The starting pistol and the loaded gun: Next steps for STPs

By Rachel Ross

Jeremy Hunt and Simon Stevens sat side by side yesterday (19 July 2017) to announce the latest step in the plan to transform health service delivery and put the NHS on a more sustainable footing.  The allocation of £325 million to 15 Sustainability and Transformation Partnership (STP) areas marked the start of investment in the locally-led reform agenda.  However, in the months to come, it won’t be the money that is remembered, but the set of new, centrally-mandated performance metrics that were also announced.

The central rationale for STPs has long been clear, if nuanced: identify new, local-needs based care models capable of driving economic efficiencies across the system.  Divided across 44 geographical ‘footprints’ in England, but with no statutory status, STPs have long drawn ire for attempts at service reconfiguration, while failing to engage the public and provide accountability.

In March, the Chancellor announced a £325 million package to back the “strongest” STPs, hoping to embolden the best and inspire the rest.  It was that money which Mr Hunt and Mr Stevens “fired the starting gun” on yesterday.  Despite such rhetoric, the sum itself is broadly considered a “very modest” funding injection.  It was not even the star of its own show.

While conscious to emphasise that these were local plans, based on the needs of local populations, Mr Hunt introduced new centralised criteria for evaluating success: four tiers for ranking STPs, measured against performance indicators in secondary care, patient-focused change and transformation.  The Health Secretary promised that STPs showing the most progress against these metrics would receive more autonomy, devolution, freedom to innovate and faster access to capital – suggesting the announcement of further funding in the Autumn Statement.

When assessing these new metrics, however, it is important to recognise that the STP plans were developed in just a few short months – and with little in the way of public engagement.  This bullish approach to service reconfiguration has already seen intense local and national opposition.  Well-resourced national organisations, such as 38 Degrees, and other local groups have been determined to halt the process through whatever loopholes available.

With such resistance in mind, there is an obvious danger in newly announced metrics which financially incentivise rapid progress.  Especially if that progress comes at the expense of effective local outreach.

A trade off that yesterday’s hosts, The King’s Fund, also recognised regards the quality of service redesign.  In February it warned that ‘a more realistic timescale’ than that currently mandated should be adopted, to enable innovations in care to become established and results to be delivered.

The financially-incentivised performance measures may prove too heavy a cost in the long-run; encouraging STPs to deliver rapid implementation, potentially putting both quality and patient-centricity at risk – two of the model’s founding initiatives.

Rather than “firing the starting gun” for STPs, might Jeremy Hunt and Simon Stevens have fuelled sceptics and campaigners with more ammunition?