STPs will end the purchaser-provider split, says Stevens

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Some STPs will ”effectively end the purchaser-provider split for first time since 1990”, claims Simon Stevens
NHS England chief claims STPs will be given governance “rights” over NHS organisations in their areas
Vanguards seeing a slower rise in rate of emergency admissions according to Mr Stevens

Several STP areas are moving to “accountable care” structures which ”will for the first time since 1990 effectively end the purchaser provider split”, Simon Stevens has said.

Speaking at a Commons public accounts committee hearing today, the NHS England chief executive said between six and 10 sustainability and transformation plan areas were set to become “accountable care organisations or systems, which will for the first time since 1990 effectively end the purchaser provider split, bringing about integrated funding and delivery for a given geographical population”.

HSJ understands NHS England is in discussions with several STP areas around the country with a view to them being listed in the Forward View “delivery plan” to be published next month. These are thought to include Frimley Health, Lancashire and South Yorkshire.

Mr Stevens has over the past year suggested that North Central London and Frimley Health would see this type of development, but no detailed proposals have been brought forward.

The NHS England chief executive also told the committee: “We are going to formally appoint leads to [all 44] STPs, going to give them a range of governance rights over the organisations in their areas; including the ability to marshal the forces of the local [clinical commissioning groups] and the local NHS England staff.”

Mr Stevens added that “there are a number of parts of the country where we will be looking to [local authority] leadership to take on more decision rights”. He said STPs would have to achieve their plans within the confines of current legislation and that formal lines of accountability would remain the same.

Talking about the progress of national vanguard sites in controlling emergency admissions, Mr Stevens said: “What we are seeing with the three types of vanguard, based on first 18 months of their existence, is that GP based vanguards are seeing emergency based admissions going up a third slower than rest of country per person, the fully integrated hospital vanguards have seen their admissions going up by about half the rate of the rest of the country, and the vanguards that have been working in care homes have seen a marked difference as well in growth.”

It appears to be the first time these statistics on vanguards’ progress have been cited, amid high pressure to demonstrate success. Mr Stevens said STPs would be a vehicle to accelerate these vanguard models.