NHS reforms

Few STPs meeting ‘scale and pace’ required despite 30 June deadline

Despite “lots of good initiatives” in NHS providers’ sustainability and transformation plans (STPs) so far, few are at the “degree of scale and pace” required by NHS England, it has been revealed.

In papers published ahead of NHS England’s board meeting tomorrow, the national body also acknowledged that workforce was still a “key issue in almost every footprint”, and that each area is at a different starting point.

“Some have strong relationships and a shared understanding of the problem and the solution; others have yet to agree what their base-line positon is as a system, what is driving cost and who needs to take what action when to drive cost out,” the report added.

The STPs, which were laid out in NHS England’s planning guidance for the next five years, form part of a two-pronged planning footprint that all trusts must adhere to in order to recover from financial deficit and safeguard future sustainability.

The majority of the 44 footprint areas have already nominated a leader to oversee and co-ordinate the STP process, which will be providers’ golden ticket to receiving a slice of NHS England’s £1.8bn bailout fund.

At the heart of these plans is the need to close the three ‘gaps’ highlighted in the FYFV – health, quality and finance – which NHS England admitted today will require providers to “confront” some “big choices” if they are to make the necessary changes to these gaps.

The board paper, presented by Ian Dodge, NHS England’s national director for commissioning strategy, added: “We have made clear it is the responsibility of each footprint to set out the big decisions that will really shift the dial, we will need to be ready to scrutinise then back them, and support the process of implementation.

Despite the majority of plans falling behind where they need to be, with just a few moving at the expected pace and scale, footprints will have to submit their plans by 30 June.

“These will form the basis of a face-to-face conversation with each of the 44 footprints throughout July,” NHS England added. Up until now, 24 footprints were seen directly by a national panel, with the remainder set to meet regional directors over the next couple of weeks.

These plans must take into consideration a broader view of where footprints need to be in 2020-21, taking into account allocations and the requirement to achieve financial balance by then. This will in turn highlight the “critical decisions” they need to make in order to “really shift the dial in their geographies/populations to close the three gaps”.

Different forms of support will be made available in due course, including workshops for programme directors, clinical leads and project teams; example plans from footprints; support by regional and central teams; system leadership support via the Leadership Board; and peer support through face-to-face and virtual events.

As well as identifying which actions lie within individual organisations and which changes rely on a footprint-wide transformation, areas must also ensure they consult the public, partners and clinicians on proposed changes through “meaningful engagement”.

“We appreciate that each footprint will be starting from a different point on this journey, so the level of detail expected in June submissions will differ accordingly,” NHS England added.

“For footprints that already have mature plans, we will expect fuller, more comprehensive submissions which reflect progress made to date.”

While final 2020 allocations are still subject to board decisions, NHS England has already made indicative allocations available. It said the funding available will be greater in 2020-21 than it is today, but admitted that levels of future growth “are more modest than the NHS has received historically”.

Local place-based funding will increase from just over £92bn this financial year to £107.7bn in 2020-21.

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