Five issues to consider when developing STPs

LKady writting notes meeting

Sustainability and transformation plans (STPs) are a new way of planning health and care across local areas – ‘footprints’.

This emerging way of working will require a new set of skills and will create a new set of challenges for leaders at national and local level. Relationships will be key to their success.  

To support Confed members and their local partners with this new approach to planning, we’ve compiled a list of five issues to consider when developing STPs. You can also view how else the NHS Confederation is supporting members.

1. Camaraderie is critical

Over the next few months, new partnerships will need to be formed across a range of organisations often working with differing priorities, accountabilities and understandings of population health needs. Our recent member survey suggests that such relationships need time and nurturing, with immaturity of local relationships most commonly cited as a barrier to the success of STPs.     

Evidence suggests that in order to build these strong relationships, the NHS and a wide range of partners will need to unite around a common cause and stay focused on the ambition of doing what’s right for their local population. In some cases, this may even be at the cost of their own organisation’s interests.   

All key players across the local health economy will need to inform the local planning process from the outset to increase the likelihood of success. 

You may want to consider… 

As well as NHS, local government and community leaders, consider how to involve independent sector providers of NHS services and local enterprise partnerships (LEPs) in STP development. LEPs are business-led bodies authorised by government that provide local strategic economic leadership of growth (see consideration four for more information). 

Taken together, these leaders can bolster STPs with insights into how to access capital, the provision of additional capacity, and how to strengthen capability. Download the NHS Partners Network's briefing Capital, capacity and capability for further information on the independent sector's role.

2. Local views and voices 

The voice of voluntary and community sector partners, social care providers, patients and local government must be heard in the STP development process. This can be challenging at the best of times, but with such short timescales, meaningful engagement with everyone may not be easy. But having support from clinicians, politicians and the public can provide the necessary bulwark against challenges to local plans. 

The knowledge and insight into population health and care needs that voices can bring should be at the root of local plans. 

You may want to consider…

With such tight timescales, consider how best to engage with a wide range of local voices

  • Download Public and patient partnerships for tried-and-true techniques and case studies on effective patient and community engagement. 
  • Download the Five Year Forward View People and Communities Board's six principles for changing the way health and care organisations relate to people and communities. These are the six principles of engagement and involvement referred to in the NHS shared planning guidance (page 17). STPs are required to detail how localities will embed them to help deliver the Forward View.
  • Take a look atComparing apples with oranges?  for ideas on how to use evidence from the voluntary and community sector to help commissioning decisions that better meet the needs of local populations. 
  • Download Reconfigure it outfor tips on how to engage local stakeholders in planning and decision-making around health and care services.
  • View NHS England's Transforming participation in health and care for insights on how to involve patients and carers in decisions relating to care and treatment; and the public in commissioning processes and decisions.

3. Avoiding command and control 

The success of STPs will require a move away from the old command and control style of leadership to one in which the intentional and skilful management of relationships enables others to succeed individually, while achieving a collective outcome. 

Local leaders will need to come together to have difficult conversations and agree a shared course of action based on a shared understanding of local health and care needs. In turn, local leaders will need to feel they have the support and backing from national bodies to make difficult decisions locally.

You may want to consider…

This new approach to planning requires leaders to develop a new set of core skills. Consider the insights in Leadership in a matrix, which explores a range of skills needed operate across health and care, including conflict resolution and multi-party negotiation.

You may also find the following slide packs useful, as they share valuable learning and insight from health and wellbeing boards on their development as system leaders. 

4. Influencing the local economy

Since 2010, the local growth agenda has seen an increasing focus on place-based economic partnerships, including city deals, local growth deals and now devolution. As the NHS has a significant role to play in driving growth within local economies, a better understanding of this agenda can bring significant external investment into the sector. 

You may want to consider…

Engaging with your local enterprise partnership (LEP) and combined authority (if appropriate) to understand areas of mutual benefit between the evolving economic development landscape and your local health and care transformation agenda, particularly around innovation, skills, estates and public health.

Our local growth adviser, Michael Wood, is on hand to advise members on how to link up with their local leaders of economic growth. 

5. Alignment and support from national bodies

In our recent member survey, 86 per cent of respondents said they feel the national bodies work in a contradictory way. The national NHS will need to work more collaboratively to address what one Confed member recently described as: 

“NHS England directing local leaders to go right, NHS Improvement directing them to go left, when what they really wanted was support in going straight on with the common purpose they have already achieved locally.” 

You may want to consider…

There will need to be a balance of challenge and support between national bodies and local leaders. This challenge will need to be aligned to, and in pursuit of, the best interests of the local community.

Take a look at A culture of stewardship for insights on how local leaders can remain focused on the task of delivering greater value. Written by Professor Sir Muir Gray, the publication says national frameworks needs to "support local delivery by providing the space to make decisions of value and resist the temptation to encourage a blame culture."

Confed viewpoint and activities

Sustainability versus transformation 

STPs are just one building block – the assurance process will need to ensure that the foundations of STPs align and build on work already being done, including joint strategic needs assessments, Better Care Fund plans and existing integration strategies. 

STPs need to be a useful milestone in developing place-based integration plans. They are not the end of the journey – especially in relation to system transformation. We recognise that the first priority of STPs is achieving financial sustainability in 2016/17, so localities should focus on system transformation and prevention in integration plans. 

But health and care economies will need to ensure the plans don't simply shore up existing models of care, and that they lead to a transformation which sees greater resources put into community services and primary care, as well as self-care and preventative services. 

Supporting members

The NHS Confederation is supporting members' STP development in a number of ways. We are:

  • Hosting a roundtable with Lord Prior exploring what support the STP leads need.
  • Holding two workshops (organised by our NHS Partners Network) on how the independent sector and help health and care economies develop effective STPs.
  • Conducting interviews with those involved in STPs and will share learning and insights. 
  • Feeding in members' views to the STP Oversight and Advice Board, which we sit on on behalf of the whole system.

Find out more about STPs on NHS England's website

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