• Local NHS areas must jointly agree five year “sustainability and transformation plans” over the next six months
  • Quality of these joint plans will determine how quickly areas are able to access transformation funds from April 2017
  • Local leaders have until 29 January to decide the ‘geographic scope’ of their planning units
  • National bodies to intervene in areas where “collaborative and capable leadership can’t be found”
  • Final plans must be submitted to NHS England by June 2016

NHS organisations’ access to billions of pounds worth of transformation funding from April 2017 will hinge on the quality of the “health system sustainability and transformation plans” they agree with local counterparts over the next six months, according to national guidance published today.

The guidance states that planning across health economies will play an increasingly signficiant role, and that NHS England and NHS Improvement will need to “help secure remedies” in areas where “collaborative and capable leadership can’t be found”.

The document, Delivering the Forward View: NHS planning guidance 2016-17 – 2020-21, says local organisations must collaborate to produce “local blueprints” over the next six months setting out how they will “accelerate the implementation” of the NHS Five Year Forward View between October 2016 and March 2021.

It says: “Planning by individual institutions will increasingly be supplemented with planning by place for local populations. For many years now, the NHS has emphasised an organisational separation and autonomy that doesn’t make sense to staff or the patients and communities they serve.”

It continues: “System leadership is needed. Producing a [sustainability and transformation plan] is not just about writing a document, nor is it a job that can be outsourced or delegated…

“Where collaborative and capable leadership can’t be found, NHS England and NHS Improvement will need to help secure remedies through more joined-up and effective system oversight”.

The quality of these plans will be critical to determining how quickly areas are able to access funding from the national ‘sustainability and transformation fund’ from April 2017. This fund is worth £2.1bn in 2016-17, but is set to grow to £3.4bn by 2020-21, with a growing share of the pot invested in transformation schemes.

The guidance states: “For the first time, the local NHS planning process will have significant central money attached.

“The STPs will become the single application and approval process for being accepted onto programmes with transformational funding for 2017-18 onwards.”

The “most compelling and credible STPs” will secure the “earliest additional funding from April 2017 onwards”.

Last month’s comprehensive spending review settlement provided for a number of “dedicated funding streams for transformational change”, the document explains. These are targeted at changes such as the spread of new care models, improved primary care access and infrastructure, new technology, and clinical priorities like diabetes and cancer. Many of these funding streams will be channelled through the national sustainability and transformation fund.

The first task is for local organisations, including CCGs, providers and other local organisations, to come together to form “transformation footprints” – the geographical grouping on which their local plan will be based.

Local areas will have little more than a month to decide which organisations will be included in their planning unit – they must let NHS England know the geographical scope of their STPs by 29 January 2016.

Final plans need to be submitted to NHS England by June and will be subject to formal assessment in July 2016. 

The guidance says the footprints should be based on “natural communities, existing working relationships, [and] patient flows” and take account of the “scale needed to deliver the services, transformation and public health programmes required”. It suggests that the “scale of the planning task may point to larger rather than smaller footprints”.

It also suggests that areas should take account of how their footprint “best fits with other footprints such as local digital roadmaps and learning disability units of planning”.

Where geographies are already involved in the Success Regime, or devolution bids, this is likely to determine the transformation footprint, but the guidance caveats that there “is no single right answer [and] the footprints may well adapt over time”.

Further “brief guidance” on the STP process will be published in January.

What the plans must cover

The guidance said producing a STP “involves five things: (i) local leaders coming together as a team; (ii) developing a shared vision with the local community; (iii) programming a coherent set of activities to make it happen; (iv) execution against plan; and (v) learning and adapting”.

Success also depends on ”having an open, engaging, and highly iterative process that harnesses the energies of clinicians, patients, carers, citizens, and local community partners including the independent and voluntary sectors, and local government through health and wellbeing boards”.

The plans must cover all areas of CCG and NHS England commissioned activity including: “(i) specialised services, where the planning will be led from the 10 collaborative commissioning hubs; and (ii) primary medical care, and do so from a local CCG perspective, irrespective of delegation arrangements”.

The plans must also cover ”better integration with local authority services, including, but not limited to, prevention and social care, reflecting local agreed health and wellbeing strategies”.

Planning guidance: Access to billions in transformation funding tied to quality of 'system leadership'