1. Sustainability & Transformation Plans (STP)
October 2016

2. Background: The Five Year Forward View
The NHS Five Year Forward View, published in October 2014, considers the progress made in improving health and care services in recent years and the challenges that we face leading up to 2020/21. These challenges include:
the quality of care that people receive can be variable
preventable illness is common
growing demands on the NHS means that local health and care organisations are facing financial pressure
the needs and expectations of the public are changing. New treatments options are emerging, and we rightly expect better care closer to home.
There is broad agreement that in order to create a better future for the NHS, all those with a stake in health and care must make changes to how we live, how we access care, and how care is delivered.
This doesn’t mean doing less for patients or reducing the quality of care provided. It means more preventative care; finding new ways to meet people’s needs; and identifying ways to do things more efficiently.
For the NHS to meet the needs of future patients in a sustainable way, we need to close the gaps in health, finance and quality of care between where we are now and where we need to be in 2020/21.

3. Delivering the Five Year Forward View: STPs
The NHS Shared Planning Guidance (December 2015) asked every health and care system to come together to create their own ambitious local blueprint for accelerating implementation of the 5YFV
Sustainability and Transformation Plans (STPs) will be place-based, multi-year plans built around the needs of local populations:
used to drive a genuine and sustainable transformation in patient experience and health outcomes over the longer-term
not an end in themselves, but a means to build and strengthen local relationships, enabling a shared understanding of where we are now, our ambition for 2020 and the concrete steps needed to get us there
delivered by local health and care systems or ‘footprints’: organisations working together to deliver transformation and sustainability
The STP process is intended to be a process for partners to work together to identify, agree and address significant challenges

4. The Five Year Forward View
Achieving the 5YFV vision
For the NHS to meet the needs of future patients in a sustainable way, we need to close all three gaps in the 5YFV
A full STP will need to be underpinned by:
footprints’ understanding of current major local challenges against the 3 gaps
how those challenges are expected to evolve over the next 5 years
This doesn’t mean doing less for patients or reducing the quality of care provided. It means more preventative care; finding new ways to meet people’s needs; and identifying ways to do things more efficiently.
For the NHS to meet the needs of future patients in a sustainable way, we need to close the gaps in health, finance and quality of care between where we are now and where we need to be in 2020/21.
Health gap
National action required on major health risks such as smoking, drinking and obesity
Targeted prevention initiatives e.g. diabetes
Much greater patient awareness
Harnessing the ‘renewable energy’ of communities
Care gap:
Defining and measuring quality and tackling unwarranted variation
A menu of New Care Models for local areas to consider, backed by investment and flexibility in implementation
Neither ‘one size fits all’, nor ‘a thousand flowers’
New whole systems intervention regimes to transform local health economies and raise standards
Funding gap:
Action required on three fronts: demand, efficiency and funding.
Action on prevention and care could deliver significant efficiency gains
The Government has committed to an additional £8bn in funding by 2020 and, with this investment and implementation of new care models we believe that we could achieve 2% rising to 3% over the next Parliament, closing the £22bn gap

5. Forming and managing footprints
Footprints are local geographic areas where people and organisations have agreed to work together to develop robust plans to transform the way that health and care is planned and delivered over the next five years
In defining the footprints, local areas considered:
Geography - including patient flow, travels links and how people use services
Scale - the ability to generate solutions which will deliver sustainable, transformed health and care which is clinically and financially sound
Fit with footprints of existing change programmes and relationships, such as Vanguards and Devolution areas
The degree of existing and future challenges across the footprint
Leadership and capacity to drive change
44 footprints collectively cover the whole of England
They range in size and population – around 300,000 to 2.8 million people:
Each footprint asked to set out governance arrangements
The majority of STP footprint leads now confirmed:
RECOGNITION THAT THIS MEANS THAT IT DOESN’T MATCH TO LOCAL HEALTHWATCH FOOTPRINTS AND SOME, E.G. GREATER MANCHESTER, HAS AT LEAST 13 LOCAL HEALTHWATCHES
Geography - including patient flow, travels links and how people use services
Scale - the ability to generate solutions which will deliver sustainable, transformed health and care which is clinically and financially sound
Fit with footprints of existing change programmes and relationships, such as Vanguards and Devolution areas
The degree of existing and future challenges across the footprint
Leadership and capacity to drive change
Footprint leads include NHS provider Chief Executives, CCG Accountable Officers, Local Authority senior leaders, and clinicians – recognising the need for local systems to work in partnership. Footprint leads will be responsible for convening and chairing system-wide meetings, facilitating the open and honest conversations that will be necessary to secure sign up to a shared vision and plan. They are part of an emerging national cadre of system leaders who will drive health and care transformation. This is a new kind of leadership role, working across organisational boundaries. Footprint leaders will help to build consensus and ownership in their communities for their local plans, while providing the leadership needed drive the transformation needed improve the quality of care, health and wellbeing, and finance and efficiency.
Local areas considered: geography, scale, fit with existing programmes, leadership etc.
Approaches varied across the country to take account of local circumstances

6. In July we held a face to face review with all 44 footprints to provide a checkpoint and review their draft plans 8 7
December onwards 6
21 October 5
16 September
Understand key local issues
Define early vision and priorities
July
Draft plans identifying 3-5 key decisions
15 April checkpoint
30 June checkpoint
44 visits to Footprints 2 3 4
29 July
2-year planning round complete
STP submissions
Finance template submissions
Aggregate analysis day 1
Transition into implementation
Planning guidance published
Collective leadership agreed
Communications to footprints
Establish common purpose
Identify and quantify opportunities and develop plan
Build the leadership
Develop the vision and take early action
STP agreement and implementation
Engagement of staff and communities at every stage

7. Further information… More details can be found at:
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