What are STPs?

An STP – sustainability and transformation plan – is a new planning framework for NHS services. STPs are intended to be a local blueprint for delivering the ambitions NHS bodies have for a transformed health service, which is set out in a document called Five Year Forward View.


They were announced in the NHS planning guidance issued on 22 December 2015.

They are:

  • based on a ‘place' footprint rather than single organisations, covering the whole population in this footprint, which is agreed locally
  • multi-year, covering October 2016 to March 2021
  • umbrella strategies, spanning a range of delivery plans which may cover different geographies or types of services
  • required to cover the full range of health services in the footprint, from primary care to specialist services, with an expectation that they also cover local government provision
  • to address a number of national challenges, such as around seven day services, investment in prevention, or improving cancer outcomes.

These plans will become increasingly important in health service planning because they are the gateway to funding. In 2016/17 they are the basis for accessing a transformation pot of £2.1bn. This will encompass the funding streams for all transformational programmes from April 2017 onwards, and will rise to £3.4bn by 2021.

Five Year Forward View

The Five Year Forward View, published jointly by all the NHS organisations in October 2014, sets out a vision to transform the NHS by 2020; this includes addressing three ‘gaps':

  1. The health and wellbeing gap – the pressing need to reduce demand on the NHS by shifting the focus towards prevention and addressing health inequalities
  2. The care and quality gap – to harness technology and innovation to reduce variations in the quality, safety and outcomes in care
  3. The funding and efficiency gap – to ensure that additional funding for the NHS is used to improve efficiencies, transform services and achieve financial sustainability

The document marked a step change in the system's collective understanding of the links between and across the NHS and social care. It also recognised the crucial role of wider services in effective prevention. It provides the policy ambitions which STPs must address for example STPs are required to set out how they will address each of the three gaps in their local system.

STP footprints

NHS organisations are required to agree with local government partners a STP planning footprint. The guidance suggests this should be based on "natural communities, existing working relationships, and patient flows and take account of the scale needed to deliver the services, transformation and public health programmes required, and how it best fits with other footprints such as local digital roadmaps and learning disability units of planning". It also says that STPs should build on existing arrangements such as devolution or the Success Regime. Local areas submitted proposals on 29 January 2016. At the time of writing, the approved footprints have not been published formally.

By when do STPs need to be produced?

Initial STP guidance sets out in high level the process and milestones each STP area needs to address:

  • submit an outline plan by 11 April
  • presentation of this early thinking at regional events in the week beginning 22 April
  • submit the final plan by 30 June
  • series of regional conversations between national teams and STP footprints in July.

The outline plan is expected to cover the:

  1. governance arrangements needed to produce, and then implement, an agreed STP
  2. scale of the challenge locally for each of the three gaps
  3. key priorities identified to address each gap.

The guidance also requires each STP to nominate a lead to oversee their plan's development. Further guidance is expected in March, which will set out in more detail what the outline and final plans should cover. It is expected this will also include details of reporting requirements.

How NHS national teams support development of STPs

The national NHS teams are focusing on helping local leaders come together to develop robust plans. They, with input from partners including the LGA, are developing resources in six areas:

  1. provide advice and information on how local areas can assess each of their three gaps, including providing analytical support
  2. share information and provide support to identify priorities and shape a vision, including the use of tools such as logic models
  3. publish advice on engaging individuals, communities and staff, including drawing on exemplar practice around the ‘six principles' developed by the People and Communities Forward View Board
  4. establish communities of practice to share learning such as through the vanguard programme
  5. identify and enlist experienced facilitators to mentor and catalyse system leaders where it is needed
  6. share tools, templates and exemplars to support local developments.

For more information, contact your regional offices or visit the NHS England website. The national teams intend to develop further support as the needs of local STPs are identified – for example ‘how to' guides, regional workshops and bespoke support to address emerging issues.

The role of health and wellbeing boards in STPs

How the LGA is supporting local leaders

The emphasis on place-based planning is welcomed, especially the recognition that a good plan requires all local leaders to come together to develop a shared vision and plan of action. This aligns closely with the LGA's long-standing vision for a fully integrated system built around the needs of communities. We continue to argue that our current fragmented system of health has failed to achieve better health outcomes, services or the most efficient use of public resources, and that we need a place-based approach to address demographic, financial, health and wellbeing challenges.

We have raised concerns, however, that aspects of the process are creating difficulties for some local systems, such as where proposed footprints cut across existing local government and partnership planning arrangements. The LGA is working with the national teams to address these concerns and we continue to advocate for local government's perspective and role at national, regional and local levels. We continue to stress that health and wellbeing boards must be central to the development of STPs, as a system-wide forum with a democratic mandate from local communities. We will continue to support board chairs in their development as well as the wider board understanding and influencing wider regional issues. This will also include supporting local boards to work with neighbouring boards, as well as to explore implications for overview and scrutiny arrangements.

Regional representatives, including principal advisers and care and health improvement advisers, are also working across the country to identify and address support needs in terms of STP development as well as integration transformation more generally. They are also accessing the LGA's range of sector-led improvement tools and resource. Contact our advisers for support, and to advise us on how we can develop our support going forward.

Questions to consider

  1. Is your organisation involved in discussions about the local STP?
  2. Who or what organisation is leading the work in your area?
  3. What footprint(s) is your organisation in?
  4. Does this align with existing partnership work, for example the local health and wellbeing board, devolution arrangements, Better Care Fund or integration transformations?
  5. Are you aware how to access the regional or national activity to support local areas?