NHS uncovered: Revealing STP footprints

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The NHS loves nothing more than a sub-plot, preferably nestled beneath an overarching narrative. Another acronym or abbreviation by the presiding administration is simply an additional layer on top of the most multi-tiered healthcare cake in the world – one that was lovingly prepared back in 1948, and has never stopped growing.

One of the latest strategies involves ‘Sustainability and Transformation Plans’ (STPs) – the kind of concept that keeps you up at night, as you try to decipher the ambiguity of its title. In reality, it deserved to be called something far more explicit like ‘Tailored Local Care Services’ (TLCs, if you will).

Indeed, STPs are part of a more tailored system, which focuses on the local populous and aims to help deliver the main objectives outlined in the ‘Five Year Forward View’ – a title which still makes you assume that whatever you’re targeting is perpetually five years away (the original paper was actually submitted in 2014).

Nevertheless, in NHS terms, STPs are pretty wild – they appear to encourage ambition, a results-driven culture, radical ideas and even calculated risk. Ultimately, the aim is to accelerate health and welbeing strategies in a specified zone.

A collection of 44 ‘footprints’ have been duly trodden into the turf of our beloved NHS landscape and, in January this year, local healthcare luminaries in each area convened to thrash out what the footprints would resemble – their heart and ‘sole’. Now it is about transforming the patient experience and the overall health of the nation across the board – using the sequence of footprints to reach the ‘Promised Land’.

Each region has also had a ‘leader’ appointed, who will act as a guardian, while the fledgling process starts to germinate within an already crowded infrastructure. The ‘footprints’ – while not possessing any real clout in terms of statutory authority or accountability – will have the ability to draw notable healthcare personnel for frank discussions on STP delivery.

The aspect of STPs that really sets them apart from other new NHS ventures – and, boy, there have been plenty since the 1950s – is the emphasis on local requirements and, encouragingly, a rejection of a one-size-fits-all nationwide ‘solution’. It is an acceptance that different areas of the country – through a range of reasons, such as alcoholism, unemployment, ethnicity, nutrition, mental health, heart disease and even the weather – have vastly contrasting needs.

The term ‘footprint’ itself is an intriguing and possibly deliberate one – there is a suggestion of the digital world in its use, while also indicating a forensic, personalised approach. Cynics may well assume, however, that ‘footprints’ – by virtue of their nature, may be brushed away at a moment’s notice.


There’s no place like home

STPs handle variables in a way that focuses on the specific needs of a demographic. This ‘new layer’ feels somewhat different – the cookie-cutter approach to healthcare appears to have been cast away, appreciating that there are fundamental differences between Bournemouth and Blackpool and Blyth.

Taken as an example, North West London’s STP has one of the highest population footprints in the UK, with two million people. Within that area there are several sub-regions, which all have very distinctive requirements. In Hillingdon there are only 20 rough sleepers, while 5.2% of registered patients above the age of 18 have depression, whereas a few miles down the road, in Westminster, the rate of depression drops to 3.9%, however, there is an explosion of rough sleepers, to the tune of 921.

Meanwhile, when you migrate upwards to Nottinghamshire in the East Midlands, there is a population footprint of one million, while an intimate and aspirational STP focuses on ‘what local people want’ including maintaining independence, quality care provision, joined-up services and healthcare set-ups which can offer a legacy to future generations.

Further up north, the Lancashire and South Cumbria STP – with a population footprint of 1.6 million – specifies needs across typical disease pathways. It states that control of hypertension, cholesterol and blood pressure are priorities, while noting that stroke patients’ time in the appropriate unit and patient access to psychological therapy completion must improve.

This all paints a picture of a very diverse Great Britain, which requires input from practitioners and demographic experts at ‘street level’, and STPs would appear to be a robust response to that. Identifying differences and homing in on solutions all seems like positive stuff.

Decideum’s Deputy Managing Director and Pf Magazine’s Political Correspondent, Alex Ledger, said: “STPs represent a practical invention by NHS England to unpick one of the changes, introduced by the Lansley reforms of 2012, by restructuring NHS commissioning and pooling budgets at a larger, regional level, rather than across 200+ CCGs. Critically, this nullifies the need to tinker with the statute book and introduce new legislation.


View from the expert

David Thorne is Chair, Washington Community Healthcare and Non-Executive Director, City and Vale GP Alliance


Thirty years of policy reversed in a year, suggests STPs matter more than you may think!

We now have one health economy joint plan for commissioners, providers and social care – the internal market has been abandoned and replaced by ‘One Local Team NHS’. Integration, consolidation and collaboration will all be rewarded, but sanctions are applied to those not responding. Darwinian management has been enforced by NHS central control.

STPs have the ‘control total’ of local NHS virtual combined budgets. They can move money between NHS bodies, replacing ‘Payment by Results’, while funding is available to help CCGs join together. These major changes herald an imminent NHS with 44 integrated units along Accountable Care Organisations lines, so watch for changes to the named leads, as that will signal STPs evolving from planning to managing.

The absolute aim is financial balance and hitting ‘Key Performance Indicators’, so expect bullet-biting hospital rationalisation and intolerance of opposition to implementation and workforce reform. Stormy times ahead.