News

Councils must give STPs democratic legitimacy to make effective change

Local authorities must be “hard wired” into the governance and practical arrangements of sustainability and transformation partnerships (STPs) in order to give them democratic legitimacy to deliver effective local change.

According to Jim Mackey, CEO of NHS Improvement speaking at Confed17 yesterday, the next phase of STPs and Accountable Care Organisations needs to see “local government hard wired into the governance systems, and not kept outside”.

In the early stages of the STP process, a PSE investigation revealed that many local authorities felt locked out of the discussions, which were mainly being driven by local NHS partners.

But Mackey stated, as many local authority figures have done in the past, that this needs to be looked at as a “fully joined-up and integrated system, where everyone has a proportionate say at the table”. He added that in some areas of the country STPs have involved councils, but in other areas more could be done.

But speaking in a panel session shortly after at the NHS Confederation event, Cllr Robert Smart, who has acted as an informal advisor to the “Save the DGH” campaign group in Eastbourne for the past five years, claimed that his reading of the STPs, in general, is that they are “disappointing” and do not provide a long-term plan for health in their areas.

“I also don’t see any accountability for STPs at the moment,” he added.

During the same debate, David Lock QC, who has spent over 15 years advising NHS bodies, added that if some of the changes are about saving money then “you must tell the truth about the changes” in order to get the public on board.

Defending the STP corner, Dr Amanda Doyle, co-chair of NHS Clinical Commissioners and STP lead for the Lancashire and South Cumbria, told delegates in Liverpool that local authorities need to be “absolutely embedded as key members of STP governance and practical arrangements”.

“If you come to my part of the world, the reason why our maternity outcomes are poor is because a third of our women smoke throughout their pregnancy,” she said. “If I could do one thing, it wouldn’t be reconfiguring neonatal care and maternity units, it would be doing something about smoking.

“Local authorities commission public health services, but the public health grant has been absolutely stripped back – it is making it impossible for us.

And Dr Doyle added that more needed to be done to align the agendas of commissioners, as well as public health and social care services together.

“And local authorities need to be in there with us giving us democratic legitimacy. If we bring clinical and democratic legitimacy together then we will effect change,” she concluded. “We really need to be doing that!”

Julian Hartley, CEO of Leeds Teaching Hospital NHS Trust, added that all partners across the city are involved with the plan, and it goes through the Health and Wellbeing Board.

“We work collaboratively with local authority across all West Yorkshire, and we rely on an intimate knowledge of each other’s challenges and issues,” he said. “But however good the STP plans are, they need to be backed. They also need upfront investment to get them moving.”

Have you got a story to tell? Would you like to become a PSE columnist? If so, click here.