Fears over potential failure of high-cost NHS Sustainability and Transformation Plans

London South Bank University report claims five-year plans will fail unless they are radically overhauled

NHS Sustainability and Transformation Plans - which the Government hope will form a blueprint for the future of health, care, and finance across the country – will fail to save the health service unless they are radically overhauled, claims a new report.

The report Sustainability and Transformation Plans: How serious are the proposals? A critical review, is based on the findings of a team of researchers from London South Bank University (LSBU).

The health and care system needs time to develop partnerships, and a legislative and accountability framework that fosters collaboration

To deliver a better future for the NHS, they 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
  • The lack of legislative framework to support collaboration across health and care
  • A lack of clarity on the role of the STP and its leadership
  • The challenge of collaborating across multiple organisations in financial challenge
  • The speed of planning that was required
  • A failure to ensure engagement with local government
  • The lack of clarity about accountability to citizens
  • A failure to produce adequate business plans
  • The lack of workforce plans (two thirds have no detail)
  • The lack of focus on reducing demand before switching resources away from the acute sector

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’

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, they say, 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, added: “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.”

STPs need time to clarify and develop their leadership function – moving from a top-down command-and-control approach to a planning and enabling approach

And 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.”

The Government launched STPs in an effort to ensure health and social care services in England are built around the needs of local populations.

Under the scheme, NHS organisations and local authorities in different parts of England came together to develop five-year ‘place-based plans’ for their areas, initially under three headings; improving quality and developing new models of care; improving health and wellbeing; and improving the efficiency of services.