How the King’s Fund report can help us get engaged in STPs
The NHS Sustainability and Transformation Plans (STPs) have been a source of pain for many NAVCA members throughout 2016. As we near the end of the year they are starting to attract more public and press attention. Sometimes it is good to share the pain.
Last week headlines on the BBC included the King’s Fund report on STPs. The BBC reported secret cuts and threats to hospitals but these headlines don’t tell the full story. The report is a really well written and clear explanation of STPs and how they are being produced, focusing on four of the 44 STP footprint areas.
A clear message that came out was that there was support for the aims of STPs within health systems and local authorities but the process wasn’t what anyone really wanted. What I found interesting was that although this report focussed on STPs from a local government and local health system perspective, a lot of the lessons and issues highlighted were similar to the issues NAVCA members have told us about.
Here are some key lessons from the report.
- The timescales are tight. Where STPs are working it is based on pre-existing relationships. This matches what NAVCA members have told us. Voluntary sector engagement is best where there are existing relationships, particularly between NAVCA members and CCGs.
- Local authorities often feel left out (although in a few cases local authorities are leading STPs). Birmingham City Council chief executive Mark Rogers has already said that STPs are being forced to adopt an “NHS first” approach and councils seem to be particularly unhappy when STPs are suggesting hospitals can be closed or services downgraded. One local authority leader complained in the report that there is a difference between being informed about a plan and being actively involved in developing it. It made me think ‘welcome to our world’.
- The report says “the groups most obviously absent from STP governance processes were patients and the public”. It suggests there are two main reasons for this; lack of time for adequate engagement and instructions from NHS bodies to keep details of draft plans out of the public domain. This won’t come as a surprise to NAVCA members. The report does suggest that public involvement will improve once plans have been published. Does this mean we need to get ready to be more involved after Christmas/in the new year? Be prepared!
- The report says that STPs started being about transformation but have increasingly become about savings. This makes me think that a major offer the voluntary sector has is to inject back in to the process a bit of transformation.
- Quite a few times the report shows that everyone agrees with the idea and there is a lot of goodwill but not the structures to get decisions made. This should be borne in mind as you try to engage with your local STP – local health partners are struggling at times to understand how they work with each other.
- The report says that management consultants are being used in the plans. I only raise this as something to think about if your STP team want you to help them with their plan.
The final point I’ll highlight is that it says “interviewees talked about the difficulties of accessing and engaging with a disparate number of VCS groups across their area”. Although this may at first frustrate us, this presents you all with a tremendous opportunity to contact your STP team to help them connect with all the disparate VCS groups if you haven’t already done so.
You may want to quote from NHS England’s September advice to STP teams, Engaging Local People, that “locally, the best source of support for linking with the voluntary sector is frequently the council for voluntary services (CVS), sometimes called a local development and support agency.”
Finally, I would like to share my favourite quote from the report. It seems to explain in a nutshell how the NHS works;
“In many ways, STPs represent a complex ‘workaround’ to the fragmentation and complexity introduced by the Health and Social Care Act”.