House of Commons Library

NHS sustainability and transformation plans

Published Monday, September 12, 2016

There will be an Opposition Day Debate on NHS sustainability and transformation plans on Wednesday 14 September 2016. This House of Commons Library page provides a summary of the issues and links to Parliamentary and press coverage.

Summary

In December 2015 NHS England and its partner organisations (NHS Improvement, Care Quality Commission (CQC), Health Education England (HEE), National Institute of Health and Care Excellence (NICE), and Public Health England (PHE)) published NHS shared planning guidance 2016/17 – 2020/21, which outlined a new approach to planning health and care services across regional areas rather than around individual institutions.

As in previous years, NHS organisations are required to produce individual operational plans for 2016/17 but, in addition, every health and care system has to work together to produce a multi-year Sustainability and Transformation Plan (STP). The STP must show how local services will develop and become sustainable over the next five years – ultimately delivering the NHS Five Year Forward View vision.[1] STPs will cover the period October 2016 to March 2021.

To deliver these plans NHS providers, Clinical Commissioning Groups (CCGs), Local Authorities, and other health and care services have come together to form 44 STP ‘footprints’. These are geographic areas in which organisations will work together to develop plans to transform the way that health and care is planned and delivered for their populations. In particular, health and care organisations within these geographic footprints will work together to narrow the gaps in the quality of care, their population’s health and wellbeing, and in NHS finances.

Information on the 44 different footprints is available from NHS England: https://www.england.nhs.uk/wp-content/uploads/2016/02/stp-footprints-march-2016.pdf

Initial STPs had to be submitted to NHS England by a 30 June deadline, with a view to implementation starting in “Autumn 2016”. The Government have said that these initial STP submissions are for local use and there are no plans to publish them centrally, although local areas may publish them if they so choose. Footprints will be expected to submit a final plan in October 2016. The arm’s length bodies that developed the NHS Five Year Forward View – NHS England, NHS Improvement, the Care Quality Commission, Public Health England, Health Education England and the National Institute for Health and Care Excellence – plan to publish STPs “once they are final”.[2]

In the last few weeks, the BBC[3], the Guardian[4], and others have reported widespread concerns about changes to local health services resulting from STPs. In response NHS England has committed that any changes proposed in the STPs will be consulted on – see for example, this statement from NHS England on 26 August 2016:

https://www.england.nhs.uk/2016/08/stp-statement/

Responses to PQs about consultation on STPs state that: “Where plans propose service changes, formal consultation will follow in due course in line with good practice and legislative requirements. The arm’s length bodies will be holding conversations with each area to assess their plans for local engagement.” [5]

 

STP guidance

Delivering the Forward View: NHS Shared Planning Guidance 2016/17 – 2020/21[6] stated that planning by individual NHS institutions will increasingly be supplemented with planning for local populations (referred to as “place-based planning”). It included the following keys points regarding STPs:

  • STPs will cover the period between October 2016 and March 2021.
  • Every health and care system is to identify their own geographic “footprint” and create their own STP, a “blueprint” for accelerating implementation of the Five Year Forward View.
  • Areas must submit their STPs by June 2016 and these will then be subject to an authorisation process.
  • Where collaborative and capable leadership can’t be found, NHS England and NHS Improvement will help secure remedies through “system oversight”.
  • The STPs must cover all areas of CCG and NHS England commissioning responsibility including primary care, hospital and community based services. Plans for specialised services will be led from 10 collaborative commissioning hubs.
  • The STP must also cover better integration with local authority services, including, but not limited to, prevention and social care, reflecting local agreed health and wellbeing strategies.

STPs are intended to show how local services will develop and become sustainable over the next five years, part of delivering the Five Year Forward View vision. The NHS Five Year Forward View (FYFV), published in October 2014, identifies three key drivers for change across the NHS: health and wellbeing, care and quality, and funding and efficiency. It sets out a new central-local partnership to support and stimulate the creation of new care models that can be deployed in different combinations locally across England. The FYFV also set out a range of financial scenarios for the NHS and called for £22 billion of efficiencies by 2020/21 – implying productivity improvements averaging 2.4% per year. Further guidance for STP areas was published by NHS England in May 2016, and is available here: 

https://www.england.nhs.uk/ourwork/futurenhs/deliver-forward-view/stp/support/

On 16 February 2016, NHS England and its partner organisations wrote to local health and care leaders to set out steps for developing Sustainability and Transformation Plans (STPs). NHS England state that they will invest £2.1bn in a Sustainability and Transformation Fund in 2016/17. Of this total, £1.8bn of funding has been allocated to the sustainability element of the fund to bring the NHS provider trust sector back to financial balance.[7] It is envisaged that the Fund will rise to £2.9bn in 2017/18 and to £3.4bn in 2020/21.[8] Quarterly release of sustainability funds to NHS trusts and NHS foundation trusts will depend on achieving recovery milestones for (i) deficit reduction; (ii) access standards; and (iii) progress on transformation.

STPs and existing plans at regional and local level

NHS England state that STP footprints “are not statutory bodies, but collective discussion forums which aim to bring together health and care leaders to support the delivery of improved health and care based on the needs of local populations. They do not replace existing local bodies, or change local accountabilities.”  [9]

The letter of 16 February also set out how STPs would interact with existing plans at the local and regional level, acknowledging that STPs will not be the right size for all planning. It also noted that for areas with devolution plans crossing STP boundaries “further discussion will be required”:

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.[10]

 

Statutory requirements for patient and public involvement in health service reconfiguration

Under section 14Z2 of the NHS Act 2006 (as amended by the Health and Social Care Act 2012) clinical commissioning groups must make arrangements that secure the involvement of people who use, or may use, services in:

  • planning the provision of services;
  • the development and consideration of proposals for change in the way those services are provided – where the implementation of the proposals would have an impact on the manner in which the services are delivered or the range of services that are delivered;
  • decisions to be made by the NHS organisation affecting the operation of services.

Providers of NHS-funded services have a separate but similar legal duty regarding the involvement of service users under Section 242 of the NHS Act 2006.

NHS England’s statutory guidance on planning and delivering service changes (November 2015) provides further information on these duties.

 

Further reading

NHS plans closures and radical cuts to combat growing deficit in health budget, Guardian, 26 August 2016

NHS plans 'not just about closures', bosses insist, Guardian, 26 August 2016

The health policy think-tanks the King’s Fund and the Nuffield Trust have also produced information on STPs:

http://www.kingsfund.org.uk/projects/sustainability-and-transformation-plans

http://www.nuffieldtrust.org.uk/

 

[1]     NHS England, NHS Improvement (Monitor and the NHS Trust Development Authority), Care Quality Commission (CQC), Health Education England (HEE), National Institute of Health and Care Excellence (NICE), Public Health England (PHE), Five Year Forward View, October 2014

[2]     PQ 37280 23 May 2016               

[3]     BBC News, NHS cuts 'planned across England', 26 August 2016

[4]     The Guardian, The NHS secret is out. And local communities won't like it, 26 August 2016

[5]     See for example PQ 43326, 19 July 2016

[6]     Links to this and some earlier NHS England planning guidance can be found here:

https://www.england.nhs.uk/tag/planning-guidance/

[7]     Letter from NHS England and partner organisations Re: Developing Sustainability and Transformation Plans to 2020/21, February 2016

[8]     NHS England, Health and care bodies reveal the map that will transform healthcare in England, 15 March 2016

[9]    NHS England website

[10]    Letter from NHS England and partner organisations Re: Developing Sustainability and Transformation Plans to 2020/21, February 2016

 

Press articles

Guardian, 26 August 2016

NHS plans closures and radical cuts to combat growing deficit

Investigation by the Guardian and 38 Degrees reveals NHS faces £20bn funding shortfall by 2020-21 if no action is taken

 

Health Service Journal, 30 March 2016

Sustainability and transformation plans: an opportunity to see the wood for the trees

STPs are the first time the NHS has got serious about populations – but system leaders must only demand the deliverable

 

Health Service Journal, 16 December 2015

NHS England sets aside £1.8bn ‘sustainability and transformation fund’

  • £1.8bn of NHS England’s 2016-17 funding increase to go to “sustainability and transformation fund”
  • Funding from the pot to be allocated to all “emergency care providers” to help trusts cut deficits
  • Payment dependent on “non-negotiable conditions”, such as agreeing plans to cut deficits and maintaining core standards
  • Fund comprises just under a third of NHS England’s £5.5bn cash terms increase next year

Parliamentary questions

NHS: Sustainable Development

Asked by: Madders, Justin

To ask the Secretary of State for Health, if he will publish all sustainability and transformation plans that were submitted within the June 2016 deadline.

08 Sep 2016 | Written questions | 44970

NHS: Sustainable Development

Asked by: Madders, Justin

To ask the Secretary of State for Health, if he will publish the minutes of all the meetings his Department has held related to each of the 44 sustainability and transformation plans.

08 Sep 2016 | Written questions | 44968

NHS: Sustainable Development

Asked by: Ritchie, Ms Margaret

To ask the Secretary of State for Health, what discussions he has had with his counterparts in the devolved administrations on the draft sustainability and transformation plans for NHS England; and what the Barnett consequentials of those plans will be.

07 Sep 2016 | Written questions | 44727

NHS: Sustainable Development

Asked by: Jones, Helen

To ask the Secretary of State for Health, what steps he is taking to ensure that (a) hon. Members, (b) members of the local authority and (c) the public are consulted about the sustainability and transformation plans being developed for Warrington and its surrounding area.

26 Jul 2016 | Written questions | 43326

Clinical Commissioning Groups

Asked by: Wollaston, Dr Sarah

To ask the Secretary of State for Health, when clinical commissioning groups will be required to update their local transformation plans; and what plans he has for such plans to interact with sustainability and transformation plans.

13 Jul 2016 | Written questions | 41915

Topical Questions

Asked by: Dr James Davies (Vale of Clwyd) (Con)

Will the Minister confirm how he plans to implement the general practice forward view? Will he also confirm that sustainability and transformation plans will be returned to for further development if they fail to deliver the investment in general practice mandated by the forward view?

05 Jul 2016 | Topical questions - Supplementary | 612 c745

NHS: Sustainable Development

Asked by: Madders, Justin

To ask the Secretary of State for Health, what guidance (a) his Department and (b) NHS England have provided to Sustainability and Transformation footprint teams on involving university providers in the development of Sustainability and Transformation Plans.

28 Jun 2016 | Written questions | 40616

NHS: Sustainable Development

Asked by: Lucas, Caroline

To ask the Secretary of State for Health, pursuant to the Answer of 23 May 2016 to Question 37279, if he will make it his policy to ensure there is a formal public consultation on every Sustainability and Transformation Plan footprint.

28 Jun 2016 | Written questions | 40553

NHS: Sustainable Development

Asked by: Madders, Justin

To ask the Secretary of State for Health, whether meeting notes, correspondence and plans produced by the Sustainability and Transformation Plan footprint leadership teams are included within the remit of clinical commissioning groups in their capacity as public authorities for the purposes of the Freedom of Information Act 2000; and if he will place in the Library a list of contacts for each footprint area.

27 Jun 2016 | Written questions | 40404

NHS: Sustainable Development

Asked by: Madders, Justin

To ask the Secretary of State for Health, what recent representations he has received from Sustainability and Transformation Plan leadership teams on the deadline for delivery of Sustainability and Transformation Plans.

21 Jun 2016 | Written questions | 40377

NHS: Sustainable Development

Asked by: Smith, Mr Andrew

To ask the Secretary of State for Health, how the proportion of each Sustainability and Transformation Plan area's total place-based target allocation was calculated.

14 Jun 2016 | Written questions | 39975

NHS: Sustainable Development

Asked by: Smith, Mr Andrew

To ask the Secretary of State for Health, what accountability mechanics are in place related to decisions in Sustainability and Transformation Plan footprints.

14 Jun 2016 | Written questions | 39795

NHS: Sustainable Development

Asked by: Smith, Mr Andrew

To ask the Secretary of State for Health, what the legal status is of the changes to health and social care proposed in Sustainability and Transformation Plans.

13 Jun 2016 | Written questions | 39771

NHS: Sustainable Development

Asked by: Madders, Justin

To ask the Secretary of State for Health, what proportion of Sustainability and Transformation Plans have been submitted to his Department; and what the deadline is for such plans to be submitted.

13 Jun 2016 | Written questions | 39614

NHS: Sustainable Development

Asked by: Madders, Justin

To ask the Secretary of State for Health, whether members of the public will have a right to attend Sustainability and Transformation Plan board meetings.

13 Jun 2016 | Written questions | 39612

NHS: Sustainable Development

Asked by: Lamb, Norman

To ask the Secretary of State for Health, whether he plans to ask NHS England to publish the initial Sustainability and Transformation plans submitted on 15 April 2016 to permit scrutiny of those plans.

23 May 2016 | Written questions | 37280

NHS: Sustainable Development

Asked by: Lamb, Norman

To ask the Secretary of State for Health, whether he plans to assess the extent to which Sustainability and Transformation plans address (a) mental health provision in a locality and (b) the case for the integration of mental and physical health.

23 May 2016 | Written questions | 37278

NHS: Sustainable Development

Asked by: Lucas, Caroline

To ask the Secretary of State for Health, with reference to the Answer of 18 April 2016 to Question 33537 on Sustainability and Transformation Plan footprints, how his Department defines a system control total; and if he will make a statement.

26 May 2016 | Written questions | 37495

NHS: Sustainable Development

Asked by: Lucas, Caroline

To ask the Secretary of State for Health, which NHS bodies will authorise Sustainability and Transformation Plan footprints; what role NHS Improvement will play; and if he will make a statement.

26 May 2016 | Written questions | 37450

 

Commons Debate packs CDP-2016-0161

Authors: Tom Powell; Alex Adcock

Topics: Health finance, Health services

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