NHS transformation plans 'lack involvement from front-line staff'

Plans being developed for the future of health and social care services in England, are being drawn up with almost no public or patient involvement, and will be extremely difficult to implement – according to an analysis by a leading think tank.

The King’s Fund report says Sustainability and Transformation Plans (STPs) offer the best hope to improve health and care services but have been plagued by problems.

Since the process was announced in December 2015, the NHS’ financial problems have worsened and the plans have become more focused on achieving financial balance by changing or reducing hospital services.

King’s Fund chief executive Chris Ham said he was very concerned about areas where local leaders were ‘working against the clock’ to reorganise hospital services.

'Full capacity'

Professor Ham questioned whether cutting hospital beds was ‘credible’ given that hospitals were ‘running very hot’ at almost full capacity and the huge pressures on district nursing and community services.

‘We know from the work we are doing that out of hospital services are under even more pressure than hospital services.’

He suggested that asking community services to take on even more was unrealistic ‘given the lack of funding to employ more nurses and GPs. That’s why we are going into this with a healthy scepticism.’    

He revealed that some of the STPs do not have a plan to achieve financial balance because the local leaders ‘can’t see a way of doing it’.  

Lack of structure

The report, based on interviews with leaders in 4 of the 44 STP areas, highlights how they are struggling with a confused process, changing instructions from national bodies such as NHS England, and a lack of governance structure.

There is tension between the collaborative ethos of STPs and the competition between organisations set out in the Health and Social Care Act. One STP lead described the role as being like ‘operating in a sea of fog’. 

But despite the problems, the report urges the government and the NHS to continue to back STPs and says there is no plan B. ‘We are not saying STPs are a busted flush,’ said Professor Ham.

‘They are here to stay and the best chance we have of making a complex set of challenges work. It’s the only game in town.’

'Operating in a sea of fog'

The report recommends changes to make the STPs work better, including greater involvement from the public and all parts of the health and social care system, improved governance and clarity around regulation to make it easier for organisations to work collaboratively, and a ‘stress test’ of the plans by national bodies to ensure the proposed changes are realistic.

Further information

Sustainability and transformation plans in the NHS: How are they being developed in practice?