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Many STP areas are yet to find a joint understanding

john rooke | health service journal | 25 October 2016  

The ink has yet to dry on the sustainability and transformation plans submitted last week. However, our survey of CCG leaders shows that 66 per cent have low or very low confidence their plans will have the intended impact on either their financial position or NHS constitutional performance standards in 2017-18.

Only one of our respondents reported high or very high confidence in their chances of success.

Nearly three quarters felt that the biggest barrier to the success of their STP was a lack of revenue and capital funding. With financial control totals fixed, we believe funding constraint has to be seen as a driver of change rather than a barrier to progress.

A further 68 per cent believe there is a fundamental gap in the transformational capacity and capability of their system to bring about the transformation set out in the STPs.

The survey also indicated a number of particular barriers to success including:

  • NHS payment systems (55 per cent);

  • NHS provider opposition or resistance to planned changes (54 per cent); and

  • Organisational duties/priorities trumping whole system plans (61 per cent).

As complex multi-lateral negotiations begin with other commissioners and providers, we are likely to see the tension between parties’ collaborative efforts to increase the size of the pie with their competitive drive to obtain the largest share.

We know that the outcomes of successful negotiations consist of joint agreements with implicit and explicit understanding of the parties’ future behaviour.

Yet our survey suggests to us that in most areas this understanding has not been reached, meaning the critical issue for STPs is a lack of clarity about the future intentions of those involved.

In the impending contracting round, leaders may benefit from recognising this tension and focusing on the creation of the explicit terms and known implications of their new coalition agreement.

John Rooke is head of healthcare commissioning at PA Consulting Group

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