How soon is now?
Debbie Sorkin summarises recent developments in Sustainability and Transformation Plans and explains why now is the right time for social care to take a central role.
Earlier in the year, I wrote about Sustainability and Transformation Plans (STPs), and why it is vital for social care providers, alongside commissioners, to be involved with them as much as possible.
What are Sustainability and Transformation Plans?
To recap: Sustainability and Transformation Plans are plans covering large-scale areas around England – for example, there’s one for the whole of Cheshire and Merseyside; one for Dorset; and one for Greater Manchester. There are 44 in all.
They were originally conceived and set up by the NHS, but the basic aim was to have a broad view of health and wellbeing, with an emphasis on joining-up services around the person, and on prevention as much as cure.
In theory, joining up services in this way includes between mental and physical health, and between health and social care. The main aim of Sustainability and Transformation Plans is to keep people healthier for longer. Keep people in their homes and prevent them from having to go into hospital unless it is absolutely necessary.
To do this, plans should enable more healthcare to be delivered in the community, via primary care and NHS community trusts. In turn, this puts less pressure on large, central hospitals.
For STPs to happen, we need strong systems leadership and involvement of all parties to integrate across all services. According to the guidance issued by NHS England, ‘System leadership is needed…it involves…developing a shared vision…learning and adapting…and having an open and iterative process that harnesses the energies of clinicians, patients, carers, citizens…and local community partners including the independent and voluntary sectors, and local government. The STP must also cover better integration with local authority services, including, but not limited to, prevention and social care.’
However, as I have written about before, social care providers and local authority commissioners in many parts of the country have found it hard to get a seat at the table, or were contacted very late on in the process, with plans reflecting a hospital-centric view of the world. This is perhaps not surprising when you remember that in 40 out of the 44 STP areas, the process was led by a hospital trust chief executive or their counterpart in a clinical commissioning group.
The upshot is that most of the plans are still works in progress. However, there have been some developments over recent months that may make the going easier. I want to use this article to argue for social care either looking to get involved – where it hasn’t been – or keeping central to the discussions where it has.
Firstly, at the end of March, NHS England issued its review of progress over the past three years and plans for the next two, in Next Steps on the NHS Five Year Forward View. Progress has been limited. The original Five Year Forward View, published in 2014, promised a brave new NHS world by 2020 through new models of care, accountable care organisations and much more integration.
In practice, deep-seated cultural differences between the NHS, social care and local government, compounded by cuts to health, social care and public health funding, have meant unprecedented waiting times for A&E care, a retreat from the 18-week waiting time for elective care, de facto rationing of elective procedures in some areas, and record numbers of delayed transfers of care from hospital to home or care home.
The review acknowledges the gap between ambition and reality: it talks about what its priorities will be ‘within the constraints of what is necessary to achieve financial balance across the health service’.
However, it’s in what the review proposes or highlights, or what it chooses to leave alone, that I think social care has its ‘in’.
Get in with the in crowd
Firstly, nine STP areas have been identified as good enough to get the go-ahead to becoming ‘accountable care systems’ – where commissioners and providers start to come together to take joint responsibility for the health and wellbeing of a defined local population and the resources to deliver care services. These areas are:
- Frimley Health.
- Greater Manchester.
- South Yorkshire and Bassetlaw.
- Blackpool and Fylde Coast – potentially spreading to other parts of the Lancashire and South Cumbria STP.
- Luton, Milton Keynes and Bedfordshire.
- West Berkshire
CAA members - is this your area ? Are you involved ?
This isn’t about merging organisations: it’s about people and organisations within a system coming together.
There are three key points for social care here. Firstly, leaders of these proposed accountable care systems have every incentive to make them work, not least because they’ll be the places that NHS England are relying on to demonstrate success.
Secondly, in order to make them work, they will need social care providers – for homecare and residential care – and not just commissioners, especially in areas like Frimley or Dorset where there is likely to be a relatively high proportion of self-funders who aren’t on a local authority radar.
Thirdly, they won’t necessarily have the systems leadership experience or connections to bring people together.
If you’re a provider in one of these nine areas, ( or a care association !) and you’re not already in contact with your STP lead, make a start. You can find out who they are – and the details of plans to date – via the NHS England website.
You might want to go as a group with others, or via your local care association, or through an offer collated through a membership body like the National Care Forum, Care England, the United Kingdom Homecare Association or Voluntary Organisations Disability Group.
If part of the issue with STPs has been about timing, now might just be the right time.
Or try the out crowd (there’s more of them)
Paradoxically, if you’re based in one of the 35 other STP areas, now might also be the right time.
Their plans are in various states of progress, but the idea in the review is that they will keep going and continue to make progress, and have a degree of freedom around the approaches they take.
The review emphasises that support for STPs, to make them work better, will be strengthened. This means there will be funding for an STP leader to work at least two days a week, rather than fitting the role around other jobs, alongside more management support. Might this open the door more widely to social care, as people have more time and resource, so that a broader set of people can come onto the radar? We’ll have to see, but again, it’s worth going to your STP and finding out what stage they’ve got to.
Use your capital
A good starting point for a conversation might be capital funding. An independent report for the Department of Health in March estimated that STPs needed £10bn to fully finance the capital investment they’d identified. This is unlikely to be forthcoming from the Treasury. At the same time, taking the strain off A&E, and reducing the number of bed days within hospitals is going to be a priority for STPs. As such, one area to explore would be joint ventures around step-down or convalescent facilities, such as those that Community Integrated Care has pioneered with MerseyCare and Pennine Care.
And use a crisis
The General Election, due in June, has fallen slap-bang in the middle of the period when STPs were going to start moving on major changes to services. From an NHS standpoint, the timing could not have been worse: if you’re in an area such as Staffordshire or Somerset, where this may mean service cuts, an already difficult position will be that much harder as fights for local services become part of local political battles, especially in marginal seats.
Again, without presenting the role of social care as ‘propping up the NHS’, it might be especially timely to explore options for social care having a central role in an STP, or at least to look at bringing greater influence to bear.
As I’ve argued before, you don’t have to do this on your own: find allies – such as from care associations, primary care or allied health professions – who can influence and make the case for you and with you; and keep persevering if you get a rebuff.
However, if timing is everything, now feels like an especially propitious time for social care to show health what truly collaborative systems leadership looks like: and how social care can transform the lives of people who use health and care services. How soon is now?
Are you involved in STPs? Will you make your voice heard now?
on behalf of CAA