Sustainability and Transformation Plans must be robust

28 Apr 17

Joint-working agreements between the NHS and councils called Sustainability and Transformation Plans (STPs) have been a key focus for the NHS agenda.

The broad consensus is that they should provide the route maps for transforming service models and patient pathways to provide sustainable services that are tailored to patient needs.

This is an approach that works in theory. However, there is some scepticism over whether the frameworks can work in practice.

Our recent Healthcare Financial Management Association financial temperature check found that although most finance directors see STPs as a cornerstone of reducing the current deficit, an overwhelming majority are also concerned about the way they are set up, with nearly three quarters (72%) troubled about their governance.

Finance directors have limited confidence in the simultaneous delivery of both STP and organisational financial objectives, with only 6% of trust finance directors and 17% of CCG chief finance officers (CFOs) believing that they are both deliverable.

This is understandable, given finance directors will experience different pressures coming from different directions.

While STPs have high expectations to live up to, they also represent a huge change in working practices.

They mark a move away from a focus on individual organisations and market competition, towards system working.

Complex, with a large number of stakeholders, each STP also starts from a different point in terms of local relationships.

The majority of our members still talk of many positive feelings around STP leadership, with over half (58%) of NHS finance directors witnessing clear and effective leadership and an improvement in the relationship between commissioners and providers.

It’s an encouraging step forward given the finance community in the NHS has been asked to step up.

Yet, given the concerns about governance arrangements from finance directors, HFMA has been exploring the emerging arrangements in this area and how they support the delivery of financial sustainability and transformation in the NHS.

Our recent HFMA briefing, Developing sustainability and transformation plan governance arrangements, explores the emerging governance arrangements being developed to support the delivery of STPs, as well as the range of factors those in the footprints need to consider.

Our aim was to create a useful tool for finance staff and others to use in developing their own robust governance arrangements.

Its important STP models are clear, robust and flexible to support the fundamental changes required.

We must understand that each governance model will be developing at its own pace, with tailored arrangements that suit the footprint community and organisations.

However, there are specific aspects that need to be considered when developing these arrangements such as leadership, resource, engagement and risk management.

Finance directors can use our online checklist to ensure they have considered all the key areas.

It is still very early days.

Many organisations are yet to find a balance and there are clearly still issues that will need to be worked through, but doing this in an open and transparent manner will be key to achieving the fundamental change we need to see across the NHS.

If we identify governance models that work well, we can replicate this across the country, while at the same time, be vigilant for any barriers.

Learning from and sharing with others in the sector will be one of the only ways we can all pull in the same direction and inform real change.

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