1. SUSTAINABILITY & TRANSFORMATION PLANS (STP)
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Chris Hopson
Chief Executive
15 November 2016

2. STPs: reminder of what they are
A new approach to help ensure that health and care services are built around the needs of local populations.
Every health and care system in England will produce a multi-year Sustainability and Transformation Plan (STP), showing how local services will evolve and become sustainable over the next five years – ultimately delivering the Five Year Forward View vision of better health, better patient care and improved NHS efficiency.
Local health and care systems came together in January 2016 to form 44 STP ‘footprints’. The health and care organisations within these geographic footprints are working together to develop STPs which will help drive genuine and sustainable transformation in patient experience and health outcomes of the longer-term.
The footprints should be locally defined, based on natural communities, existing working relationships, patient flows and take account of the scale needed to deliver the services, transformation and public health programmes required, along with how they best fit with other footprints.
Sustainability and Transformation Plan (STP) leaders have agreed to convene the STP process and to oversee the development of local plans. They have been selected following local discussions about who is best placed to play this role, together with discussions with national bodies.
STPs footprints are not statutory bodies, but collective discussion forums which aim to bring together health and care leaders to support the delivery of improved health and care based on the needs of local populations. They do not replace existing local bodies, or change local accountabilities.
NHS England website November 2016

3. STPs, an emerging scorecard: positives
Stimulating much needed new conversations and relationships and…
…good collaboration to solve immediate and some mid term problems
Important opportunity for system wide discussions on how to transform, integrate health and care and head towards greater sustainability
Good, well advanced, plans in small number of areas with well established relationships
Local systems know they have to make this process work and are investing real time, energy and effort into it

4. STPs, an emerging scorecard: risks to manage
Many, especially “start from scratch”, footprints taking time to build relationships and get to big issues – October 2016 timeline unrealistic: more time needed
Risk that insistence on delivering unrealistic 2020/21 financial balance driving over ambitious, undeliverable, plans that could discredit process
Is it better to “ balance bottom right” come what may or “set out how far STP can realistically get”?
Danger of over-reliance on service reconfiguration as a silver bullet: capital and political constraints
Unclear purpose: big strategic issues; balance bottom right by 20/21; 17/19 money plan; path to transformation / new care models / health and care integration; or deliver myriad planning priorities
Risk increasing as a result of issues around governance, variable local authority involvement and public / clinical engagement
Confusion over STPs and footprints: plans, delivery or both; primary footprint we work within, or one of many competing for space?
Danger of acute domination: how inclusive of mental health, community, ambulance and primary and social care?

5. STPs: the NHS Providers view of where next
STPs have huge potential to bring together key local players to resolve deep seated issues. This is the only game in town and the process must be made to work
However for STPs to succeed we must:
give footprints the time they need to do the job required
fully involve appropriate partners, including cliniciams
ensure transparency and take local communities and their elected representatives with us
ensure STPs are underpinned with appropriate governance
focus on big strategic issues
be realistic and avoid over ambition to “balance bottom right”
carefully calibrate centre’s role: these must be bottom up plans or they won’t work
accept that STPs will not solve some of the fundamental problems affecting the sector like funding and workforce shortages and the unsustainability of social care