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21.08.17

A more promising system shake-up?

Source: PSE Aug/Sept 2017

Over the years, the NHS has become known for its love of restructuring. But are sustainability and transformation partnerships (STPs) promising enough to stick around? PSE’s Luana Salles reports.

For almost 30 years, the NHS has worked on the principle of isolation, with each part of the system doing its own thing and assuming that good results and coherence would somehow emerge out of that, Simon Stevens has argued – but we now have the chance to change this.

Whatever acronym you choose to give them, the STPs are an opportunity to start structured conversations with other organisations.

Speaking at the LGA Conference this year, the NHS England boss reminded delegates that our problems were starkly different a decade ago compared to now.

“In the early 2000s, the problem facing the NHS was: how do you put another couple of percentage points of GDP into buying more operations to cut long waiting times? And we did that, with a particular mechanism that incentivised hospitals to do a lot more, and public satisfaction doubled as a consequence,” he explained.

“But the problem set that we’re confronted with now is completely different because of the economic environment we’re in. The nature of the needs of the people we’re looking after has changed such that we’re trying to deal with people with ongoing long-term conditions that require lots of teams of people to work together in better ways.

“We’re trying to find a space, a way of working, that brings together different organisations, not just in the NHS but also in the third sector and local authorities as well, to actually have a structured conversation about how to make the best of the circumstances we’re facing. And as well as doing the day-to-day firefighting, we begin to futureproof our services.”

The NHS has developed an infamous reputation for restructuring since its genesis. But because STPs seek to change the very foundations of how the system interacts, many have signalled cautious support – and called for legal footing to back it up. “Personally, I would have quite liked to have had a situation where some targeted legislation would have brought the transparency and the accountability alignment around STPs,” Stevens (pictured) admitted. “But that’s not the situation we’re likely to confront given what’s going on in Westminster for the next several years.”

But rather than retreating back into our shells and deciding every organisation should revert to fending for itself, the NHS England boss has called on leaders to work together in the best way possible. “That is the open invitation I want to put on the table,” he added.

 

Better Care Fund

Despite the positivity, not every part of the health and care system is on board with how the government is handling integration. The recent publication of the Better Care Fund (BCF) guidance is a good example of this: while Stevens supported the document and its urgency given the coming winter, Sarah Pickup, the LGA’s deputy leader, disagreed with the decision to create tailored delayed transfers of care (DToCs) targets.

These targets, divided between councils and clinical commissioning groups, specify to what extent DToCs will have to be reduced over the next couple of years.

“We have been opposing that because we think that the financial situation councils have been in mean that expecting a reduction as compared to the previous year, specifically council by council, without any reference to circumstances or volume of activity, is not something we can support,” argued Pickup.

“We do support continuing to work together, we do support people getting together on the ground, and we’ll work together nationally. But we felt we couldn’t do what we did with the framework – we put our badge on that with government and with NHS England – on the guidance, because we didn’t support the inclusion of specific targets.

“It may seem a very small thing, but I do think it’s important that we represent your views on how tough it is out there to deliver, and I know that councils are doing everything they can to help get people out of hospital. There’s so much effort that goes into this. If they can get the delays down they will, but without knowing the volume of activity that’s coming your way or the whole volume of discharges you have to deal with, saying ‘you must get to this level’ was unsustainable.”

FOR MORE INFORMATION

W: www.gov.uk/government/publications/local-area-performance-metrics-and-ambitions

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