What NHS England isn’t telling you, and more indispensable weekly insight for commissioners, by Dave West

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STP watch

Yes, I’m returning to sustainability and transformation plans and, as noted last week, the situation is changing quickly.

In the last four days we’ve published an HSJ leader on STPs, had speeches from Simon Stevens and Jim Mackey on the subject, and it has become apparent that the Local Government Association has also said it’s pretty unhappy about the STP process. NHS Providers has raised some concerns too.

What may have particularly irritated the LGA, as well as a feeling local government has been left out of shaping the process, is the narrowing of health and wellbeing boards’ role and the fact STPs straddle lots of political boundaries – developments which might, in some areas, help the NHS make progress.

But it has come up with a pithy critique, stating: “The STPs are intended as umbrellas encompassing a range of delivery plans across the defined place, yet the differing planning requirements, timescales and footprints is creating duplication, confusion and additional bureaucracy.”

NHS Providers chief Chris Hopson said he backed STPs as an important way to create sustainable services, but that the current process was giving many areas the impression of top-downery, creating a risk they wouldn’t feel the essential “sense of ownership”.

Mr Stevens and Mr Mackey both spoke about STPs at a King’s Fund event on Tuesday. Both talks were a worthwhile listen for STP watchers, and at least one of them is available on this page.

Mr Stevens gave a forceful defence of the project. He rebuffed those who’d pointed out to NHS England that a complex health/care planning process involves “shades of grey” rather than being just “black and white”, declaring that he was already well aware of this, thanks very much. STPs were a chance, he said, to take the kind of whole system approach NHS leaders have been asking for, and to make changes needed to close the funding gap.

“History will not thank” those who don’t embrace them, he warned. History is written by the victors.

Responding to accounts of areas being pressured and bounced into larger STP footprints than they wanted, Simon asserted: “We’ve actually not been prescriptive, at least not nationally, about the footprints.” It’s true that no officials in SE1 drew lines on a map (although they did make some suggestions).

That doesn’t mean no pressure was applied: in some areas it was, and it is entirely typical for such business to be left to regional and sub-regional teams.

The NHS England boss also gave some facts on the STP footprint configuration, which is now final – unless NHS England is listening to those who might like to get theirs changed:

  • Population size varies from 300,000 (presumably North Cumbria) to 3 million.
  • North of England and London average population: 1.8million to 1.9 million, with an average of six to seven CCGs and seven or eight trusts.
  • South and the Midlands and East average population: 1 million to 1.1 million, covering three or four CCGs and a similar number of trusts.
  • Most STPs have identified their single leader (although a small number of these may yet be rejected).
  • Of those which have, half are CCG leaders and half are either trust or local authority chief executives (the split not specified – but presumably a handful of the latter at most).
  • Mr Stevens said there were only a small number where no leader had been picked, to which he is expecting to send in an outsider.

Despite the impression of a clear plan, I’m not expecting full details of either patches or leaders to be published this week.

Mr Mackey’s talk had some tough messages too, including affirmation of his provider-friendly credentials with strong put-downs for commissioners excessively fining struggling trusts, and/or not fully sharing their plans with providers.

He spoke some sense on STPs: acknowledging that it wasn’t always easy to get the patch right, and that within some of them there would need to be flexibility to let constituent areas get on with their own plans.

Both Mr Mackey and Mr Stevens’ talks gave a sense that one of their overriding priorities for STPs was major service reconfiguration. The latter said the most important thing was that difficult issues were confronted and not ducked – giving the example of an area with a surfeit of district general hospitals proposing to build a new one elsewhere, rather than squaring up to overhaul the existing ones.

Mr Mackey repeated his message that there was a fairly short window with last year’s general election out of the way to begin controversial change, and said STPs should be used to grasp that.

This week’s progress on prevention

FORWARDS: Ten “healthy new towns” have been named. This admirably takes up the health sector’s duty to help promote wellbeing by shaping where and how people live, including by taking a lot more notice of the housing crisis. The places to keep an eye on for the future of urban health – or to avoid if you’re seeking a high value chicken burger and chips – are:

  • Whitehill and Bordon, Hampshire construction of 3,350 new homes
  • Cranbrook, Devon 8,000 homes will be built
  • Darlington 2,500 residential units planned
  • Barking Riverside, east London 10,800 homes
  • Whyndyke Farm, Fylde, Lancashire 1,400 homes
  • Halton Lea, Runcorn, Cheshire 800 homes
  • Bicester, Oxfordshire 393 homes
  • Northstowe, Cambridgeshire 10,000 homes
  • Ebbsfleet Garden City, Kent up to 15,000 new homes
  • Barton Park, Oxford 885 homes

BACKWARDS: The government’s obesity strategy has been delayed – again – until the summer, and a sugar tax appears to have been taken off the table. It’s concerning this is being put off again, and not hard to imagine political disruption after the June EU referendum resulting in yet further delay.

The prospect of a tax may only ever have been used by officials as a way to scare industry into action – specifically reformulating food and drinks – but thus far there’s no clear picture of what this deal would look like.

Weekly briefings: The Commissioner and What’s New in Care Models

This is the third outing for HSJ’s new weekly email briefing on the NHS commissioning sector.

We’ve also launched another email briefing this week – on new care models and integration. Written by our senior correspondent for integration, David Williams, it will track progress on these top priority areas. I expect it will be a lively and worthwhile read: Use this page to sign up.

I’m grateful for feedback on how I can improve this email, tips on what I should be covering, and comments/complaints on our new series of email briefings in the round.

Dave West, senior bureau chief, HSJ

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