The changing NHS: when will our STP come out of the shadows?

Written by Tony Millett on .

In this series of articles, we have looked at the region's Clinical Commissioning Groups (CCGs) and the new Primary Care Networks.  Another other new-ish kid on the local-ish block is the BSW STP - aka the Bath & North Somerset, Swindon and Wiltshire Sustainability and Transformation Partnership.  It covers some 900,000 people.

It is in fact only fairly new.  Our STP began life in 2016 when its 'P' stood for 'Plan'.  But the 'P' soon became 'Partnership' - signalling its arrival as a permanent fixture as an NHS organisation. 

What began with England being divided up into 44 'footprints' (or areas) to produce new plans for NHS services, has become another layer of NHS management with a staff of managers and a leader. 

You only need a touch of cynicism (or realism?) to see STPs as a variation on the Strategic Health Authorities abolished by the Lansley reorganisation of 2012.  BSW is now under the direction of Tracey Cox - its third leader and also boss of the footprint's three 'effectively merged' CCGs. 

The BSW STP did not receive a universal welcome.  Wiltshire Council, which is prone to take an exceptionalist view of its role, initially found the STP unnecessarily intrusive. 

Why, it seemed Councillors were asking, were STP tanks parking on their well-trimmed lawns? As the Care Quality Commission pointed out last year: "...there was little buy-in to the STP from Wiltshire Council's elected members.  While some organisations within the Wiltshire health and care system supported the STP, others did not see any value in engaging with the overarching plan."

The initial Plan's priorities were pretty broad and aspirational:

That first and most specific aim was something already being undertaken in Wiltshire.

Because the BSW STP's second leader, Chris Bown, realised its three local authorities were too remote from the action, he asked Wiltshire Councillor and cabinet member for health, Jerry Wickham to be vice chairman of the Sponsoring Board.  He is now its chairman.

Apart from its Sponsoring Board, the BSW STP has two other boards - executive and clinical.  None of them meet in public and none publish minutes of their meetings.   

Their website does carry a 'summary' of two meetings - the Executive Board (15 February) and the Sponsoring Board (29 March).  These will not mean a great deal to anyone unfamiliar with current NHS-speak  and jargon. 

In February, Councillor Wickham told that at his first meetings he was 'dismayed' at the 'NHS language' being used: "One of my aims is to get to the stage where the STP as an entity is not seen as secretive." 

We do get a tweet from the Chairman (29 March 2019):  "I’m presently chairing the @BSW_STP sponsoring board with a packed room representing local authorities and health organisations. Communicating what the STP actually does for people in BaNES, Wiltshire and Swindon." 

But not yet communicating with its 900,000 potential patients.

On the BSW website we can find their 'Update' report.  It includes the 'system priorities and deliverables' in the STP's Operational Plan for 2019-2020 - their first such plan.  It has 'five key priority areas':

"Improving the Health and Wellbeing of our population - Developing Sustainable Communities - Sustainable secondary care services - Transforming care across BSW - 

Creating strong networks of health and care professionals to deliver the NHS Long Term Plan and BSW’s operational plan."

A little more detail is given for each area - the full summary can be read here.  For instance this is the detail for first of the five 'priority areas':

• Increasing our focus on prevention  and reducing inequalities.
• Taking a Life course approach
• Health in all Policies
• Making shared decision making with individuals regarding plans for their care the norm in BSW.
• Supporting people to take more responsibility for their health and wellbeing and seeking to involve the third sector and communities in the planning, provision and delivery of care.
• Using initiatives such as Making Every Contact Count & 3 Conversations to offer a strengths based approach to care support.
• Engaging with stakeholders and the public about our local vision for delivering the NHS Long Term Plan and agreeing early priorities.

That still ranks as aspirational signposting rather than practical planning.  No sign yet - in public at least - of how these are going to be implemented, staffed or paid for.

It seems that each main member of the STP (see below for the full list) is providing funds for its running costs - though there is no sign of a budget plan or budget update on its website.  Wiltshire Council is contributing £15,000 a year.

Councillor Wickham believes the Lansley Act "needs unpicking": "But for Brexit", he told, "the CCGs would have been reformed." 

And he is none too pleased with the national NHS' status quo: "I've been very unhappy for a long time that it was acute [hospital] centric - where is social care?  Where is the Green Paper on social care?  It's been kicked further down the road.  Even the new [NHS] Long Term Plan has very little about social care."

STPs as live entities are on a fast track evolutionary track to becoming - wait for it - Integrated Care Systems (ICS): "In an integrated care system, NHS organisations, in partnership with local councils and others, take collective responsibility for managing resources, delivering NHS standards, and improving the health of the population they serve."  This will probably emerge in the 'BSW 5-year Plan' due this autumn.

Some STPs have already made the change - nearby Berkshire West is an example. The danger is that once a single organisation has so much muscle over such a wide area, it could be eaten alive by a commercial health service company. For that reason alone we should be able to observe - or at least read - what the STP discusses and decides.  It will have an impact on us all.

This is the third in a series of articles on the new shape of the local NHS - following our introductory report of 28 March 2019.  Next: shrinking the hospitals - really?
The BSW STP partnersThe BSW STP partners