STPs – how sustainable or transformative are they?

Posted on 21/02/2017 by Tim Gilling.

Tim Gilling, discusses how scrutiny should approach Sustainability and Transformation Plans (STPs).

Last year the BBC called STPs ‘secret plans to cut services’. At the time, the Guardian was slightly more charitable describing them as ‘either radical local modernization plans or the end of the NHS as we know it’ – on reflection, maybe they weren’t being all that charitable. Today (21.02.17) the BBC reports that STPs include cuts or scaling back of hospital services across the country

Whatever your point of view about the published plans, as they gain visibility over the next few months STPs are likely to generate a mixture of reactions. Some people will welcome them as the products of a radical collaborative approach to planning and delivering future care. Some people will be suspicious of the process that has led to the published plans. Some people will be worried about the impact on their local services – will they still be able to access services in the same ways? And if not, how can they be sure that new ways of access will lead to better outcomes than before. 

These are the issues and questions that are likely to dominate local discussions and debates about STPs – whether they take place with local populations or politicians. Last November, CfGS along with NHS Clinical Commissioners, the NHS Confederation and National Voices, published a checklist about STP governance and engagement. The checklist contains some key questions about governance, scrutiny and accountability, about system wide financial control totals, about public engagement and about partnerships and collaborative working.

For STPs to be successful, the relationship with local government is key – the synergy between healthcare and social care and the essential council public health role. Things work differently in local government – decisions are taken in a very public and political arena, in ways that do not always match local or national NHS planning cycles. And local councillors have different roles in local government. It’s important to understand these roles so that engaging councillors about STPs is efficient and effective. It’s important to understand that council cabinets, health and wellbeing boards and the scrutiny function are different and that talking to one is not sufficient to be able to say you’ve talked to the council. And for clarity, engaging with elected representatives is separate and different to fulfilling other patient and public participation duties.

Councillors’ health scrutiny role is a separate, significant part of the patient and public involvement architecture – alongside patient participation groups, CCG lay members, local Healthwatch, provider non-executives, public governors in foundation trusts. These other roles could be described as ‘outsiders inside’ – they are part of internal institutional or organisational governance. The scrutiny role is different – it is part of the outward facing, place based governance of an area or place.

So, in relation to STPs, there are two processes in play here – first a process which allows councils right now, through their health scrutiny function, to get information and answers to questions about STPs as they exist currently. And they can make recommendations based on what they find which must get a response. The second process is one which will likely have more impact in the coming months – where STPs contain plans for changes to services that are substantial, councils will need to be formally consulted on those plans and the referral powers of health scrutiny could well be triggered. I know that NHS England, the LGA and CfGS are very keen to develop knowledge and skills around this aspect of health scrutiny and the implications for STPs and service change. It seems to me there are risks for both the NHS and local government if the process doesn’t work well.

I’ve identified five issues around which initial engagement will take place around scrutiny of STPs:

  • Clarity about the status of STPs – are they products of informal collaboration that now need to go through more detailed discussions with stakeholders? Or are they a set of detailed, costed proposals for service changes that require consultation with council scrutiny functions?
  • Clarity about the content of STPs – are they simply an amalgamation of existing organisational plans that have been in public view for a while? Or are they radical transformation plans that contain lots of new thinking that now needs testing in public?
  • Clarity about the timeline for implementing STPs – is there an intention to write new contracts for new patterns of service during 2017? Or is there a longer timescale?
  • Clarity about purpose of STPs – what are the ambitions for the outcomes from STPs? Is there a balance between better outcomes and reduced cost?
  • Clarity about responsibility and accountability for STP implementation – where there has been an independent local STP leader, has that role ceased with publication of the plan? Or have they a role in future discussions about implementation?

We’re keen to develop a resource for health scrutiny that supports proportionate, effective and influential engagement with STP leaders. There are risks if future engagement doesn’t work well – but there are undoubted opportunities to improve the health and care of local populations if it works well.  

If you want to find out more about how CfGS can support your area around scrutiny and governance of STPs then get in email Tim Gilling or call: 020 3866 5101. CfGS is also running an Advanced masterclass in health and social care scrutiny on 16 May which will focus on reconfiguration (including STPs) and public health prevention – follow this link for more information and to book.


About the Author: Tim Gilling

Tim is a Director at the Centre for Governance and Scrutiny, leads on health and social care and oversees our work in Wales, Scotland and Northern Ireland.