• Local authority-level areas, often towns and boroughs, are normally the focus for developing integrated care
  • This means STPs performance-manage them and oversee things like acute service configuration, says Matthew Swindells
  • £600m is spent on “excess bed days” annually

Sustainability and transformation partnerships are not “the centre of gravity for every great piece of thinking”, with smaller patches the main focus for developing integrated care, the NHS England director of operations has said. 

Matthew Swindells was speaking at the NHS Confederation conference today.

He said system-working was improving, with no contract arbitrations “reaching my desk” for 2018-19 compared to last year’s planning round.

Mr Swindells, who oversees STPs and implementation of the Five Year Forward View at NHS England, said: “When we look across the best systems around the country… what we see is that they have turned the concept of the STP upside down.

“They are starting not with a top-down bureaucracy, ‘how do I sort out the governance’… they are thinking about the local areas, neighbourhoods, networked GPs coming together to address long term conditions and care management and prevention, and delivering extended access and support for care and nursing homes, and focusing on how do we make people who work in primary care and community services’ lives better and more productive.

“These networks are coming together at a place level – usually around the boundaries of a local authority - a footprint that makes sense to local politicians and local communities.

“And at that level we’re seeing primary care, community services, mental health, [and] acute services trying to focus on the needs of a town or a borough, but we’re also seeing with local government starting to come together around police and housing and education and social care.

“When I travel around talking about what systems and integration means now what I’m hearing is people talking about the Barnsley pound, the Bradford pound, the Blackpool pound.”

He said this meant the role of the STP or integrated care system changed. Few STPs are coterminous with local authorities.

Mr Swindells said: “As they come together the role of an STP is therefore not to be the centre of gravity for every great piece of thinking but the coordinating and performance management of the strategic development, what do we have to do at a higher level that you can’t do at the level of a borough?

“And how do we make sure that best practice is flowing, that we think about the biggest questions of population health, acute provider design, and community services design.” Other things STPs might lead included workforce planning and IT, he added.

Mr Swindells also highlighted a target announced today by NHS England and NHS Improvement for the health service to reduce long-stayers in hospitals, particularly over this winter.

He said £70m could be saved by moving towards top quartile performance.

“We’ve got 7,000 beds or £600m worth of spend attached to excess bed days,” he said.

“If we closed by one-third the gap between all areas and the top quartile in terms of excess bed days, it would release 1,000 beds and save £70m.

“What I want to see is [clinical commissioning groups] and STPs working together to say, how do we get that money that we’re no longer having to pay to acute trusts because we don’t have excess bed days, into community services so we can expand and grow and develop [them] because we need that piece of the puzzle to shift the balance of the expenditure.”