NHS long-term plan must let local systems lead, says new report based on provider and commissioner views

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The NHS long-term plan must help bring about a “breakthrough” in the development of local health and care systems by allowing them greater freedom and minimising central control, according to a new report based on the views of NHS Confederation members.


The Confed is calling for a focus on tackling the barriers to local system working as NHS England prepares to publish its blueprint for the coming decade.


Its chief executive Niall Dickson said: “We recognise we are calling for increased freedom for local systems at a time when the health and social care service faces significant challenges – and that this may feel counterintuitive.


“But if the logic of the Five Year Forward View and the STP/ICS movement is that the serious systemic problems facing the service will only be addressed via close partnership working at a local level, it is vital every effort is made to make these local approaches successful. Otherwise, we risk stifling local solutions by excessive top down control.”


The NHS Confederation’s report Letting local systems lead: How the long-term plan could deliver a more sustainable NHS is published today and comes after the NHS Confederation asked its membership, which is made up of NHS providers and commissioners, for a frank assessment of where local health and care systems are in their development and which key issues the long-term plan must address.


Key findings from the survey include: 

  • Six in ten leaders (61%) agree that sustainability and transformation partnerships (STPs) and integrated care systems (ICSs) currently under development in local areas represent the right approach for partnership working between the NHS and local government.
  • But the majority of respondents considered that only moderate progress (44%) or a little progress (42%) had been made in implementing the system working approach set out in the NHS Five Year Forward View
  • When asked what would make a difference, local leaders identified better local partnership working, improved engagement with staff, patients and communities, more effective local governance and a more supportive oversight regime

Based on the findings, the NHS Confederation is calling for the long-term plan to:


  1. Make support for effective local leadership and relationships a priority
  2. Focus attention on the key factors that will allow local improvements to health and social care services
  3. Shift the focus of regulation from performance management to improvement support
  4. Support local systems to strengthen ownership in their communities of the long-term plan vision

Niall said this call for greater freedom comes with a quid pro quo. He added: “For this to work, of course local leaders from within and beyond the NHS will need to implement new ways of working, embed local accountability mechanisms and involve staff and the wider public as services transform.”


Jane Milligan, Senior Responsible Officer for the East London Health and Care Partnership said: “In North East London we have made some real progress in partnership working over the past two years, but strengthening this further is key if we are to accelerate our local integrated care development and tackle key challenges such as workforce and prevention.”


Wendy Saviour, Managing Director of Nottingham and Nottinghamshire ICS, said: "Nottingham and Nottinghamshire have a long history of collaboration and we will continue to build on these foundations to help us deliver positive change and help people be treated and cared for at home, or as close to home as much as possible.


"Now more than ever we need to be able to work across organisational boundaries to put patients at the heart of decisions around health and social care. We welcome the plan and the challenge for our partnership is to ensure that we use the resources we have to provide the most efficient and effective care for local people."

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