If many finance directors believe in the rationale of STPs, why are they less confident about how they can be achieved, asks Paul Briddock

It’s no secret collaboration nurtures innovation and sustainability, and to repeat an over-used phrase of late, we really are ”stronger together”.

This is the ethos behind the much anticipated sustainability and transformation plans (STPs) from NHS England. Welcomed by many in the healthcare finance community, because of their aim of reshaping services and better serving patients on a local level, STPs are a huge focus for finance directors in the coming year.

The plans are a new approach to help ensure that health and care services are built around the needs of local populations. Each plan is delivered in a ‘footprint’, of which there are 44 across the county. The footprints are locally defined, based on existing working relationships and established patient flows.

Finance directors, on the provider side and in clinical commissioning groups (CCGs), support the concept of STPs and see them as a way of driving better collaboration and reshaping services effectively. They understand that STPs are the right way to deliver on the aims of NHS England’s Five-Year Forward View, but are under no illusions as to the scale of the challenge.

If many finance directors believe in the rationale of STPs, why is there a lack of confidence about achieving the objectives of them?

New figures from HFMA’s latest Temperature Check survey of around 200 finance directors and chief financial officers in England reveal some encouraging trends. Among them is the fact that 35 per cent of our respondents believe relationships between commissioners and trusts in their STP footprint are strong enough to deliver on the plans they have in place.

However, some of our respondents were apprehensive. Just 16 per cent of finance directors are ‘very’ or ‘quite’ confident that organisations in their STP footprint can deliver a connected strategic plan covering the period up to March 2021. Potentially, this is a trend we should expect given the development of these plans are in such an early phase. But if many believe in the rationale of STPs, why is there a lack of confidence about achieving the objectives of them?

Silo working

A key factor here is that STP footprints are larger than many organisations have experienced previously for joint working arrangements. As such, the governance and ‘ways of working’ structures may take a little time to evolve. Additionally, whilst commissioners and providers fully support STPs, they are also all under individual organisational pressure to meet financial targets.

There is clearly some scepticism about the practicalities of joint working, and a concern exists that many FDs and CFOs will prioritise their own organisation’s financial targets, over the aims of the STP itself.

The shared risk is a crucial factor that could make or break STPs, and support for the new ways of working needs to come from regulators, too

Openness, transparency and longer planning cycles will be key to working through this early phase and establishing a workable governance for STPs. Our Temperature Check shows that many FDs and CFOs have started to take this approach already, with 79 per cent saying they have shared, and are transparent about, their finances to all partners within their STP footprint.

Notably, 71 per cent of our respondents believe it is too early to say whether the STP will result in fair sharing of financial risk between organisations.

The shared risk is a crucial factor that could make or break STPs, and support for the new ways of working needs to come from regulators, too. There needs to be joint working and accountability within a place-based system whereby the incentives to perform are at an STP level, not only an organisational level.

As many are used to silo working, there is currently little incentive for leaders to work together beyond organisational boundaries. It may be that area control totals are introduced, which would see all individual organisations within a footprint working towards one goal, eradicating individual winners and losers when it comes to financial risk.

Of course, it’s early days for STPs, so teething problems are inevitable. And within the financial community of the NHS, there is a clear belief that STPs will deliver the change they’ve been created to achieve. But there is much to consider, and the implementation of the STP model mustn’t be rushed.

In truth, STPs come at a time when we need them the most, but they also need to be delivered in a way that works for a sector which is already under unprecedented pressure.

Paul Briddock is director of policy at the Healthcare Financial Management Association.