Public Sector Focus

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

Comments

There are no comments. Why not be the first?

Add your comment

 

related

public sector executive tv

more videos >

latest public sector news

Cheshire East faces police probe over tampering of air quality data

22/09/2017Cheshire East faces police probe over tampering of air quality data

Cheshire East Council is to be investigated by police following allegations that air quality data collected by the local authority had been delib... more >
Birmingham bin strikes called off following key High Court ruling

21/09/2017Birmingham bin strikes called off following key High Court ruling

Strikes by refuse workers in Birmingham have this week been called off after the union won an important High Court ruling. Unite has called ... more >
IFS: Public sector faces recruitment chaos if pay cap is not dropped

21/09/2017IFS: Public sector faces recruitment chaos if pay cap is not dropped

The public sector will face major recruitment and retention issues if pay restraints, which are pushing wages to historically low levels, are con... more >

editor's comment

14/08/2017Time for reflection

A lot has happened since the last edition of PSE was published. In particular, the snap general election delivered an astounding result that many of the pollsters and political experts could not have predicted when Theresa May initially called for it back in April. Chris Painter, Professor Emeritus at Birmingham City University, provides ... read more >

last word

The importance of openness after Grenfell

The importance of openness after Grenfell

Following the recent Grenfell Tower tragedy, Lord Porter, chairman of the LGA, argues that if the public are going to have faith in the safety testing process then everything must be out in the o... more > more last word articles >
149x260 PSE Subscribe button

the raven's daily blog

How do we deliver true social and economic value for the community?

18/09/2017How do we deliver true social and economic value for the community?

Five years on from the introduction of the Social Value Act, Alison Ramsey, frameworks co-ordinator at Scape Procure, reflects on the key questions that prompted the legislation’s introduction. The Social Value Act was an important landmark. It decisively addressed the need for major public projects led by all public bodies to maxim... more >
read more blog posts from 'the raven' >

comment

Support for councils following Grenfell

04/09/2017Support for councils following Grenfell

Ian Moore, CEO of the Fire Industry Association (FIA), discusses the wider lessons of the tragic Grenfell Tower fire and what measures and assess... more >
A quiet revolution

04/09/2017A quiet revolution

Dermot Ryan, programme director at NHS Digital for the Health and Social Care Network (HSCN), talks to PSE about the importance of moving to the ... more >
Effective leadership in uncertain times

04/09/2017Effective leadership in uncertain times

Dr David Beech, lecturer in people management at Salford Business School, argues that continuous renewal and progress is fundamental to effective... more >
Refocusing professional development

04/09/2017Refocusing professional development

Graeme McDonald, managing director of Solace, discusses the importance of taking time out to focus on learning, especially in the ever-changing l... more >

interviews

‘The HSCN is the realisation of industry best practice’

30/06/2017‘The HSCN is the realisation of industry best practice’

Keith Smith, public sector business development manager at Virgin Media Business, tells PSE’s Luana Salles that health and social care orga... more >
HSCN: The enabler for a more joined-up public sector

26/06/2017HSCN: The enabler for a more joined-up public sector

Mark Hall, Chief Assurance Officer at Redcentric, discusses NHS Digital’s project, the new Health and Social Care Network (HSCN) and what b... more >
Maintaining the momentum for further devolution

25/04/2017Maintaining the momentum for further devolution

Ahead of this year’s mayoral elections, Lord Kerslake, the former head of the Civil Service, tells PSE’s David Stevenson why the argu... more >
New social care funding misses the point

13/04/2017New social care funding misses the point

Clive Betts MP, chair of the Communities and Local Government (CLG) Committee, reflects on the social care funding released in this year’s ... more >