LGC commentary on a new analysis of London STPs
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The joint analysis by the King’s Fund and Nuffield Trust of the five sustainability and transformation partnerships in London offered no surprises but further highlighted some familiar and troubling themes.
There is consensus that as demand and financial pressures rise in tandem across the health and care system, genuine collaboration through a strong sense of shared enterprise needs to be entrenched across the NHS, local government and beyond.
But as those attending the report’s launch today were reminded, a perceived lack of transparency and engagement with politicians, the public and key organisations such as social care providers has allowed mistrust and scepticism to fester as huge projected funding gaps loom ominously on the horizon.
In this context, the report calls on STPs to be “realistic about what can be achieved within the timescales and resources available” when planning to deliver more co-ordinated community care and warns that “significant investment” is needed to support new care models but “it is not clear where this investment will come from.”
The report, which was commissioned by the London mayor, also says STPs should guard against overstating the expected impact of these new care models on hospital use and the cost of care, as growing pressures on social care and community services will limit what STPs can achieve.
STPs in London and elsewhere have ambitions to prioritise prevention and reduce inequalities, but the report warns that the role of the NHS in addressing non-medical needs has not been defined. It also adds that cuts to public health funding and other council services are significant contributors to the challenges faced by STPs.
While the scale of the challenges is clear, the report also highlights the potential importance of London mayor Sadiq Khan’s role in efforts to overcome them.
Mr Khan has no statutory powers over the NHS, but he is a popular politician who could contribute to helping STPs navigate a potentially treacherous road to unpopular service reconfiguration – if and when a convincing case has been made.
The mayor’s health adviser Tom Coffey told today’s launch that, despite some politically contentious proposals on hospital services in London STPs, Mr Khan views the process as a “fantastic opportunity” to work at scale.
The report highlights the mayor’s ability to facilitate the co-ordinated action that will be required to improve the health and care system across London as a whole.
Mr Coffey acknowledged that both clinicians and councils were concerned about the process and made it clear that Mr Khan sees himself as both a “champion and a challenge” to STPs.
He said today’s report would serve as a preliminary overview of plans before each detailed proposal will be scrutinised, adding that Mr Khan sees the London Health Board – which brings together the mayor with council leaders and representatives from NHS England and Public Health England – as the ideal vehicle to do this.
Mr Coffey’s emphasis on the importance of social care funding will please any London boroughs concerned over a tight focus on NHS priorities. Echoing the report’s finding that STPs are lacking in any specific proposals to address growing pressures across adult social care, Mr Coffey insisted that there was a “need for a vibrant, effective social care system” if STP objectives were to be reached.
Mr Coffey also hinted that the mayor was close to being able to announce further undefined devolution agreements with government. He said, for example, this could help address the recruitment and retention issues in health and social care that the report identifies as a key barrier to progress.
This could also mean that the new powers for London over health and social care announced by chancellor Philip Hammond at the March budget may finally be forthcoming after falling victim to inertia in government.
Any further flexibilities, combined with a mayor who could help to nurture consensus on what needs to be achieved – while making sure the voices of communities are heard – could give London STPs a fighting chance of overcoming what sometimes appear to be insurmountable challenges.