Why Sustainability and Transformation Plans might be one of the NHS’ greatest challenges yet

The NHS Five Year Forward View sets out an ambitious transformation plan for our health services in the UK. Up to 44 NHS ‘footprints’ in England, which comprise ground-breaking partnerships between health and care organisations, are close to submitting their Sustainability and Transformation Plans to achieve those goals.

But, as their visions are mapped out and attention turns to executing those commitments by 2020/21, what must be done to help an NHS, which already is under severe budgetary and resourcing pressures, to deliver?

For such a major structural change, it is clear that people will be at the heart of any solution to ensure the clinical and financial sustainability of health and care services.

But, there is concern from senior leaders in the system that the sheer scale of what needs to be delivered by the Sustainability and Transformation Plans may not be entirely possible and will be too demanding.

With finite financial resources available, skills shortages within senior management and the prevalence of unfilled positions in critical board-and senior management level roles, change is unlikely to be swift. Progress will be hampered by a lack of political engagement and, so we are led to believe, without any extra funding from the Chancellor at the upcoming Autumn Statement. The fundamental question remains whether these plans can be delivered in part or in their entirety.

Now that the final plans for the STPs are close to submission, we expect to see a rush for programme and project management talent to support the delivery against the Five Year Forward View. NHS leaders already find themselves under monumental pressure from the regulators to improve their own organisational performance and finding that additional support could perhaps be the biggest challenge.

The STP initiative is a true integration of local services and models of care, which will encourage demand for executives that can manage the various stakeholder groups across health and social care therefore incorporating the programme plans involved in each of the 44 footprints. Given the extensive partnerships created, coupled with relentless service performance and financial constraints, the relationships will need to be developed and fostered very carefully.

The general guidance from the NHS and its centre is to source staff on the payroll (a fixed term contract) for interim placed positions but in reality many executives are unwilling to do so, having chosen a portfolio career for multiple valid reasons, and will only carry out the work ‘off-payroll’. There is a real concern that the guidelines will hinder the partnerships’ ability to recruit for certain posts, creating a significant obstacle to the progression of the STP footprints.

Surely, with the constant challenges the NHS is facing, and at a time of intense scrutiny, now is the time to turn to an experienced resource pool, such as interim managers, that can help push the system forward and tackle these issues. The problems won’t disappear overnight, but taking on the right level of resource in leadership positions to drive forward these programmes, albeit off-payroll, is better than not having the right skill set in place. The luxury of time isn’t a consideration.

Of course, value for money is essential. But efficiency and value is precisely what the interim executive level represents and can offer. Of course, it should be noted that they ask only for a daily rate and don’t require additional employee benefits that fulltime employees enjoy.

Fundamentally, the submission of a robust and credible STP is a prerequisite for NHS organisations to access transformation funding over the next five years. So, without a long-term view to investing in skills and talent in senior positions, the austerity of today will only be storing up problems for tomorrow.

Comments

Keith Hackett at 31/10/2016 15:46 said:

You are ignoring a fundamental issue... Primary care does not want to change. For the last five months I have been working within the CIC sector demonstrating to CCGs across the country that the coproduction capability they seek from the community to deliver key MH and general wellbeing improvements already exists. The evidence of wellbeing change can be provided and numerous community partners want to engage with their CCG.... not one STP lead has stepped up to grasp the opportunities being put in front of them. Instead, referring back to "we're working on the draft" Stevens has stated time and time again for the STP Leads and their minions to stop prevaricating, roll the sleeves up and get on with it. They don't and they won't because it means stepping outside of the comfort zone. Frankly, it's frustrating and very disappointing!

Paul Clements at 31/10/2016 16:14 said:

Good article SJ - balanced, logical and yet highlighting the desperate need each of the 44 'footprints' has for quality experienced external help.

Sadly, having just finished such an assignment, there are two additional flies in the soup that will further exasperate all concerned within the local health economy – and any sane onlooker fortunate to be outside its influence:
1 - All Trusts have to adhere to the new NHS Improvement Agency caps that prescribe rate for each banded interim role, that most would recognise as being below the past market norms…. thus further challenging filling such roles with capable interims. Yes, some 'creative' Trusts have merely re-banded the roles higher than their permanent counterparts (i.e. if a typical permanent Project Manager is a Band 7, then the interim need is inflated to perhaps an 8B, so that they can keep below the centrally reported exceptions). It should be noted that anecdotally from other CIOs I’ve polled, Finance Directors working within Trusts without Foundation status or who are not meeting national targets are less likely to challenge such constraints and just accept poorer internal or mediocre interim candidates just to get some traction.
2 – Even for roles graded at VSM (Very Senior Managers), politics and arbitrary emotional comparisons to the Chief Nurse’s salary and the equivalent number of Ward Nurses an interim rate would buy are made which is merely comparing apples and oranges – let alone a fair market rate for specifically experienced professional interims.
IF the downward pressure on rates and bureaucracy further continues or increases, I foresee that the exact corporate transformational professionals that the NHS seeks and so desperately needs will simply ebb away into other more lucrative sectors and we all lose out.
It's one thing having a plan that looks broadly 'credible' - its another thing entirely to consistently deliver over a number of years a step-change in the ways of working across organisational boundaries that the STPs demand.

SJ Leatherdale at 01/11/2016 10:40 said:

Paul, you have highlighted some valid key points here. Thank you for your comments.

Keith, thank you for your comment - we always welcome a broad response to add during these enormously challenged times.

SJ Leatherdale

Ben Booth at 01/11/2016 14:48 said:

A great article and pertinent points from Paul and Keith. In my experience another limitation is that NHS is reluctant to look outside the sector for interims, a similar trait to some of the more conservative areas of FS. In both cases I feel it limits the pool of available expertise and perhaps more important enforces an entrenched and inward looking culture.