Early engagement with political leadership, through health and wellbeing boards (HWBs), will help sustainable transformation plans (STPs) build and strengthen existing place based strategies such as joint health and wellbeing strategies, better care fund plans, transforming care plans etc. The LGA continues to press for better support to ensure STPs engage members and HWBs for an open and transparent process.
To secure political engagement we would suggest the local authorities in each STP area will want to:
- engage their HWBs to discuss and sign off STPs (well in advance of the next deadline in September 2016, if not already)
- ask to include elected members on the advisory group for STPs
- share any sensitive propositions such as reconfiguration proposals with elected members at an early stage to discuss their concerns and secure their support in order to minimise opposition at formal consultation stage
- find ways to build on and cross-refer to existing plans which already have local support
- explain and demonstrate to political leaders how STPs are not just focusing on money and sustainability but wrap around care for the person by addressing the deficits in care and quality, and health and wellbeing.
It is crucial that there is an ‘honest conversation' with the public on the challenges facing the NHS and the changes that need to happen in order for STPs to deliver the objectives of the Five Year Forward View. Councils have a long track record in public engagement and a wide reach into their communities. They are best placed to advise on early and effective public engagement to support development and implementation of STPs.
STPs leads should be working with councils to use the 30 June 2016 plans and further iterations to set out how the public (and clinicians, the workforce and key stakeholders) will be engaged to help develop solutions over the summer. Ideally there should be an ongoing dialogue with citizens about the future of their health and care services, and their own responsibility for using services appropriately, supported by clear communication and engagement strategies jointly owned by STP partners.
Place-based leadership and governance
The STPs present a real opportunity for local government to reshape services for the benefit of their local communities, and the LGA encourages senior leaders to be involved and influence local conversations, particularly in demonstrating place-based leadership behaviours.
An essential element of successful transformation and greater integration is robust, transparent governance to enable implementation. The NHS leadership has recognised local government's exceptional track record in delivering transformation, efficiencies and innovation, and strong governance has an important role to play as a lever for change.
Place-based leadership also requires giving leaders greater freedoms to work outside of their organisational frameworks. This include giving commissioners the flexibility to organise their functions and responsibilities to support place-based commissioning. In addition, financial flexibilities to enable more holistic contracting or delivery options.
Supporting effective integration
Integration is a core component of a place based approach, though STPs are a milestone towards integration, not the end of the integration journey. There is already much existing good practice on integration, which provides strong foundations for STPs. All areas will need to develop plans charting their route to full integration of health and care by 2020 and we are committed to ensuring that these are aligned to and build on STPs.
The LGA, working in partnership with NHS Confederation, NHS Clinical Commissioners NHSCC and the Association of Directors of Adult Social Care (ADASS), has developed a clear vision of a fully integrated system and its essential components to support local health and care system leaders shape their own local visions. STP areas can use this vision and the evaluation tool to support, inform and refine their plans, as well as forthcoming support offers from the LGA's Care and Health Improvement Programme.
The LGA is also pressing for a stronger focus on prevention in the strategies, based on appropriate resourced approaches including community based prevention as a key component, and service transformation embedded in the plans.