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'Beefed up' leaders need enlightened approach

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Commentary on new powers for STP leaders

The announcement by NHS England chief executive Simon Stevens that the role of leaders of sustainability and transformation plans would be “beefed up” is an acknowledgement that there is a long way to go in some areas before the process can begin to deliver on its promise.

Insisting STPs “were here to stay”, Mr Stevens told a meeting of the NHS England board a Five Year Forward View delivery plan, due next month, would strengthen “implementation capability” within each of the 44 footprints.

This would involve an STP being given “decision rights” to recommend fundamental changes to the “configuration of constituent statutory organisations” where it believes “veto power or inertia” is hindering progress.

So where could this leave local government in the STP process?

Some councils have already complained of being illogically sidelined in a process that has at its core the requirement for a viable and effective social care system that relieves pressure on acute services.

While few would argue for making STP governance arrangements more robust, the fear could be that the further empowerment of those leading the process – the vast majority of whom are from the NHS – could reinforce a focus on managing financial pressures and the complex reconfiguration of health services.

This could potentially lead to a demotion of social care in a hierarchy of priorities and further weaken the position of councils that are best equipped to contribute to a thorough, place-based strategic approach to address pressure points throughout the whole system.

There have been warnings from local government of the culture change required within the NHS to create a sustainable health and care system.

But could these new powers simply serve to encourage inwardly focused deficit deliberations, reinforce existing attitudes and create further barriers to the culture shift required?

Mark Rogers, Birmingham City Council chief executive and one of the four council officials who currently lead an STP, has spoken of his wish for a shift from “atomised thinking” about silos to action on creating sustainable systems.

Whether Mr Rogers would be tempted to go through the formal appointment process for STP leads being drawn up as part of the delivery plan remains to be seen, but many councils will be hoping whoever does will take an enlightened approach to driving through positive change, rather than closing their mind to the bigger picture.

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