1/11 We have published an important new report on Sustainability and Transformation Partnerships (STPs) and Integrated Care Systems (ICSs) today: nhsproviders.org/key-questions-…. Here are ten thoughts the excellent report stimulated in my mind.
2/11 The single biggest defining characteristic of STPs and ICSs is perhaps the diversity of progress being made. Some are rapidly becoming the integrated systems policy makers want. There are others where providers (and other players) have given up / see it is an irrelevance....
3/11 The diversity of progress in STPs/ICSs therefore provides a big challenge for policy makers - how do we develop policy for an approach that is going very well in some parts of the country but is in danger of failing in others.....
4/11 One obvious question that diversity of progress in STPs/ICSs stimulates is: “how quickly can we pass formal responsibilities to whole class of STPs/ICSs?”. As we’ve found with the vital task of capital allocation, many STPs simply not ready to take on some responsibilities.
5/11 It would be really helpful to have much greater clarity on how national system leaders see STPs/ICSs developing. Are all STPs definitely going to become ICSs and what happens if they are incapable of completing that journey in their current form?
6/11 Would be good to understand what responsibilities national leaders envisage passing to STPs/ICSs when. And how that process of responsibility transfer works when we have such diversity of progress between different STPs/ICSs? How do we check fitness to take responsibility?
7/11 We need to think carefully about how far we can consistently go down STP/ICS route given constraints of 2012 Act where responsibility is clearly vested in individual organisations and STPs/ICSs have no formal statutory basis. This is not to block change but to manage risk.
8/11 We know that effective and well thought through governance of frontline health and care delivery is absolutely central to managing risk. It’s notable that even the most advanced STPs and ICSs are taking time to develop appropriate challenge mechanisms. This should worry us.
9/11 V striking that, on the ground, trust leaders tell us that, as has always been the case, health & care delivery/planning takes place on a variety of different geographic footprints. So, what should we be doing on an STP/ICS footprint and how much will it be the dominant one?
10/11 Striking at recent @themjcouk roundtable I attended how the local authority CEOs were already looking beyond what they perceived as “the failed STP/ICS experiment” for how to create integrated health and care systems. How do we ensure vital local government involvement?
11/11 There seems to be a national system leader assumption that STPs/ICSs will be the “key footprint of choice” for integration, performance and financial management. Is this realistic? And what happens if the STP/ICS isn’t able to perform that task.........
12/11(!) But, perhaps most importantly of all, how do we ensure that the most advanced STPs/ICSs can continue to pioneer away whilst ensuring that we don’t pass vital responsibilities (like capital allocation) to STPs/ICSs that can’t deliver them effectively at this point.
