Sustainability and Transformation Plans
What are Sustainability and Transformation Plans?
STPs are five-year plans covering all areas of NHS spending in England. They are part of the NHS Shared Planning guide to 2020/21 and sit as part of the implementation of the Department of Health 5 Year View.
A total of 44 areas have been identified as the geographical ‘footprints’ on which the plans will be based, with an average population size of 1.2 million people (the smallest area covers a population size of 300,000 and the largest 2.8 million). A named individual has been chosen to lead the development of each STP. Most come from clinical commissioning groups (CCGs) and NHS trusts and foundation trusts, but a small number of STP leaders come from local government.
The proposed scope of STPs is broad. Initial guidance from NHS England and other national bodies set out around 60 questions for local leaders to consider in their plans, covering three headline areas: improving quality and developing new models of care; improving health and wellbeing; and improving efficiency of services. Leaders have been asked to identify the key priorities for their local area to meet these challenges and deliver financial balance. While the guidance focuses mainly on NHS services, STPs must also cover better integration with local authority services.
The timelines for developing STPs and the process for approving them have been somewhat fluid. The original deadline for submitting plans to NHS England and other national bodies was the end of June 2016, but most plans will now be further developed and re-submitted by October. The plans are likely to be assessed and approved in phases, depending on their quality. From April 2017, STPs will become the single application and approval process for accessing NHS transformation funding, with the best plans set to receive funds more quickly.
A new Sustainability and Transformation Fund has been established that will hold £1.8 billion to support providers in deficit - money that up until now came from the Department of Health. When other funding streams that support transformation are added in, this will create a total fund of £2.1 billion.
The new NHS shared planning guidance covering the years up to 2020/21 contains much that is new and indeed radical. Already one element that has drawn comment is the new Sustainability and Transformation Fund.
This fund will hold £1.8 billion to support providers in deficit – money that up until now came from the Department of Health. When other funding streams that support transformation are added in, this will create a total fund of £2.1 billion. The £1.8 billion is under a separate ring-fence from other NHS money, and provides confirmation that it is for sustainability ( i.e deficits) rather than transformation - at least for 2016/17. Agreement for applying this fund must be agreed in advance with HM Treasury and DH. This means that in the future local areas (i.e the 44 areas) must formally apply to the centre for financial help and the centre now comprises o NHS Improvement, NHS England, HM Treasury and the DH. The formal and public arrival of HM Treasury into the process for agreeing deficit-funding for NHS providers might be an indication of the anxiety in central government over NHS finances.
Defining these geographies is the first task for local areas. The strength of these sustainability and transformation plans will then be a key factor in the release of future transformation funding as well as guiding local co-operation and implementation. There is some indication in the guidance of what these plans need to address in order to get sign-off and unlock the central pot of money. There are more than 60 nationally determined questions that the plans will ultimately need to answer and, of course, this is before dealing with any specific local priorities.
STPs could provide a foundation for a new way of planning and providing health services based around the needs of local populations. While STPs are primarily being led by the NHS, developing credible plans will require the NHS to work in partnership with social care, public health and other local government services, as well as third sector organisations and the local community.