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Sustainability and Transformation Plans – Promise or Peril?

Two fictional characters, Val, a volunteer, and Sal, a salaried professional, last seen talking about the experience of volunteering, having been having a chat about what they’ve been getting up to recently.

Val – So, what have you been up to this month?

Sal – Lots – health and wellbeing policy, public health research funding applications, the state of the local health service.

Val – Anything you’d particularly like to talk about?

Sal – Well, I suppose the things that’s on everyone’s lips. You really can’t go to a work do or a social event without people bringing the subject up.

Val – The referendum?  But what’s that got to do with health and wellbeing?

Sal – Well, perhaps only second to the referendum in its profile.  I’m talking about STPs of course.

Val – STPs?  OK, you’ve got me.  Sexually transmitted … what?

Sal – No, more important (and perhaps more insidious and harmful) than that.  Sustainability and Transformation Plans.

Val – Glad you brought those up – we’re getting rather too many people reading these blogs so anything you can do to keep the numbers to a manageable-

Sal – OK, no need to be like that.  They’re important.

Val – Really?  Will they solve the problems of the health service?

Sal – there’s a chance they might help.  But there’s also a risk they could be just a bit disastrous.

Val – Not a fan then.  Can we just go back a few steps, remind me again, what are these sexually trans-

Sal – Sustainability and transformation plans.  Well, planning guidance at the end of last year [ref 1] said every area had to produce a one year operational plan and a five year sustainability and transformation plan.

Val – Sounds good to me (except perhaps for the soviet overtones) – a bit of long term planning.

Sal – And it was to be about integration – bringing different parts of the health system together, oh and local government.

Val – Integration – good.  That’s another thing on everyone’s lips.  And not forgetting local government, even if only as an afterthought.  I’m not quite getting why you’ve got this adverse reaction to them.

Sal – Well, the geographical areas these plans would cover were to be decided locally, and they were to be drawn up with the involvement of local people.

Val – No, I’m still not getting it.  It still sounds fine to me.

Sal – Except that’s not what happened.

Val – Don’t tell me – it’s one of those things that takes so long to get agreed, by the time you do, it’s too late to get anything useful done?

Sal – No, the first plans have to be submitted by the end of June.

Val – Well, that’s good.  Quick progress.  Submitted to whom?  To the Health and Wellbeing Board, to local people?

Sal – No, to NHS England.  Involvement with local people has been virtually impossible in the timescale.  The areas, which were pretty much imposed from above, include a number of different Health and Wellbeing Board areas.  And June seems to have proved too short a timescale to get anything meaningful agreed [ref 2].

Val – Oh, I’m starting to get it.  But you talked about local authorities being involved – that’s a good thing, surely, and that must mean Health and Wellbeing Boards involved too.  … Mustn’t it?

Sal – Well local government has been involved but not very much in many areas [ref 3].  And this is all independent of Health and Wellbeing Boards.

Val – But if this is about longer term strategy integrating health and local government, wasn’t that what Health and Wellbeing Boards were set up for, by statute?

Sal – Exactly.

Val – So why not use them?  Why not push these new plans through them?

Sal – Probably because they think they haven’t worked.  Simon Stevens recently said that the STPs were “work-arounds” for a set of institutional arrangements, governance structures and incentives that are pulling people apart [ref 4].  It’s not clear what he was talking about – it may have been about tariffs and the relations between CCGs and providers, but he may also have had Health and Wellbeing Boards in mind.

Val – So it’s not the idea of long-term, joint planning you object to then.

Sal – Not at all.  No, it’s the short term imposition of the areas and process, where relationships will have to be developed virtually from scratch, with lip service paid to the involvement of local government and local people and cutting across other initiatives, some of which have been going for some time and are about to bear fruit.

Val – So, you’re saying they’re a dangerous distraction?

Sal – Yes.

Val – And if they don’t deliver much and take people away from existing good work, they could do more harm than good?

Sal – Couldn’t have put it better myself.

[ref 1] NHS England’s planning guidance, December 2015

[ref 2]

[ref 3] “Over two-thirds of councils shut out from STP health leadership talks”:

[ref 4] in a speech to the NHS Confederation:

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