The context in which STPs have been developed is much more challenging than when the Forward View was published in October 2014. Financial and operational performance have deteriorated sharply, and the additional resources allocated to the NHS by the government are being used mainly to reduce hospitals’ deficits. Funds to invest in strengthening and redesigning care in the community – one of the top priorities in STPs – are in short supply, raising serious questions about the credibility of those plans that seek to reduce hospital capacity. Similar questions arise about proposals to prioritise prevention when public health budgets are being cut.
Notwithstanding these concerns, we believe that STPs offer the best hope for the NHS and its partners to sustain and transform the delivery of health and care services. The challenge now is to translate the ambitious proposals contained in the drafts into credible plans, with clarity about the most important priorities in each area. New care models demonstrate how services are being transformed, and their work needs to be shared and spread as rapidly as possible.
We have been supporting the work of the vanguard sites involved in NHS England’s new care models programme. The enhanced care home vanguards in Sutton, Sunderland, Wakefield and other areas are showing particular promise, closely followed by the most advanced primary and acute care system vanguards in Northumbria, Salford, Morecambe Bay, Somerset, North East Hampshire and Mid Nottinghamshire.
Multispecialty community provider vanguards in areas as diverse as Dudley, Stockport and Whitstable also offer a glimpse of a future centred on integrated out-of-hospital care, with ambitions in some places to evolve into accountable care organisations. A number of areas, including Frimley, aim to use STPs to close the care and quality gap by scaling up the work of the vanguards.
Two major challenges face STPs. The first is the need to adopt a realistic timescale for implementation of the plans that recognises how long it takes for innovations in care to become established and deliver results. The second is to create sufficient capacity to build on the foundations that have been laid already, when so much attention is being given to financial and operational pressures. New care models have the potential to address the root causes of these pressures in the medium term, which is why transformation and sustainability must be seen as two sides of the same coin.
NHS England and NHS Improvement should work together to oversee the development of STPs, and the government should support proposals to improve services. This should include backing plans to reconfigure acute and specialised services where the case for change has been made. The NHS also needs to strengthen the leadership and staffing of STPs without adding unnecessary complexity to an already cluttered organisational landscape.
Wherever possible, the proposals set out in STPs should be taken forward by NHS organisations and their partners working at a local level, with STPs leading only on those priorities that require co-ordination across a bigger footprint.
In the immediate future, these challenges have to be addressed by using existing resources more effectively and setting aside planned increases in funding to support new care models. In the longer term, the need to find extra resources for social care is becoming ever more urgent, while the claims of the NHS will also require a response given the infinitesimal growth in its budget planned for 2018/19 and 2019/20. It is no longer credible for the government to argue that it has provided ‘the funding needed to deliver the NHS’s own plan’ when most of the additional funding identified in the 2015 Spending Review is being used to keep services afloat rather than to transform care.