Putting Sustainability and Transformation Plans into action
Now that NHS organisations around the country have drawn up individual Sustainability and Transformation Plans (STPs), the harder work of actually putting them into practice must begin.
It might be easy to be cynical about yet another round of efforts to make the NHS work better for patients and break down rigid organisational silos, given that such attempts have been made many times in the past.
However, if the NHS is to overcome the significant budgetary constraints it faces, and at the same time better meet the needs of patients into the future, it is vital that these plans work. And it is possible for some of these changes to be put into action now.
There are clear challenges which must be overcome to make STPs a success, the first of which is overcoming significant public scepticism.
Informing patients and the public is fundamental to STPs for two different reasons: firstly, if local plans don’t have public support, it’s unlikely they will ever be able to get off the ground; secondly, the plans themselves rely on encouraging patients to behave differently.
For example, currently 27% of people who see a GP don’t need to see one, and between 30 and 50% of people who go to A&E also don’t need to. STPs depend on changing those percentages to improve urgent care, and offering more appropriate pathways for people who should be visiting a pharmacy or getting online advice, rather than taking up precious urgent care resources.
But people will not change their behaviour if they are not properly informed of the alternatives. If STPs are not effectively communicated, people will continue to behave as they always have done. However, unfortunately plans started making their way into the public domain without significant attention having been given to communicating with the public the implications of changes to them. The resulting media coverage was negative as a consequence, focusing on closing hospitals, cutting appointment hours, and so on.
Tied in closely with this is the need to break down silos and encourage staff to work to support STPs. It is human nature to have tribal loyalties, and healthcare staff are no different, retaining natural loyalties to the tangible organisation they have known for many years. Conversely, STPs, being no more than plans, struggle to acquire that same allegiance. Yet, for the new models of care to work, it will be critical for staff to see their place within the new STP and develop that same loyalty they have for their current employer.
There may be a tendency to wait for all the details of an STP to be documented and agreed before real action is taken to deliver change – but this would be to the detriment of patient care and the NHS. There are things that can be happening now to bring about change and help to deliver the aspirations of STPs.
Two of these are infrastructure and information. We already know that the NHS has the wrong infrastructure in the wrong places. If it is to deliver new models of care in different settings, the places to do that need to be developed quickly.
The temptation is to wait until the planning is complete, and yet the extent of surplus estate within the NHS is sufficient to start making changes to healthcare infrastructure now to support local STPs. There is no reason to delay this work – and, what’s more, rationalising the estate is unique in that it can unlock resources to be ploughed back into front line services. Every penny will count, and this could prove to be a vital catalyst for much needed change.
Secondly, while there may be governance rules that restrict the sharing of patient information, the perception of those barriers can be greater than the reality, and we need to tap in to the ingenuity of NHS staff in solving problems such as this to make it happen. Again, knowing this is the right thing to do under any planning scenario means that it is not necessary to wait.
Finally, we need to learn the lessons of evidence-based medicine that recognised many years ago that best practice can be determined, and then should be adopted, by all practitioners. Similarly, STPs need to establish what best practice looks like, and others should then adopt that approach consistently nationwide.
These may seem like technical points, and of less significance than the big clinical or change issues, but they could be the key to success or failure for STPs. Both the rationalisation of the healthcare estate and better sharing of patient data will be catalysts to breaking down barriers and encouraging people and organisations to work closer together. This, in turn, will generate support among healthcare professionals and, coupled with measures to better inform the public about their healthcare choices, could be of critical importance for STPs.