Local government and STPs


By Paul Carey Kent, technical manager, health, CIPFA

The recent Budget announcement will see Sustainability and Transformation Plans (STPs) receive an additional £3.5bn in capital over the current Parliament. This came alongside promises from the Chancellor that the Treasury will ensure STPs are progressed and prioritised. But will extra resources, however welcome, ensure STPs bring about change and transform services, or is there more that needs to be done?

A survey released in the autumn, conducted by CIPFA and iMPOWER, suggests that there are more than just financial issues that are affecting STPs. The survey highlights that integration is proving to be a major challenge for local authority and health partners. A challenge they are struggling to overcome.

In the survey of 56 organisations involved in STPS, over half of respondents said that they believe relationships to be ‘reasonable’ , less than a quarter consider current relationships between the NHS and local authorities to be ‘very strong’, with rather more believing them to be ‘limited’. However, 90% of those surveyed claim that they consider successful integration is critical to their organisation’s long term sustainability. The results show that although health and social partners recognise the importance of the integration agenda and are rather optimistic about its potential benefits, they are still not managing to break down the barriers to collaborative working.

The extra resources promised in the Autumn Budget may help organisations integrate, as a system-wide shortage of resources and capacity may be causing organisations to look inwards to protect budgets and position. However, there are other solutions available. 

The most radical option would be to provide STPs with a statutory role. On the back of that could come local democratic ownership and financial accountability based on local government’s requirement in law – not shared by the NHS – to set a balanced budget. This would hopefully mean that if the savings assumptions are too optimistic, CFOs would be better placed to state that targets are unlikely to be met. If STPs were statutory, local politicians could also more reasonably be expected to support them, and may be more inclined to back any tough and unpopular decisions that the plans require. 

There are also some less committal adjustments that might help local authority and NHS partners integrate. These include more explicit risk sharing and clarity of accountability, along with more open discussions on what they think can realistically be afforded in the short to medium term.   

Local NHS services also have to actively ensure that they involve local government. Indeed, it is worrying that the NHS’s ‘top down’ culture of target setting led to the initial plans under-involving local authorities and even keeping the draft STPs secret from them.  

Considering the point of STPs is to bring together key local players to improve outcomes and achieve financial balance by 2020, it is worrying that they are struggling to do just that. STPs, however flawed, remain our best hope of putting the sector on a more sustainable footing. And so, it is critical that the government, as well as providing resources, explores how else they can support partners involved the transformation plans. Otherwise, it is difficult to imagine that the ambitious targets set out by STPs will be achieved.

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