Public Services

STP plans under spotlight as parliament raises care sustainability fears

Neil Merrett Published 13 January 2017

With parliamentary committees urging clear cross-party agreement to address intensified funding pressures on care services, industry figures raise importance of consistent digital leadership

In a week where the impact of service and funding pressures on the NHS dominated media coverage and an NGO came under criticism for claiming a domestic "humanitarian disaster" was taking place in some hospitals, significant questions remain over the sustainability of healthcare service delivery.

As Whitehall continues to press technology-led strategies to integrate health and social care systems, funding set aside to meet these aims whilst maintaining current services is being seen as increasingly insufficient.

Over the last seven days, the chairs of three key Whitehall select committees urged MPs to reach a new cross-party agreement on health and social care funding in a joint letter that called for an urgent parliamentary review.

Health Committee chair Sarah Wollaston, her Public Accounts Committee (PAC) counterpart Meg Hillier, and Clive Betts, head of the Communities and Local Government Committee, wrote to Prime Minister Theresa May following her comments to the Commons Liaison Committee about health and social care in December.

"We were encouraged by your recognition at the Liaison Committee that everyone has a part to play in finding a sustainable way of ensuring social care provision in the future. You also accepted the need for a review to find a way of funding social care sustainably for the long term," they wrote.

"We believe that can best be achieved if there is cross-party consensus, and therefore urge you to invite all parties to become involved in a review, which should begin as soon as possible. Given the scale of rising demand, this immense challenge will face whichever party is in government over the coming decades."

In planning future government spending, the letter highlighted a need to swiftly prepare for a renewed focus on integrated care reform.

"We also feel that the ongoing separation of health and social care is creating difficulties for individuals and avoidable barriers and inefficiencies. Any review should cover the two systems", the MPs added.

From a technology perspective NHS England is committed to its Sustainability and Transformation Plans (STPs).

These are designed to set out a clearer strategic direction to integrate and overhaul UK health and social care services and the systems underpinning them up to meet the aims of the 'Five Year Forward View' plan.

In July last year, NHS England chief executive Simon Stevens pledged a commitment to have all 44 STP area strategies, which detail their local commitments to interoperability, completed and published by October 2016. Work was then expected to get underway on the separate STPs by the end of this month.

With all 44 plans now published, further work is understood to be needed to ensure clearer strategies for care organisations.

Speaking at a PAC session this week on the financial sustainability of healthcare, Chris Hopson, chief executive of NHS Providers - a trade association for NHS acute, ambulance and mental health services - said he expected delays and further issues with STP implementation.

"Our view is that that STP process will probably need to carry on for at least another three or four months until we can get some genuinely robust, rigorous and credible plans to close that financial gap," he told the committee.

"But in a sense, the STPs are just a localised reflection of the gap that we have at the national level, so you might argue that effectively, all we have done is parcelled up a national gap and asked a whole bunch of local systems -- 44 systems -- to try to come up with a local answer to their share of the national gap. Not entirely surprisingly, it is proving to be a very difficult task."

Hopson also noted that STP planning required the 44 local areas involved in the process to set out both how they intended to meet the aims of the Five Year Forward View, while coping with slowing funding increases.

"To be frank, the feedback from our members is that they are finding it very difficult to identify how they can meet that very stretching target," he added.

From a technology perspective, the recently elected chair of the CCIO Industry Network - a grouping of clinicians working for technology and software suppliers - has played up the importance of ensuring sufficient digital leadership among the 44 areas charged with setting out individual STP plans as a significant challenge.

Professor Michael Thick, who has taken leadership of the network this month, said that with interoperability forming a key part of challenges for suppliers looking to work with the NHS, collaboration was already underway with organisations like the Professional Record Standards Body.

However, he noted that a much clearer focus would be needed in areas such as understanding datasets used for health and social care delivery and how they may be linked going forward to support more shared working and systems approaches.

Thick said that there was also a need for clinical leadership and safety expertise being guaranteed by authorities when working on transformation projects. Nursing input was given as a key example of how technology suppliers should be helping the NHS to overhaul systems or technology.

"There are eight times more nursing staff than doctors, their voice is therefore crucial on how new technology works," he said.

Thick maintained that clear leadership and clarity on plans had to be central to any successful STP implementation strategy, with questions unanswered about how 44 separate plans can be managed and set out.

He argued that a failure to ensure this would make it impossible to understand the realistic technology needs of care organisations:

"What do we need to build and what do we need to supply?"

Related articles:

Government pledges to expand digital mental health services

King's Fund urges STP perseverance, despite local authority engagement fears

NHS England chief addresses Brexit and integrated care challenges

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