Exclusive: Over two-thirds of councils shut out from STP health leadership talks

Council involvement in the ongoing and arguably momentous Sustainability and Transformation Plans (STPs), designed to integrate health and social care across 44 ‘footprints’, has been inconsistent nationwide – with most areas locked out of leadership nomination discussions entirely.

The STPs were pitched in December as part of NHS England’s planning guidance for 2016-17 to the end of the decade, as reported by PSE’s sister title, National Health Executive. Amongst other reasons, they were created to bring together health and care in designated footprints under “ambitious local blueprints”.

Despite two of the five pillars of the STP programme being the involvement of local government and developing a shared vision, councils do not have an obligation to be engaged in the process, unlike health partners.

And many have been kept out of meetings used to appoint a single leader responsible for overseeing and guiding the STP process in each footprint, Freedom of Information (FoI) requests sent by PSE have shown.

Across the 114 councils that responded to the FoI request on time, from a total of 155 requests including to combined authorities, just 36, or less than a third, were involved in leadership nomination discussions, held at one or more joint meetings.

Some councils, such as Torbay, Kent and Oxfordshire, were informed this was “not a discussion” or said the single leader was nominated entirely or “almost exclusively” by NHS England rather than local bodies.

Given the strong influence from NHS bodies and clinical commissioning groups (CCGs) in this process, the vast majority of footprint leaders are based in health. Just four of the 41 leaders announced hail from councils – including Nottinghamshire’s David Pearson, Norfolk’s Wendy Thompson, Manchester’s Sir Howard Bernstein, and Birmingham’s Mark Rogers.

While several footprints have enjoyed positive engagement between all regional health and care bodies, with many setting up monthly joint meetings between NHS and council bodies, some local authorities criticised how the process had been taken forward from the very start.

In emails shared between council and NHS bodies in Bedford, Philip Simpkins, the borough council’s chief executive, said the authority would not be able to make direct financial contributions to the STP programme because the process was “a Department of Health initiative and put in place without consultation with the local government”.

In an email sent by the LGA’s Fiona Russell to Bedford’s health and care leaders, she said the association would “continue to work to increase understanding and utilisation of local government’s experience, expertise and perspective” as result of national feedback.

In Northumberland, the county council said the process was led at the level of the sub-regional footprint rather than by local NHS organisations the authority works with routinely.

“Because of this, we were not initially invited to meetings about the STP as consistently, or as systematically engaged with the process, as we would have hoped to be,” the council said. “However the position has been improving.”

STPs ‘creating another tier across NHS and councils’

Other councils were critical of how the footprints were chosen by NHS England. Minutes from Torbay Council’s Health and Wellbeing Board (HWB) meeting on 24 March, for example, said its members “expressed great concern regarding the impact the STP would have upon the existing Integrated Care Organisation and outside influences destabilising the arrangements”.

“Members were extremely anxious that local developments were not slowed as local people were expecting change and the momentum needed to be sustained,” the council said. “Members were advised that the CCG were being looked upon by NHS England to lead the process, however CCGs recognised that partners needed to be engaged as the plan was place based, therefore partners were important if the plan was going to succeed.

“Members felt that previously the ‘bottom up’ approach had been working well and partners were transitioning into what looked like a good place, with the public being taken on the journey.  Members were anxious that the STP felt like a ‘top down’ approach being enforced by ‘big brother’ with service users being overridden.”

According to the council, South Devon and Torbay CCG had “similar feelings”, with the STP potentially replacing some elements of the region’s Joined Up Plan.

In North Yorkshire, council members warned that STPs must not undermine the success of local HWBs who have published their own health and wellbeing strategies, overseen Better Care Fund investment and brought forward new models of care.

“STPs are creating another tier across the NHS and local government. It is difficult to see how democratic accountability in the NHS is being enhanced when leadership of the STPs sits out-with established local and county wide accountability arrangements,” the council said.

“Maintaining effective overview and scrutiny across the STP boundaries is likely to require the setting up of joint committees drawn from the relevant upper tier local authorities.”

A handful of other councils were simply “updated” on the STP progress by their relevant CCGs or NHS bodies – many times after critical ‘checkpoints’ established by NHS England, when footprints would have to report on progress, had already passed.

The final of these checklists will be the official STP deadline on 30 June. While this is less than a month away, NHS England acknowledged just last week that few of these plans are “at the degree of scale and pace” required so far.

It also acknowledged that workforce is still a “key issue in almost every footprint” and that each area is at a different starting point. Some councils are caught in this crossfire as a result, with North Yorkshire, for example, engaging with three different STP areas at once – with groups all progressing at different speeds.


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