NHS England should learn a lesson from Ofsted and get tough over STPs

When Suffolk County Council introduced a warning scheme for performance in its primary schools, it was met with a storm of protest.

Red meant a school was inadequate, amber that improvement was needed and green indicated standards were excellent.

Schools that received warning letters were given 15 days to provide a “recovery plan”.

Headteachers complained that the scheme would demoralise schools, but the council insisted it was part of a plan to raise standards.

Is it now time to introduce a similar scheme in health and social care?

It soon emerged that some had not even considered mental health at the outset, let alone made it their plans’ “golden thread”

Readers of HSJ – but not, it seems, anyone else, as HSJ’s exclusive story shows – know that the vehicle through which this was to be done was sustainability and transformation plans, unveiled in 2015 by NHS England.

The country was carved up into 44 areas, with GPs, hospital leaders and council chiefs in each asked to come up with an overarching strategy that would inform their health and social care spending – with mental health put front and centre (the so-called “golden thread” which would run through the plans).

Those people duly came up with plans, but it soon emerged that some had not even considered mental health at the outset, let alone made it their plans’ “golden thread”.

Golden opportunity

In June last year Claire Murdoch, NHS England’s national director of mental health, warned that STPs which neglected mental health would be rejected.

But last month she modified that stance, saying that STPs not doing “justice” to mental healthcare would be offered support, rather than simply rejected.

No clarity on what this support will consist of has been offered.

The Royal College of Psychiatrists believes there is now a real risk that STPs in some areas will fail and that a golden opportunity to transform the way health and social care is provided in this country will be missed.

Liberal Democrat MP and mental health campaigner Norman Lamb welcomed the idea of a rating system.

He said: “We could rate the transformational quality of the plans and part of the rating would have to be [that] the golden thread was clear and obvious. We would probably want to know whether the plan as a whole was in any way effective.

“Greater transparency about the STP process – having an assessment process on STPs – would mean the public in any given area could have a way of holding their leaders to account.

“It doesn’t take away the local autonomy to design and deliver but it does give the local citizens the ability to challenge their leaders on, for example, mental health, and say: get your acts together.”

When Ofsted, the schools inspector, ruled that education standards in 33 schools in Suffolk were “unacceptable”, the county council took bold action – it is time for NHS England to do the same with STPs.

Professor Sir Simon Wessely is president of the Royal College of Psychiatrists.