Addressing a King’s Fund conference on sustainability and transformation plans, Ben Dyson, executive director of strategy at NHS Improvement said there was a need to “get away from the wretched system” where people from different national regulators pile in when things go wrong.
“We need a more streamlined system of provider oversight,” he told delegates. “I’m confident we can do that by working more intelligently together.”
In his speech, Dyson also said governance models should not be overcomplicated. The 44 STP areas in England, which aim to provide local health and care services across systems, should not feel they have to work towards a single governance model.
An accountable care organisation (ACO) model where there is a single organisation making all decisions was tough to do and would not be for everyone. In areas where a number of independent boards remain they needed to work together, he said.
“The key to good governance is not necessarily to bring decision making into one place. Getting people to come to a shared view can be better than appointing a commissioner who makes all the decisions for you,” Dyson suggested.
The conference also heard from Hugh Alderwick, a senior policy adviser at the King’s Fund, who led research on STPs published earlier this week.
He stated they were the right thing to do but beset with systemic problems and implementation challenges. National bodies could sometimes be inconsistent with the support they were offering, he noted.
“STPs are an imperfect and complicated workaround to do something the structures weren’t designed to do,” he said.
Stephen Dorrell, chair of the NHS Confederation who has been involved with the leadership of the Birmingham and Solihull STP, told the event there was a need to be “clear sighted” about what STPs were. They were not central authorities, he said. “It’s a melting pot, not a new structure.”
STPs would not succeed unless they were understood to be a process of cultural change, Dorrell said.
“If you think ‘what are they doing to me’, it doesn’t work. There has to be joint ownership of objectives.”
