The NHS is a remarkable organisation.
With greater support than any analogous institution, it can command more resources than most other parts of the state, with the possible exception of pensions.
It is responsible for a budget at least double that of local government, yet its accountability is pitifully weak. Members of the public who wish to scrutinise its local funding, decision-making or future planning will find it impossible to work out who, apart from the health secretary, is responsible for what.
Last December, the Department of Health initiated a process whereby localities of England would generate sustainability and transformation plans. The precise geography of these areas was not specified, with the onus placed on health trusts, clinical commissioning groups and local authorities to sort themselves out into groups.
These areas, when determined, were given the name ‘footprints’. There are 44 of them, grouped into regions with names such as ‘North’; ‘South’, ‘Midlands & East’ and London. As in schools administration, Eric Pickles’s war on regional government has been lost.
A government planning document published earlier this year stated: “The boundaries used for STPs will not cover all planning eventualities. As with the current arrangements for planning and delivery, there are layers of plans which sit above and below STPs, with shared links and dependencies”. STP boundaries may change in future.
NHS England has stated it will invest £2.1bn in an STP fund in 2016-17. Of this total, £1.8bn of funding has been allocated to the sustainability element of the fund to bring the NHS provider trust sector back to financial balance. STPs are thus partly about reducing NHS deficits and partly about longer-term improvement between now and 2020-21.
In the last week or so, a number of local government partners have chosen to publish their STPs. Those for Birmingham & Solihull, South West London and North Central London are now available online for their residents to read.
STPs are likely, as changes are implemented, radically to alter health and social care provision. Yet the NHS appears to be less than enthusiastic about their publication, evidently preferring private planning over a public debate. Local government really is better at accountability and responsiveness.
Tony Travers, director, LSE London