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Sustainability and transformation plans in the NHS

How are they being developed in practice?

Sustainability and transformation plans (STPs) were introduced in NHS planning guidance published in December 2015 (NHS England et al 2015). NHS organisations in different parts of England were asked to come together to develop plans for the future of health services in their area, including by working with local authorities and other partners. These plans are being called STPs. Forty-four areas were identified as the geographical ‘footprints’ on which the plans would be based, and final plans were due to be completed in October 2016.

STPs represent a significant and wide-reaching exercise in health care planning in England, covering all areas of NHS spending on services from 2016/17 to 2020/21. They also represent an important shift in NHS policy on improvement and reform. While the Health and Social Care Act 2012 sought to strengthen the role of competition within the health care system, NHS organisations are now being told to collaborate rather than compete to plan and provide local services (Alderwick and Ham 2016). This is being called ‘place-based planning’.

Given the history of short-term policy initiatives in the NHS and the speed at which new initiatives are often introduced (Ham 2014), the future of STPs is by no means certain. But they look like they are here to stay for now, at least. Recent operational planning and contracting guidance for the NHS sought to further embed STPs into NHS planning processes over the next two years (NHS England and NHS Improvement 2016a).

STPs have attracted growing media attention since they were first announced (see box, pp 14–5), particularly after some draft plans were published following an early planning deadline in June 2016. Major service changes are being considered in many of the plans (Edwards 2016), often involving changes to acute hospital services, and cautions have been raised about the kind of benefits that these changes can deliver (Murray et al 2016a).

The plans have also attracted growing political attention. A large number of parliamentary questions have been asked about STPs since June 2016 (see Appendix). The plans were the subject of an opposition day debate in the House of Commons in September 2016, when many Members of Parliament (MPs) voiced concerns about potential cuts to services and the ‘secrecy’ of the STP process (Hansard (House of Commons Debates) 2016–17). Questions about STPs have also been raised at the Public Accounts Committee (House of Commons Public Accounts Committee 2016) and the Health Select Committee (House of Commons Health Committee 2016).

Despite the importance of STPs for the NHS and the public, little is known about the process of developing the plans and how the initiative has worked in practice. The purpose of this qualitative study was to understand how STPs are being developed in different parts of the country and to identify lessons that can be learnt for local areas and national policy-makers.

Specifically, we wanted to understand:

  • how the work to develop STPs was being led, governed and managed at a local level
  •  the extent of collaboration in developing STPs and the involvement of different partners
  • the role of external advice and support in developing STPs – for example, by management consultants
  •  how the process has been managed at a national level and the relationship between national bodies in the NHS and local areas
  •  how the process was perceived by local leaders and the challenges experienced in developing STPs.

To do this, we carried out a series of interviews with senior NHS and local government leaders involved in developing STPs in four parts of the country. This report is based on analysis of data from these interviews. It therefore focuses on the local experience and perceptions of the STP process by those directly involved in developing the plans. Taken together, the four STP areas involved in the study cover a combined population of around 5 million people – just under 10 per cent of the total population of England.