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STPs set to fail without appropriate legal powers and role clarification

Already hobbled by too little time, cash, and lack of detailed business/workforce plans, says report

Caroline White

Monday, 19 June 2017

Sustainability and Transformation Plans (STP) can’t possibly deliver a better future for the NHS unless they change direction, are given appropriate legal powers, and some much needed clarification of their role, argues a highly critical review of the proposals for the 44 existing STP areas, published by London South Bank University.

The report* recommends that STP leaders need to plan ahead based on the reality of their current situation and identify changes that are evidence-based. They should also develop workforce plans that match their ambitions, and focus on reducing demand before removing resources from the acute sector, it says.  

Overall, there is a distinct lack of comprehensive planning and evidence-based policy making that is of the quality needed to deliver the level, pace, and scale of change required for the future transformation of the NHS, says the report.

It also highlights several key issues which mean that none of the STPs is ready for implementation.

Chief among its concerns are the funding shortfalls, made more acute by the challenge of collaborating across multiple organisations in the midst of a financial squeeze; an absence of any legislative framework to support collaboration across health and care; and a lack of clarity on the role of the STP and its leadership.

STPs have already been hobbled by the speed of planning that was required and a failure to engage with local government or to clarify accountability to the public.

Furthermore, none of the STPs has produced adequate business plans and two thirds have failed to produce detailed workforce plans. And there has been insufficient focus on reducing demand before diverting resources away from the acute sector, says the report.

It is essential that a viable business case must first be drawn up to take full account of the proposed changes to the health and care system and to ensure that sufficient staffing and adequate capital are made available to establish new services and prove their effectiveness, before existing services are reduced, says the report.

The STPs need clarity on their accountability and authority, and a change in existing legislation to enable them to work together effectively, it says.

Health economist and report co-author, Seán Boyle, said that the health and care system needed time to develop partnerships and a legislative and accountability framework that fostered collaboration.

“That is why this report recommends a constructive overhaul of each of the 44 STPs, looking at the appropriate framework for that work in terms of geographic area and what parts of the health and care system should be involved including the stakeholders for that area of work, the partnership agreements required and the accountability to the population of the proposed changes,” he said.

Professor Rebecca Malby of London South Bank University’s School of Health and Social Care, commissioned the report. She said: “There is an acute need for the evidence base supporting the case for change in each of the 44 STPs within the NHS to be substantiated further before the service commits to launching plans for widespread ‘transformation’."  

STPs also needed time to clarify and develop their leadership role, moving from a top down command and control approach to one that is about planning and enabling, she added.

Professor Warren Turner, dean of the School of Health and Social Care, said: “Faced with tightening financial pressures on the NHS and social care, the weakness or absence of serious workforce plans means there is little reason to believe that these ambitious reductions in demand and pressure on acute services will be achieved in the timescale proposed.”


* Boyle S, Lister J, Steer R. Sustainability and Transformation Plans - How serious are the proposals? A critical review. London South Bank University, School of Health and Social Care, March 2017.

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