The once in a generation opportunity could be thrown away unless we take action now - here’s what we need to do, says Jon Restell

Jon Restell

Jon Restell

Jon Restell

We at Managers in Partnership were enthusiastic supporters of the Five Year Forward View. Now we see the sustainability and transformation plans as a once-in-a-generation opportunity to change our care system for the better.

Our views are shared by many managers. As one of my colleagues noted recently, the vast majority of managers “see the logic of trying to unify the system and address the particular needs of the communities they serve”.

And one of our members wrote recently that: “The benefits of STPs could be huge. The whole system is short of money, and we have a growing and ageing population with increasingly complex needs: to have any chance of sorting this out, we must integrate health and social care services – and STPs have sparked some real collaboration.

We’re bringing together people who’ve been plugging away at different aspects of the same problem for years, and there’s huge enthusiasm.”

The STPs have done good work in bringing a new kind of conversation to local health and care systems and analysing the big local challenges. But what happens next is less solid, with many blithely thinking that the impossible will be achieved.

But as our members took stock at our conference at the end of November, it started to look as though we’re throwing away this once-in a generation opportunity.

While being optimistic, we have always been realistic and sceptical. No MiP member believes the funding gap of £30bn could be closed by 2020-21 with efficiency gains of £22bn.

Not only were the efficiency claims overblown at the time, but some of the Forward View’s other assumptions have unravelled.

The baseline was out because the NHS started with a £3bn deficit, not a balanced position. There have been cuts to public health funding, a further deterioration in social care and drastic reductions in capital funding.

And all this is before we even think about Brexit and inflationary pressures.

And certainly no one believes now that the extra money (whether you choose to believe the government or the Commons health select committee about how much that is) will be anywhere near enough.

The sum needed is probably closer to £20bn than £8bn, plus a sizable extra bucket of transitional funding and a longer time scale for transition.

These are the financial gaps. But there are other gaps, in stability, engagement and accountability, which could prove just as fatal to the STPs.  

Money woes, regulatory and performance pressures are destabilising more and more providers. Unstable systems generally don’t transform themselves. Then there is public and staff engagement (and I include engaging with leaders here).

There are great examples to the contrary, but on the whole it has simply not been good enough. This has contaminated the STP brand before launch.

These are the financial gaps. But there are other gaps, in stability, engagement and accountability, which could prove just as fatal to the STPs. 

And then there is accountability. The STPs have done good work in bringing a new kind of conversation to local health and care systems and analysing the big local challenges.

But what happens next is less solid, with many blithely thinking that the impossible will be achieved.

The unreality of some plans begs some unavoidable questions about the reality of accountability and the capacity to deliver.

Campaign objectives

As a result of all this, political pressure is building. It’s possible to sense the start of a retreat from the big decisions. Many of us are feeling that it’s a bit like Groundhog Day.

If we want to grab this once-in-a-generation opportunity to change our care system, let’s go for it

Will STPs in the end boil down to another restructure of commissioning and a poorly-executed back office rationalisation?

Let’s hope not. Now is the moment to launch a campaign to Save Our STPs.

Here are four campaign objectives -

  • Honesty as well as optimism from NHS and other local leaders about the money and the scope for efficiency gains. NHS leaders must be clear that despite their best efforts the funding gap will remain.
  • Stabilising the system, with extra money for social care as a priority, and a transitional fund to create conditions for transformation.
  • A full year to allow thorough public and staff engagement, with a political understanding that after this local systems will make the tough decisions.
  • Accountability and delivery mechanisms with bite and bark to implement those tough decisions, and decent support for local leaders.

Unrealistic? Perhaps. But more realistic than the present hopes for STPs. If we want to grab this once-in-a-generation opportunity to change our care system, let’s go for it. Save Our STPs!

Jon Restell is chief executive of Managers In Partnership