Sustainability and Transformation Plans: another NHS reorganisation?

Earlier this year, new structures were announced to oversee health care in 44 areas of England. On 19 May, the NHS Chief Executive, Simon Stevens, said that these structures needed a firmer footing, implying that legislation would be needed. The new structures could create a more coherent approach to health in local areas, with decisions taken closer to the people who use the services. But austerity, the pace of change, and questions about the role of local authorities create risks that need to be addressed.

The NHS Five Year Forward View called for ‘decisive steps to break down the barriers in how care is provided.’ Services need to join up around citizens, but for this to happen, nationally organised services need to be able to plan and take decisions together in different areas of the country. The mechanisms for this integration, and for the restructuring of health services, are the bureaucratically named ‘Sustainability and Transformation Plans’ (STPs). The STPs will produce plans in 44 areas of England by the end of June – if everywhere meets this tight deadline. The idea is that the various NHS and local authority health and care services should be planned jointly. STPs are already taking on staff and becoming part of the institutional landscape, with Simon Stevens working directly with the STP leaders.

The first challenge to the STPs is the austerity and rising demand that is affecting services. We have recently explored the tough financial position in the NHS, highlighted by the announcement of deficits of £2.45bn across hospital trusts. The additional money that will be made available for STPs is conditional on progress on deficit reduction and transformation.

Local authority services are under even greater pressure. Social care saw some of the most significant cuts under the Coalition, with poorer parts of the country facing larger reductions. In the Spending Review in November, the Chancellor announced two big changes to funding for social care:

Local authorities were given scope to increase Council Tax by an additional 2% to fund social care
An additional £1.5 billion was allocated to the Better Care Fund, which is managed through the 130 Health and Wellbeing Boards.
Institute for Government 3 June 2016