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Sustainability and Transformation Plans (STPs): What, why and where next?

The NHS is facing one of the most challenging periods in its history. A toxic combination of ever rising demand and stagnant funding growth means that
the service is facing a funding gap of more than £22 billion over the coming years. Meanwhile, the pressure on the social care system is even more acute, with many councils raising eligibility thresholds and making cuts to social care budgets.

Sustainability and Transformation Plans (STPs) – which are local health and care reform plans, authored jointly by NHS and local government leaders to improve outcomes and drive greater efficiency in their local area – are one of the government’s main responses to this problem. These plans rightly focus on decentralising power within the NHS, investing in leadership and relationships (over incentives or structural change) to drive improvements,
and on local health and care organisations coming together to overcome the silos created by the 2012 Health and Care Act.

Although these plans vary in content, they have (by and large) correctly identified the most promising reform solutions, including the reconfiguration of the acute sector, the movement of care into the community, and the delivery of an upswing in prevention, with reform to commissioning, workforce, estates and local innovation infrastructure all considered key enablers.

However, going forward, there are a range of challenges that stand in the way of STPs realising their vision for improved health outcomes and greater efficiency.

In particular, they:

• face a deficiency in leadership, especially at the national level, which means that the public is either unaware of the reform plans or is misinformed about them, leading to unnecessary opposition
• risk getting engulfed by the funding pressures on the service, with much of the existing funding being channelled into maintaining existing ways of working or filling in deficits, rather than enabling the reform agenda
• have no statutory powers with which to deliver their reform agendas, with the fragmentation created by 2012 Health and Social Care Act retained – making STPs a workaround – rather than addressed directly.