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It’s complicated (part I): Why health cannot afford to go it alone on STPs

Vanessa Reeve

STP Part 1

It has been reported that a number of Sustainability and Transformation Plans (STPs) have been developed with little or no buy-in from local authorities.

Going back to basics, the proposed scope of the STPs was to improve quality, develop new models of care, improve health and wellbeing, and improve efficiency of services. The guidance was also quite clear that although the focus of the STPs would be on NHS services, that they must also cover better integration with local authority services.

Relationships are therefore key to the success of the STPs. However, recent reports on STPs – such as the Kings Fund saying that ‘STPs are the right things done badly’ – shows that health services and partners still have a long way to go in making these relationships work.

  • Firstly, the decision by councils to publish STPs over accountability and transparency concerns demonstrates the gulf in culture between ‘top down’ NHS and locally conscious and connected (and political) councils. All key players across each local health economy need to inform the STP, and be bought into the planning process to increase the likelihood of success.
  • Secondly, STPs are being developed in an NHS environment that was not designed to support collaboration, resulting in an inherent mentality to focus on their own services and finances rather than working with others. If STPs are going to work, then they need to establish a mutual understanding of each other’s priorities, and work towards common goals.
  • Thirdly, it raises a question of leadership. Simon Steven’s himself has said that some STPs are “short of the leadership that is capable of engaging in the task ahead”. Strong leadership is key to bringing the key partners and stakeholders together, and to set clear direction and priorities. This leadership – that focuses on the whole system, including councils and patients themselves – appears to be lacking.

It is critical for NHS organisations to collaborate with (as opposed to competing with) local authorities to integrate and provide a fit-for-purpose model of care that can manage increasing demand on the system, and ultimately improve population health and wellbeing. Health services cannot do this alone – purely because of the growing resource and capacity constraints within the existing system. It is not possible to develop care coordinated and centred around the needs of the patients and service users without taking the time to understand what local communities want and without the inputs from local authorities and other health and care partners.

My colleague Caroline flagged up back in May how crucial relationships would be in the STP process. They are still crucial. In fact, the future of the health service relies on them.

Written by

Vanessa Reeve



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