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Can Sustainability and Transformation Plans deliver a better future for the NHS?

LSBU publishes 'Sustainability and Transformation Plans: How serious are the proposals? A Critical Review', looking at the 44 existing STP plans for the NHS
15 June 2017

“In short, ‘No’, not unless they change direction”, say the authors of a new report, entitled ‘Sustainability and Transformation Plans: How serious are the proposals? A critical review’, published this week by London South Bank University (LSBU).

To deliver a better future for the NHS, the authors argue that the 44 existing Sustainability and Transformation Plans (STPs) for the NHS in England, initiated by NHS England in December 2015, would need to be given the legislative powers and support necessary to achieve effective collaboration, plus some much-needed clarification on their role.  

The report also recommends that STP leaders need to plan ahead based on the reality of their current situation, identify changes that are evidence-based, develop workforce plans that match their ambitions, and focus on reducing demand before removing resources from the acute sector.  At present some elements of these recommendations are missing in all of the 44 published STPs.

Overall, this critical review reveals a distinct lack of comprehensive planning and evidence-based policy making, in all 44 STPs, of sufficient quality needed to deliver the level, pace and scale of change required for the future transformation of the NHS.

The report finds that none of the STPs are ready for implementation due to:

  • funding shortfalls;
  • lack of legislative framework to support collaboration across health and care;
  • lack of clarity on the role of the STP and its leadership;
  • challenge of collaborating across multiple organisations in financial challenge;
  • speed of planning that was required;
  • failure to ensure engagement with local government;
  • lack of clarity about accountability to citizens;
  • failure to produce adequate business plans;
  • lack of workforce plans (two thirds without any detail); and
  • lack of focus on reducing demand before switching resources away from the acute sector.

The authors propose that a viable business case must first be established in order to take full account of the proposed changes to the health and care system and to ensure that sufficient staffing and adequate capital are made available to establish new services and prove their effectiveness, before existing services are reduced. The STPs need clarity on their accountability and authority, and legislative change to enable collaboration.

Co-author of the report, health economist Seán Boyle said: “The health and care system needs time to develop partnerships, and a legislative and accountability framework that fosters collaboration.”

“That is why this report recommends a constructive overhaul of each of the 44 STPs, looking at the appropriate framework for that work in terms of geographic area and what parts of the health and care system should be involved including the stakeholders for that area of work, the partnership agreements required and the accountability to the population of the proposed changes.”

Professor Rebecca Malby at LSBU’s School of Health and Social Care, who commissioned the report said, “There is an acute need for the evidence base supporting the case for change in each of the 44 STPs within the NHS to be substantiated further before the Service commits to launching plans for widespread ‘transformation’.  STPs also need time to clarify and develop their leadership function – moving from a top down command and control approach to a planning and enabling approach.”

Professor Warren Turner, Dean of LSBU’s School of Health and Social Care said: “Faced with tightening financial pressures on the NHS and social care the weakness or absence of serious workforce plans means there is little reason to believe that these ambitious reductions in demand and pressure on acute services will be achieved in the timescale proposed.”

Read a full copy of the report and commentary here, under ‘Research’.

The 44 sub-reports can be read here.

Read a blog by Professor Rebecca Malby about the findings and the potential here.