Sustainability and Transformation Plan (STP) bulletin

Thank you to colleagues for your continued support and feedback on how the STP and partnerships with NHS colleagues are in your area. You are reporting a number of common themes and issues, and we have collated these below as ‘frequently asked questions'.


 Although we have made some real progress to improve the process and to gain much greater local government engagement, we know there is much more to do. As colleagues, we rely on each other's support and wisdom, so please get in touch with me or my teams to share good and bad experiences, ask for advice or offer some help.

We are also proposing to gather your views through your ongoing conversations with your principal adviser and other LGA staff. In the meantime, we would welcome your feedback on the issues and questions listed below; contact fiona.russell@local.gov.uk  or sally.burlington@local.gov.uk

Mark Lloyd

Chief Executive
Local Government Association

Quick links
 

STP network - note of 30 Augusts 2016 meeting
At the meeting, colleagues highlighted key themes and concerns, including what local government brings to the table, and fed back views on what further support the LGA could provide.

Opposition day motion
We have produced a briefing for MPs ahead of next week's Opposition Day motion on STPs.

Frequently asked issues and questions
We have collated your feedback, ideas and concerns to create a picture of how colleagues across the country are dealing with the most common issues concerning STPs, such as how social care is recognised in plans, or the shape of partner-wide governance arrangements.

 

CEO Network, 30 August 2016 notes

Key messages and themes

Building on the messages developed with colleagues after the July challenge sessions, the LGA has continued to press on a number of points of immediate concern, to create minimum expectations for the October STP submissions, as follows:

  1. Each footprint to evidence that it has held meaningful strategic conversations with local politicians. The nature and timing of this dialogue should be agreed with council partners based on their advice, and could involve formal channels of the health and wellbeing board, the health overview and scrutiny committee, or council cabinet and/or informal or specially convened arrangements to address the needs of the footprint. We are emphasising the importance of discussing the strategic headlines of the plans with key decision makers in councils including council leaders as well as the cabinet lead for health and social care and/or the chair of the health and wellbeing board
  2. The publication of a summary of the plan online alongside the submission, based on the advice of council colleagues; this should set out at a minimum the locally agreed vision and case for change across the three gaps, the identified agreed priorities and milestones and a plan for further communications with local authority partners  and wider community engagement as proposals take shape
  3. That the submission evidence how it will engage local health scrutiny committee(s) and others including Healthwatch in supporting their discharge of their statutory functions
  4. That the plan should set out the challenges within the local social care system, and that health partners should be working with local government colleagues to identify the totality of the health and care financial  gap locally, including social care and public health

In, discussion colleagues noted these were the right messages, and that the push for visibility of social care in STPs should be the top priority. Colleagues shared how they are looking to ensure sustainability of markets in STP delivery plans and operational plans in this regard.

There was agreement that as well as pressing for these ‘asks' local government also has a great deal to offer the STP process, which includes expertise in:

  • A proven track record of delivering significant efficiencies while continuing to support vulnerable individuals
  • Innovation around capital investment, such as One Public Estate
  • System leadership, as leaders of place and securing political engagement if approached well
  • Developing a positive narrative around health and wellbeing improvement
  • Bridging the divide between strategy and delivery, as well as being able to work across both providers' and CCGs' perspectives

Other points raised in the discussion included:

  • Use of the LGA's integration vision, Stepping Up To The Place, and tool to support an assessment of readiness; councils in the North East London STP are currently part of the pilot
  • London is waiting for a signal from the mayor on the shape of the health and wellbeing board role in transformational work
  • Although the timetable is rushed, it is creating momentum for change
  • Look to raise the profile of the social care workforce in any relevant discussions

The meeting also discussed the existing and potential support offer from the LGA

  • The opportunity to share learning, pitfalls and achievements is welcome – both through the LGA network, plus also the possibility of a STP leads network with NHS Confederation; some colleagues asked for support for transformation leads too
  • Any network should include sharing learning widely including with those colleagues who are not heavily involved in their local STP
  • There is an appetite for support on One Public Estate, financial modelling (to make social care visible in finances), using the integration tool and understanding control totals
  • Colleagues also asked for better understanding of where regulatory frameworks are stymying integration

 

Opposition day motion

There is an opposition day motion scheduled for next week. It asks the following:

That this House notes with concern that NHS Sustainability and Transformation Plans are expected to lead to significant cuts or changes to frontline services; believes that the process agreed by the Government in December 2015 lacks transparency and the timeline announced by NHS England is insufficient to finalise such a major restructure of the NHS; further believes that the timetable does not allow for adequate public or Parliamentary engagement in the formulation of the plans; and calls on the Government to publish the Plans and to provide an adequate consultation period for the public and practitioners to respond.

We have produced a briefing for MPs.

 

Frequently asked issues and questions

Are social care pressures and demand recognised in STPs?
Some two-thirds of submissions in June at the least acknowledged the funding pressures on social care. The LGA argues it is essential that plans are whole-system and recognise the totality of the health and care funding gap, and so we encourage you to expect this from health partners.

A few plans go further than detailing the pressures and offer whole-system solutions which help alleviate shortfalls or funding pressures in council services. This has included a commitment to fund council-commissioned health services; investment in joint priorities such as around reablement, prevention or extra care housing; or joint work on the ‘fair cost of care'.

Are prevention and public health adequately resourced in STPs?
Although all draft plans recognise the importance of investing in prevention, fewer describe in detail what this would look like, and some focus more narrowly on health prevention such as smoking cessation. Some of the stronger examples specify the proportion of budget to be allocated, with one STP committing to ringfencing 4% of NHS STP spend, while other calculate the return on investment, with one predicting £100m savings from £10m investment.

The strongest prevention workstreams have clear leadership from health and wellbeing boards and local government senior officers including directors of public health. They draw too on wider public sector reform, tapping into economic growth agendas.

What new funding sources are being investigated?
Several STPs are building on the work of councils' One Public Estate programmes, for example in building housing on NHS sites to fund transformation or folding NHS estates into existing OPE programmes. The devolution pilot in north London is looking at ways to speed up decision-making and loosen restrictions on estates strategy. A couple STPs are exploring social impact bonds, while one council has invested capital into establishing an integrated care hub, drawing revenue from the project. One or two are also exploring the use of the social care precept.

What integrated arrangements are included in plans?
Although there is no set model or arrangement promoted by NHS bodies, common themes are emerging. A significant number of STP partners are proposing to streamline clinical commissioning by federating or merging CCGs. Some of these are also intending to integrate council commissioning to create single place-based arrangements. Further, over a third of footprints have asked for a single control total, with a number of these including social care in their proposals to create single place-based budgets (to support integrated commissioning functions). Any such arrangements would not override council constitutional arrangements.

Many of the plans also propose developing integrated delivery arrangements, such as accountable care organisations, and are often building on locality based multi-disciplinary teams. These plans tend to develop integration programmes predating STP planning, although many have accelerated or upscaled their plans. Several others also build on devolution or combined authority ambitions and activity.

The LGA has launched a

which helps local leaders assess their readiness, capacity and capability to lead integration and transformation locally. We are trialling it currently in eight areas, and intend to roll it out nationally later in the year. For further information, contact caroline.bosdet@local.gov.uk

What does ‘good' accountability look like?
Virtually all of the June plans, rightly, acknowledge the role of health and wellbeing boards in their governance arrangements, and many recognise the statutory responsibilities of health scrutiny. All STP governance arrangements should also include members from local government in their programme oversight boards. The more effective models have a joint programme or oversight board with members drawn equally from all partners including local government. A handful, currently, include political members such as the chair of the health and wellbeing board; many more have council officer representation at CEO, DPH or DASS level. A couple others have established reference groups of councillors or have strengthened links to the health and wellbeing board.

We would expect also to see local government representatives and issues evident in the programme board's workstreams, and council leads are heading up workstreams in a number of areas, such as prevention or the integration of services for older people. More and more footprints are establishing delivery boards or groups to support implementation and we would expect to see local government well represented on these.

What does good political engagement look like?
At the very least the LGA expects STP footprints to engage local political leaders through a briefing or conversation with the health and wellbeing board, scrutiny committee or cabinet, with a plan for when and how proposals will be discussed and agreed through councils' governance arrangements. We have also stressed that sometimes there will be a need also for informal, private discussions ahead of consultation processes, and that these are most effective when describing change as part of a positive vision to improve health and wellbeing rather than as simply closures or services reconfigurations.

The stronger plans have visible health and wellbeing board leadership, particularly around local priorities such as prevention, integration or health inequalities. Only a couple of STPs have visible leadership from the council leader or cabinet member.

Health and wellbeing boards in up to a quarter of footprints are exploring joint arrangements to improve oversight. For a few this is a merged board, but for several it involves establishing a joint committee, joint development time or joint chairs' sessions. A few STP footprints are establishing joint scrutiny arrangements, and we expect more are likely to be developed as the further services changes are proposed.

What resources are councils contributing to programme management, or getting to support their involvement?
It has been noted that the health side of many STP footprints tend to have more capacity. A number of councils are hosting programme teams, have seconded staff in support or are providing expertise through senior officers (such as finance directors). A number of footprints are also funding one or two posts to support full engagement by local government, and we encourage these conversations as it is vital that local government's contribution is adequately supported.