The STP guidance requires each STP footprint to set up a governance arrangement for agreeing and implementing their plan.
Sustainability and transformation plan (STP) governance arrangements
Areas must nominate a lead to be responsible for overseeing the process. This must be a "senior and credible leader who can command the trust and confidence of the system, such as CCG chief officer, a provider chief executive or a local authority chief executive". The STP lead organisation is required to submit their proposed governance arrangements in an outline plan on 11 April.
The role of health and wellbeing boards (HWBs) in STPs
The STP guidance is clear about the crucial role of local government, highlighting that success requires the engagement of all partners across a local system. It encourages STPs to build on the work of health and wellbeing boards, including local needs assessments, and health and wellbeing strategies. We continue to stress that boards must be central to the development of STPs, as a system-wide forum with a democratic mandate from local communities.
How are local communities being involved?
The guidance encourages STPs to be developed around the needs of local patients and communities, and to command the support of clinicians, staff and wider partners. The guidance points to the existing work of health and wellbeing boards to engage communities, including through joint strategic needs assessments.
What focus is there on prevention?
One of the requirements STPs must address is to include a description of how all partners will invest in prevention, "with particular action on national priorities of obesity and diabetes and locally identified priorities to reduce demand and improve the health of local people". We continue to support health and care systems across the country to achieve this ambition, including to make the most of all the assets in local communities, social care, public health, housing and more widely, to promote the health and wellbeing of local communities.
Is this just about plugging acute hospital deficits?
Bringing financial sustainability to local health and care systems, and NHS providers within that, is a priority for all, and we, with national and local health partners, continue to recognise that a sustainable NHS requires a sustainable social care system, and vice versa. STPs, however, do not just require a balancing of the books, but also for local partners to achieve a range of transformational ambitions, including seven day services, investment in out-of-hospital provision and joint investment in prevention. It is essential that we all continue to press the importance of shifting attention and investment towards preventive, whole-system solutions which will reduce demand, empower communities and promote health and wellbeing in its broadest sense.
How do STPs fit with existing transformation programmes?
The STPs are intended as umbrellas which span multiple delivery plans, ranging from specialised services at regional levels, to health and wellbeing boards' local commissioning arrangements, as well as transformational programmes, such as those redesigning services for people with learning disabilities, or urgent care.
How do STPs fit with the government requiring local areas to develop integration plans?
As well as implementing the Better Care Fund, many local areas are developing more ambitious integrated health and care provision. The Spending Review committed the government to build on these innovations – it will require all parts of the country to fully integrate health and care by 2020, and to develop a plan to achieve this by 2017. The Spending Review offered a range of models to achieve this ambition, including integrated provider models or devolved accountabilities as well as joint commissioning arrangements. The STP guidance requires STPs to be aligned with these local integration programmes and ambitions.
How the LGA is supporting local leaders
The LGA encourages and supports local authorities to play the most positive role they can to support and work with local health partners, and recognise the challenges and opportunities the STP process is creating locally. We are:
- advocating for strong local accountability, to ensure that health and wellbeing boards are central to the development of STPs
- <;i>- Supporting health and wellbeing boards and their chairs in addressing and influencing wider regional issues emerging from STP geographies, including working with neighbouring boards and exploring implications for overview and scrutiny arrangements
- raising concerns regionally and nationally about the challenges in balancing the demands of separate planning and regulatory frameworks, and will support local systems to align and simplify these, building on existing arrangements where possible
- promoting the use of health and wellbeing strategies, joint needs assessments, Better Care Fund plans and other existing partnership transformation plans as the key building blocks for identifying STP priorities
- pushing for clear guidance from the national support teams to help local systems navigate the differing planning requirements, timescales and footprints of existing programmes because this is, in some places, creating some duplication, confusion and additional bureaucracy
- urging that STPs are developed in step with future policy developments, including what 2017 integration plans should cover, around a sense of place, building preventative, person-centred approaches to improving health and wellbeing.
Questions to consider
1. Is your health and wellbeing board aware of local STP developments, has it discussed these on a recent agenda?
2. What is the role and position of local health scrutiny arrangements?
3. What is your boards' input into shaping the STP governance arrangements?
4. What contribution can your local needs assessment and transformation strategies play in identifying STP priorities?
5. Is your board supporting dialogue with all STP partners locally? Does this include considering how to align partners' governance, financial, performance and provision arrangements?
6. Do your board need to work with other boards locally?
7. How do the STP arrangements affect local reporting and scrutiny arrangements?