Key questions for the future of STPs and ICSs

NHS Providers | August 2018 | Key questions for the future of STPs and ICSs

NHS Providers have released the second in a  series of briefings on sustainability and transformation partnerships (STPs), this briefing follows a publication in February this year which set out the history of system working.  This latest  briefing summarises recent developments relevant to system working, sets out the state of play for STPs and integrated care systems (ICSs) and seeks to offer answers to a number of questions arising from the national policy focus on collaboration and integration.

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The briefing includes:

Key points

The context for collaboration

The state of play for STPs and ICSs

What works?

Questions and (tentative) answers

Summary

Resources

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Accountability and performance management arrangements for CCGs

This report explores the accountability and performance management arrangements for CCGs and looks at the implications of  STPs and accountable care systems for these| The Nuffield Trust

The NHS has developed systems to hold both providers and commissioners of NHS services to account. These have arguably become more complex with the introduction  of 44 sustainability and transformation partnerships (STPs). This report from the Nuffield Trust draws on analysis and insights from the current system, and explores the challenges and opportunities presented by STPs for accountability in the NHS. It is based on 13 interviews with senior CCG leaders and NHS England policy makers which took place in September 2016.

The report also explores how commissioners and providers respond to different approaches to accountability and performance management. The report then considers the implications of this learning for the future development of STPs, accountable care organisations and accountable care systems.

Full report: A two-way street: what can CCGs teach us about accountability in STPs?

Related Nuffield Trust blog: Staying accountable: NHS leadership in hard times

Where next for commissioning?

NHS Providers has published the next of its ‘Provider Voices’ series sharing a chief executive’s view on Where next for commissioning?

The chief executive of West Midlands Ambulance Service NHS Foundation Trust shares his view in relation to ambulance services.  Areas covered include designing pathways for continuous improvement, STPs, diversity of commissioning approaches and providing value for investment in commissioning.

Councillors’ perceptions of sustainability and transformation partnerships

Survey results strongly support the messages we have been hearing for months – STPs are largely excluding councillors from the STP planning process | LGA

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This document reports key findings from a survey of councillors carried out by the Local Government Association (LGA) between 6 April and 11 May 2017. The survey sought to  establish a clear national picture of local councillors’ views and experiences of their local Sustainability and Transformation Partnership (STP).

Single tier and county councils were targeted as they have adult social care and public health statutory duties, as well as a statutory duty to maintain a health and wellbeing board. Chairs of health and wellbeing boards and/or relevant portfolio holders, many of whom are also leaders or deputy leaders of councils, were invited to respond to the survey. A few additional respondents were also engaged through circulation of the survey in relevant online publications.

The survey was completed by 81 respondents from 68 councils, including two districts. Further information regarding methodology and respondents is outlined in appendix A at the end of this report. Council representation across regions and council types is outlined in appendices B and C.

Sustainability and Transformation Plans: What, why and where next?

The Institute for Public Policy Research (IPPR) has published Sustainability and transformation plans (STPs): what, why and where next

The NHS is facing one of the most challenging periods in its history, with a funding gap of more than £22 billion over the coming years. And the pressure on the social care system is more acute than ever, with many councils raising eligibility thresholds and making cuts to social care budgets.

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Image source: http://www.ippr.org

Sustainability and Transformation Plans (STPs) – which are local health and care reform plans, authored jointly by NHS and local government leaders to improve outcomes and drive greater efficiency in their local area – are one of the government’s main responses to this problem. These plans rightly focus on decentralising power within the NHS, investing in leadership and relationships to drive improvements, and on local health and care organisations coming together to overcome the silos created by the 2012 Health and Care Act.

This report looks at the most promising reform solutions that have been identified by STPs, and also sets out the range of challenges that stand in the way of them realising their vision for improved health and efficiency.

Download summary here or full report here

 

The future of commissioning

NHS Providers has launched a new publication series “Provider Voices” which promotes the views of leaders from a range of trusts and other parts of the service on some of the key issues facing the NHS.

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The first report Where next for commissioning? includes eight interviews that address concerns including the role of Sustainability and Transformation Partnerships (STPs) and accountable care systems (ACSs), the challenge of integrating health and care commissioning, and the future of the purchaser-provider split.

Related:

 

Saving Sustainability and Transformation Plans

Saving STPs: achieving meaningful health and social care reform | Reform

Current ambitions for NHS reform rest on Sustainability and Transformation Plans (STPs). These aim to bring local leaders together to create cohesive systems of care that are proactive, not reactive, with a focus on prevention and care being delivered in the community rather than in hospitals. They also aim for health and social care systems to properly exploit technology. All this will save time and money and deliver better quality care.

In their current form, however, STPs are not going to work. This paper identifies the three key barriers to success and sets out the five changes that need to be made if the plans are to succeed.

Recommendations:

  • STPs should design their own local health outcomes for which every organisation in the STP is accountable.
  • STPs should take a ‘one-system, one-budget’ approach. NHS, social care and public health budgets should be merged across the STP and commissioned by a single body.
  • Commissioners need to regularly evaluate whether providers are delivering on outcomes. Where these are consistently not delivered, services should be decommissioned and broken up to allow smaller providers to bid. Contracts should come up for renewal at regular intervals.
  • NHS Improvement should publish guidance clarifying how current legislation surrounding competition applies in the context of STPs.
  • STP footprints should have elected leaders who are held to account by the public.

Full report available here