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STPs: Medical professionals must be heard to avoid a policy failure

HCSA Chief Executive Eddie Saville makes the case for fundamental changes to the STP process if policy-makers are serious about success.

Sustainability and Transformation Partnerships have become one of the most controversial and politicised strands of health policy in decades.

They are held up by some as a way to infuse our health and social care system with the best principles of collaboration – the most efficient way to meet the demographic and health challenges of tomorrow. To others they are a seen purely as a vehicle for service cuts and privatisation. Certainly, to many Trust managers, they represent a liberating, bottom-up process.

But speak with hospital doctors on the front line and the perception is quite the opposite.

It is revealing that in its recent State of Care report, the Care Quality Commission notes that the most successful NHS cultures had a high level of clinical engagement and involvement in planning and delivery.1

By this benchmark, STPs have to date been an abject failure. Only a small percentage of hospital doctors have had any involvement in the process, which has led, perhaps naturally, to scepticism among medical professionals that STPs will see any improvement in care. If the process could bring benefits, it is unclear to hospital doctors what these might be.

In fact among front-line clinicians, the overwhelming expectation is that STPs will fail to produce anything positive and will instead lead to greater bureaucracy, service rationing, increased workloads, and physical barriers to access.

However, while from some quarters there have been calls for the abolition of STPs, it is clear from our research that hospital doctors do not necessarily share this view. Interestingly, while a majority express fears around the likely impact of these plans, there is neither majority opposition nor majority support for the plans in principle. For around half, the jury is still out.

This reveals a potentially fertile middle ground for policy-makers, a sizeable cross-section of hospital doctors who could be won to the process. Equally, though, they could become an increasingly potent voice of opposition.

This perhaps reflects the fact that few in the medical world would oppose the logic around greater collaboration between the intrinsically linked parts of the health and social care system. Few, too, would deny the challenges around demographics.

Yet hospital doctors feel deep unease at the  budgetary straitjacket around STPs, which means that in their current form they appear to be driven by financial rather than care priorities. Overarching all this is a lack of engagement with clinicians, whose main priority is the patients they treat. This failure to engage has encouraged suspicion, apprehension and detachment.

Policy-makers ignore these symptoms at their peril.

This report reflects the prospect that, in their current form, STPs appear increasingly destined to fail – losing the battle for support among professionals and public alike. But we also plot an alternative path, one where STPs could indeed begin to represent progress on the road to better care.