this all fits with progress on the Five Year Forward View is perhaps for another time – maybe when the plans have been published – but for now just a few comments on the process so far.

We have some idea, from an HSJ survey of 99 CCG leaders (£) what sort of things the STPs cover and what the likely problems with them will be.  The most common priorities are prevention, out of hospital services and sharing records and data.  So far, so not-unreasonable: those are amongst the things likely to make a difference in the coming years, though there could perhaps be more ambition around the use of technology.

What will undoubtedly be at the top of the headline, if not priority, list, though will be hospital closures or downgradings.  That’s what will steal the attention, and perhaps be a significant cause of their undoing.

So will it all work?  Not if you believe the survey of CCG leaders.  Asked what their level of confidence was that their plans would have the desired impact, 66% said low, 47% medium and just 1% high.  Hardly surprising considering how much was required of new, often artificial partnerships tackling complex issues in such a relatively short time.  The fact that they were required to come up with the correct answer – to balance the books – didn’t help honest planning.  But the biggest barriers as stated in the HSJ survey were funding and resources, organisational interests outweighing system wide ones and political opposition.

But the way patients and the public have been excluded from the whole process is perhaps most surprising, considering the mantra over recent years that they should be the centre of everything.  It is also somewhat counterproductive.  With indications that there will be not let up on resource restrictions (and if that changes it will only be to mop up an almighty mess) the best chance for change comes from those patients and members of the public who are now being ignored, whether in the form of self-help, peer support, co-production or active participation in system redesign.  Now, surely, is not the time to alienate them.

Something else striking about it all was exemplified by a line in a presentation I saw recently, which seems to be firmly in line with wider commentary, that STPs are ‘the only game in town’.  That seems strange when there is an existing statutory process that brings the whole of health together, along with local government and the voluntary sector to collectively plan improvement – surely just what the STPs are being asked to do?  That, of course, is the system of Health and Wellbeing Boards (HWBs) and joint health and wellbeing strategies.  They bring together all the relevant parties and at a scale where you might be able to make some difference to the prevention agenda.  And if the argument is that STPs are needed because HWBs aren’t working, where on earth is the evidence that STPs can be any better?

Sadly, it’s not as though these problems were unforeseeable.