The challenges for STPs
I spent yesterday at the NHS Health and Care Innovation Expo in Manchester. On the way up I used the train journey to read the Nuffield Trust's really useful discussion paper on 'Sustainability and Transformation Plans: What we know so far.' The paper, written by Nigel Edward draws together key themes from a workshop Nuffield Trust ran earlier in the summer, and makes it clear that there is still a lot we don’t know about how the STPs will resolve the challenges facing complex and different health economies, but there are common themes emerging. It considers finance and enablers, particularly technology and estates and in several places it highlights the issue of capital constraint describing it as a problem for a number of facets of the planning process.
The range of common themes was echoed in the presentations at Expo, not in a negative context but as part of a packed agenda covering progress in New Models of Care and the drivers for, and challenges of, establishing relationships for integration. Those discussions also emphasised the need to align an increasing number of really good but potentially overlapping initiatives.
I was struck during the course of the day by two things:
- There is widespread recognition that STPs have the potential to drive change at scale and hopefully pace. Alignment of overlapping programmes was a consistent concern though – 84 digital road maps, 44 STPs, 50 Vanguards, 16 Cancer Alliances, all make establishing a single workable local plan a challenge. There was also concern that at the moment the patient voice may not be heard loud enough in the planning process, which could create subsequent issues in any consultation process required.
- On the issue of capital, Expo is an event supported by a relatively modest number of commercial organisations from across a very wide range of services, all of whom can offer solutions to NHS problems and want to collaborate with the system. Most if not all of those solutions could involve access to capital. This is not back door privatisation; most of these organisations are already deeply embedded in the system. PFI is an understandably tainted brand (although the Non-Profit Distributing model is a model gaining some traction in certain areas with the Welsh Government committed to using the model for the £210m Velindre Cancer Centre – that's a blog for another day) but perhaps part of the STP planning process should (and maybe already does) involve consideration of innovative commercial partnerships to provide capital for investment in the assets and IT and possibly even infrastructure the plans will inevitably identify to be necessary. The CEO of a large Original Equipment Manufacturer once said to me that there was no reason why the NHS should ever have to spend cash on high end capital assets. If the system needs capital (and Simon Stevens has mentioned a 70th Birthday Fund), as a tax payer, patient and carer I hope the conversations with the organisations who can help will take place to ensure that ambitious plans don’t founder for want of funds.