Very few local NHS leaders believe STPs are likely to deliver the intended improvements to finance and performance in the next 18 months, an HSJ survey suggests.

Ninety-nine clinical commissioning group chairs and accountable officers – CCGs’ two most senior posts – responded to the survey, covering around 47 per cent of the total 209 CCGs.

The survey also reveals the changes to services being planned in STPs, including sensitive closures, but dominated by expansion and potential improvements to services. The barometer was supported by PA Consulting Group.

Respondents were asked to rate their confidence that their STP will have the planned impact on financial and operational performance in 2017-18, from “very low confidence” to “very high confidence”.

None of the 99 respondents chose “very high” and only one chose “high”. Thirty-three said they had “moderate confidence”, 47 “low confidence” and 18 “very low confidence”.

The result will be concerning, as STPs are the major national process for coming up with actions to address the current major failures in finance and service performance in coming years.

CCG leaders are in many cases heavily involved in developing the plans and they will be important to implementing them.

Respondents gave a range of reasons why they do not have high confidence, many of which are listed below. Often the CCG leaders indicated that they thought they had good plans, but there were major blocks to implementation, or that they could not meet the steep improvements required, particularly in the next two years.

John Rooke, head of healthcare commissioning at PA Consulting Group, said: “The critical issue for STPs is a lack of clarity about the future intentions of those involved. In the impending contracting round, leaders may benefit from recognising this tension and focusing on the creation of the explicit terms and known implications of their new coalition agreement.”

CCG leaders respond: Why have you chosen this level of confidence?

  • The scale of the combined commissioner/provider deficit is such that it is difficult to see how the gap can be closed to the level demanded by NHSE without affecting delivery of service and NHS constitutional standards.
  • [Parts of our area have] been chronically underfunded and we are now having to carry this into the pooled control totals.
  • It is a massive cultural change which will take time to implement and hence impact.
  • I don’t believe that we yet have the capacity in systems leadership to make the plans real. Many of our present leaders have been selected to be operational, risk adverse and organisationally focused, they are often extremely competent at these things but these changes require different skills and outlook which I see little of in senior leadership.
  • International experience suggests that such changes take several years to embed.
  • I do believe that there will be improvement locally but not to the level that is required to meet the financial challenges next year.
  • We still have a lot more detailed work to do both to nail down the practical actions and to confirm shared commitment to delivery… But we have a strong foundation to build on and some good things going for us.
  • Essentially it is the club and country issue and a lot of providers are seeing this a club opportunity rather than a system requirement.
  • Not convinced we’ll balance this year therefore financial assumptions will be challenged in subsequent years.
  • Sustaining the unsustainable rather than transforming the unsustainable seems to be the political prerogative.
  • We have good plans for years one and two and wide system sign up to delivery without blockage by organisational boundaries.
  • We are not having honest and realistic conversation with public that the NHS cannot continue to provide as it has in the past
  • Even though we will make significant savings, they will not be enough to meet gap.
  • The STP is not even off first base and is unlikely to have any real impact.
  • The financial plans are in place but some heroic concerns regarding demand management.
  • The STP is based on our local health economy plans and are therefore largely probably contains the right things to do. However modelling the impact of these is not an exact science.
  • I am not sure that all the aspiration will be turned into reality in time for 2017-18
  • Split between NHSI and NHSE is an obstacle to system-wide working.
  • The STP is great and much of it needs to be done but the size of the financial gap and the pace at which we are expected to close it is simply unrealistic given the massive cultural change programme we need to go through to deliver the new models of care.
  • Think local action more likely to have an impact than STP plan.
  • Because the centrally determined STP is the wrong size and is not addressing acute networking, mistaking this for the lazy mantra of closing hospitals rather than establishing credible demand and capacity based plans.
  • Many of the required changes will need investment and will take time to become evident.
  • The resilience of current clinical services is very low so whilst the vision and will is strong it may be too big a gap to leap from current to transformed without taking clinical and organisational risk that would be penalised, rightly, by regulators.
  • Because there’s no low hanging fruit; we will have to chase savings in specialist commissioning and clinical variation which requires provider buy-in.
  • Lack of support for commissioning and allowing CCGs to get on and deliver the job, authority constantly being undermined.
  • Until acute trusts; financial incentives are aligned with commissioners there is little chance of achieving financial balance.
  • Lack of granularity in change plans still too reliant on blue sky thinking – this gives rise to understandable reluctance of providers to put themselves at risk.
  • Delivery is hard, particularly for operational performance.
  • The STP is a distraction because it is based on a footprint which is too small to resolve higher acuity acute clinical networks.
  • Not many of us really believe the numbers as we have been asked to try to show the system in financial balance, so have done this but by stretching all opportunities beyond realistic levels.
  • Transformation needs a longer timeframe for delivery than 17-18 and demand continues to rise.
  • It’s all pretty high risk and courageous in the first place.
  • No real evidence new models of care in vanguards, with pump priming, deliver sustainable financial solutions. Clinically much makes sense, but reality is we need investment in out of hospital care, and workforce in a very bad place numerically and in terms of morale.
  • The investment required to bring about change is significant and there is no sign that it will be provided. The tidal wave has hit and we are busy trying to design and building a life raft whilst trying to keep heads above the water.
  • It is such a complex task.

Exclusive: Survey reveals STPs' service change priorities