Who is afraid of the big bad Sustainability and Transformation Plan?

In South Yorkshire and Bassetlaw we are busy thinking about the next phase of discussion on our Sustainability and Transformation Plan (STP). There is a useful and serious group of CCG engagement leads, the voluntary sector and local Healthwatch who are collaborating on developing a shared approach to deepening discussion with the public this year.

These discussions have led me to revisit our STP a number of times – simply because I cannot retain in my mind what it says the problem is and what it is trying to achieve.

I now think that my difficulty in grasping this is only in part due to my failing memory and limited intelligence- its also to do with the fact that STPs claim to be something that they are not.

I think that STPs are represented as THE overarching strategic plan for sub-regional health systems. However, if we look closely at them – the actions that stand out relate to plans to make specific NHS services – usually hospital based more effective and (hopefully) more efficient. There is nothing particularly threatening or wrong about this – in a number of cases these plans existed before STPs were thought of.

Of course STPs also try describe a wider vision and set of principles for local health systems – care closer to home, greater emphasis on prevention, tackling inequality etc. Here the actions are not clear – largely because STPs are NHS documents and this is a world where the NHS has less responsibility and influence. Again, nothing particularly new here – we have been concerned about these issues for some time …. and failed to make a great deal of progress.

The theory is that STPs will join these two issues up – greater efficiencies in hospital care will lead to greater investment in community, prevention etc – its an optimistic scenario.

Trusting STPs.

Its difficult to have faith in a plan that many people believe is primarily concerned with implementing cuts to health systems. In my experience STPs represent the projected funding shortfall (in South Yorkshire and Bassetlaw this is some £571 million) as being due to rising demand and inefficiency – when we know it is largely due to a government policy decision to restrict NHS funding and cut funding to local government.

Second, STPs run the risk of assuming that the NHS can produce plans that will of themselves solve societal and socio-economic problems.

Many of the heath and wellbeing problems that people face are caused by factors that have nothing to do with the NHS – poor quality employment, reduction in social welfare support, low wages, cuts in adult social care etc. All of these create demand on one of the few parts of the public sector that has been relatively protected and is not rationed – the NHS.

There is a real danger that if we are not clear about the actual challenges facing the health and well being of the population and why these impact on the NHS that we will have a distorted discussion about the future shape and role of NHS services.

Three things we need to do:

First – lets be honest about:

• the state of funding of the NHS – it is under pressure due to government cuts,
• where the cost pressures actually come from – for example we need to include the impact of cuts in social welfare support services and adult social care
• how much healthcare costs us in England compared to other equivalent western economies – the NHS is still one of the cheapest healthcare systems – we MUST always present this evidence to members of the public.

Second – local discussions must start from peoples experience of what health and wellbeing means to them. We have to talk about the whole experience here not just the NHS bit. Our starting point should be the whole journey not specific services such as General Practice. For example in an earlier blog I wrote about a video I had helped produce about a man who received excellent treatment in hospital for his stroke – but was then left on his own to cope with – social isolation, physical disability, lack of role, access to benefits – not surprising he became depressed and needed help from a range of NHS services that he should never have needed in the first place.

Finally – Lets be honest about what STPs can realistically achieve – otherwise we risk people feeling threatened and anxious about what they claim to be – seeing a lack of detail as an indication of secrecy rather than what it actually is – a collection of practical plans to improve hospital services and some rather vague ambitions to contribute to the development of a more integrated health and care system.

I am more hopeful about the “place based plans” which in theory underpin STPs. In Sheffield’s case they are Shaping Sheffield and sister documents such as the  Primary Care Strategy These come much closer to joining up community and prevention, not least because they have a stronger connection with local government – albeit one that still needs further development.

What do you think?