What is an STP?

The north east London Sustainability and Transformation Plan (STP) sets out how local health and care services will transform and become sustainable over the next five years, building and strengthening local relationships and ultimately delivering the Five Year Forward View vision.

Why develop a STP?

For the NHS to meet the needs of future patients in a sustainable way, we need to close the gaps in health, finance and quality of care between where we are now and where we need to be in 2020/21.

In order to create a better future for the NHS, and for local people to live long and healthy lives, we must make changes to how local people live, access care, and how care is delivered. This doesn’t mean doing less for patients or reducing the quality of care provided. It means more preventative care; finding new ways to meet people’s needs; and identifying ways to do things more efficiently.

What will the STP focus on?

The health of the population in north east London is challenging, with deprivation, significant population growth, and different population needs. We see prevention as key, and by investing it we can manage our growing population within our current hospital space.

NHS England has been clear that it expects the STP to:

“describe a local cross-partner prevention plan, with particular action on national priorities of obesity, diabetes and locally identified priorities to reduce demand and improve the health of local people;
increase investment in the out-of-hospital sector, including considering how to deliver primary care at scale;
set out local ambitions to deliver seven day services. In particular: (i) improving access and better integrating 111, minor injuries, urgent care and out-of-hours GP services; (ii) improving access to primary care at weekends and evenings; and (iii) implementing the four priority clinical standards for hospital services every day of the week;
support the accelerated delivery of new care models in existing vanguard sites [in NEL’s case, Barking and Dagenham, Havering and Redbridge and Tower Hamlets]; or, in systems without vanguards, set out plans for implementing new models of care with partners;
set out collective action on quality improvement
set out collective action on key national clinical priorities such as improving cancer outcomes; increasing investment in mental health services and parity of esteem for mental health patients; transforming learning disabilities services; and improving maternity services;
ensuring these and other changes return local systems to financial balance, together with the increased investment that will come on-stream as set out in NHS England’s allocations to CCGs; and
be underpinned by a strategic commitment to engagement at all levels.”
NEL-wide, we have started to identify some emerging priorities which might benefit from a NEL-wide focus, these include:

urgent and emergency care
mental health
We are also looking at primary care, learning disabilities and cancer system improvement (with a particular focus on early diagnosis), among others. We’ll keep you updated as we explore our priority areas further.

How will the STP impact on other programmes, such as the devolution pilots?

Rather than looking at starting from scratch, the NEL STP recognises existing local plans and supports the pace of implementation of these, driving them and focusing on delivering added value. These transformation programmes are:

Barking and Dagenham, Havering and Redbridge: urgent and emergency care vanguard, devolution pilot (ACO)
Hackney: devolution pilot
Newham, Tower Hamlets and Waltham Forest: Transforming Services Together programme
Tower Hamlets: multi-specialty community provider vanguard.

Shouldn’t the focus be on getting hospitals out of special measures before implementing a STP?

The NEL STP is supporting the improvement programmes of our local hospitals, and will set out how Barts Health NHS Trust and Barking, Havering and Redbridge University Hospitals NHS Trust will be supported.

Will the STP programme board reconsider plans to close the A&E at King George Hospital?

No. That decision has been made, and is now for the Trust and BHR CCGs to implement. The NEL STP will not revisit any previously made decisions.

Who is leading on this work?

Chief officer of Tower Hamlets CCG, Jane Milligan, is the overall lead for the NEL STP. Across the eight boroughs, all local councils and clinical commissioning groups are involved in this piece of work, alongside community, mental health and acute services providers. The leadership team also consists of:

Provider lead: Matthew Hopkins, chief executive, Barking, Havering and Redbridge University Hospitals NHS Trust

Commissioner lead: Terry Huff, chief executive, Waltham Forest CCG

Clinical lead: Sir Sam Everington, GP and chair, Tower Hamlets CCG

Local authority lead: Kim Bromley-Derry, chief executive, London Borough of Newham, Andrew Blake-Herbert, chief executive, Lind Borough of Havering and Tim Shields, chief executive, London Borough of Hackney

How will patients and the public be involved in the development of the STP?

Crucial to the development of the NEL  STP is engaging with patients, staff and communities, so we are developing priorities through the eyes of those who use and pay for the NHS. The NEL STP will be developed with, and based on the needs of local patients and communities and command the support of clinicians, staff and wider partners. Where possible, it will build on existing relationships, particularly through health and wellbeing boards. Health Education England will also have a role to play in coordinating and supporting the workforce requirements.

We are currently looking at how to best involve patients and the public to provide advice and challenge to our plans and would welcome any suggestions regarding this.

Who will pay for the STP?

Put simply, we need to have a robust and agreed STP in order to get funding.

NHS England has invested £2.139bn in a Sustainability and Transformation Fund in 2016/17. Of this, £1.8bn of funding has been allocated to bring the NHS provider trust sector back to financial balance. Funding will be released quarterly to trusts, dependent on achieving recovery milestones for deficit reduction; access standards; and progress on transformation. NHS England has been very clear that it is not a case of recovery followed by transformation. They are not alternatives; we must do both simultaneously. Any investment must not just prop up individual institutions for another year, but be used to drive a genuine and sustainable transformation in patient experience and health outcomes over the longer-term.

Mirroring this, the real terms element of growth in CCG allocations for 2017/18 onwards will be contingent upon the development and sign-off of a robust STP during 2016/17.

When is this happening?

We have (as of 15 April) submitted a summary of our initial thinking to NHS England for review. At the same time, we are continuing to develop our STP and will submit it to NHS England on 30 June. In July, ‘regional summits’ will test our STP and agree the actions to take to deliver it.

Will this replace other local NHS governance structures?

No – the local, statutory architecture for health and care remains, as do the existing accountabilities. This is about making sure that organisations are able to work together at scale and across communities to plan for the needs of their population, and ultimately deliver the Five Year Forward View – closing the gaps in quality, health and NHS finances by 2020/21. Organisations are still accountable for their individual organisational plans.

Does this mean organisations will merge?

The STP process is an invitation to commissioners and providers to understand the shared challenges they face in order to provide high quality care to the populations they serve, and to develop a coordinated plan for addressing those challenges. Having a shared STP across a local community also does not mean that NHS organisations – like a local hospital or a primary care centre – will have to lose their own autonomy or identity. But it does means that organisations will be working to a shared, agreed plan which addresses how they will collectively improve health, care and finance for their local population by 2021.

How will other partners be involved?

The NEL STP is being developed with and based upon, the needs of local patients and communities and must command the support of clinicians, staff and wider partners such as local authorities.

How does the NEL area for the STP fit with other health and care footprints?

The boundaries used for STPs will not cover all planning eventualities. As with the current arrangements for planning and delivery, there are layers of plans which sit above and below STPs, with shared links and dependencies. For example, neighbouring STP areas will need to work together when planning specialised or ambulance services or working with multiple local government authorities and, for areas within a proposed devolution footprint that cross STP boundaries, further discussion will be required in working through the implications. Other issues will be best planned at Clinical Commissioning Group (CCG) level.

Will the STP replace other local plans for change?

No. The STP will act as an ‘umbrella’ plan for change: holding underneath it a number of different specific plans to address certain challenges, such as cancer, mental health, or urgent and emergency care.