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'Round two for STPs: a fresh start or dangerous distraction?'

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The new round of planning for sustainability and transformation partnerships must allow more collaboration between key stakeholders if it is to really improve population health.

In a recent letter to trust chief executives and clinical commissioning group accountable officers, NHS England and NHS Improvement said they expect STPs and integrated care systems (ICSs) “to develop and agree new strategic plans for improving quality, achieving sustainable [financial] balance and delivering the long-term plan”.

These plans will be developed during the first half of 2019 and submitted for sign-off in the summer. One-year organisational plans will also be submitted for 2019-20.

If ICSs and STPs are to succeed, national leaders must ensure local systems have the time, resources and flexibility to create credible plans. It is vital this is in a spirit of genuine partnership, with local authorities fully involved from the start.

Done badly, planning could be a significant distraction, even destabilising relationships and undermining progress. Done well, it could strengthen local partnerships and boost efforts to improve population health and wellbeing.

There is a good case to be made for creating new systemwide plans. NHS planning must be based on a realistic view of resources. It is logical to do this at a local level rather than via individual organisations to alignpriorities and spending.

On transparency and accountability, it is unfortunate many STPs have departed from previous plans without a clear public story about how their agendas have moved on. Updated plans could address this.

But the announcement has received a mixed reaction.

There is understandable cynicism about new five-year plans being developed just over two years after the last. The concern is that their development will repeat mistakes of previous STP planning, widely criticised for failing to engage key partners and proposing unrealistic savings.

Our work with local systems has shown the value of local authority involvement and leadership, creating a stronger connection with local communities, closer working across health and social care, and chances to act on wider health determinants.

ICSs and STPs will only realise the ambition of integrating care and improving population health if they look to local partners and residents, rather than up to national NHS bodies.

While the letter communicating the plans flags the importance of developing plans with “the proper engagement of all parts of local systems”, its origin and tone are firmly NHS-focused. Let’s hope this is not a sign of things to come.

Since STPs submitted their initial plans in 2016, their focus has shifted away from producing nationally mandated plans to building partnerships between NHS organisations, local authorities and wider partners.

Progress varies widely across the country, but those furthest ahead have developed new ways of collaborative working and introduced new service models to strengthen and integrate primary and community services.

Local systems have achieved this by prioritising stronger relationships and trust between partner organisations and their leaders. The leadership of local authorities has often been key.

Areas leading the development of ICSs have benefited from an unusually permissive approach from national policy-makers, giving them significant latitude to shape systems and priorities locally.

The risk in developing new plans is that they become a tickbox exercise to meet requirements of national bodies, rather than a meaningful attempt to identify and agree local priorities. To avoid this, local leaders need flexibility.

Our work with ICSs underlines the value of local leaders undertaking focused work to agree key issues and priorities to establish common cause and a shared commitment to change.

This will require national bodies to continue with the permissive approach that ICSs have benefited from, and to adopt a more realistic timescale and budget than the last round of STP planning.

It will also require greater engagement of key stakeholders, involving people and communities in designing services that meet their needs and reflect their priorities. While it is mostly in the hands of local leaders, the national process is important in setting expectations.

With the NHS long-term plan and national planning guidance fast approaching, the direction of travel for local systems of care is likely to become clearer.

The key question to be resolved is how STPs and ICSs can balance their role as NHS planning structures responsible for managing money and performance with their wider roles – as partnerships that reach beyond the NHS to improve population health.

Anna Charles, senior policy adviser, The King’s Fund

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