I've visited eight adult social care departments this year, and talked with front line staff in all of them.
Last week the iMPOWER health team attended the HSJ Commissioning Summit. As ever, the agenda was packed with plenty of new insights to take away and conversations to reflect on. As expected, STPs were a key discussion point, with three key themes emerging:
- STP’s are viewed as a real opportunity for a positive new direction. The Sustainability and Transformation Plans (STPs) were created to help local health economies plug the financial gap, but also as a means to get CCGs, local government and other health providers and stakeholders working together. At the Summit, the speakers were enthusiastic about the potential of STPs to tackle prevention at scale and manage demand. It may take us a while to see the results, but we’re on the right track.
- Changing incentives and behaviours. However, if STPs are going to manage demand across the system, then we need to realign incentives, deploying money across the system that enables the right behaviours (this is currently what iMPOWER is working on with NHS Bromley CCG and the London Borough of Bromley). One speaker highlighted that we need to make the invisible visible (the invisible basically being everything that is not the hospital). We need to ask how community systems can support high risk patients. If we want our citizens to take different pathways into health, then the system needs to support that.
- Plans are not enough. This has to be different for patients. It was clear from the discussions that it’s all well and good having an STP, but they need to enable people and staff to work differently in a way that is genuinely different for patients. We’re currently seeing STP engagement at a strategic level, but the challenge now is to move to implementing. We must engage the workforce and the public if we’re going to see transformational change.
Finally, there was a general acknowledgement that the STP process does not stop once the plans are submitted; they will need to be revisited and revised according to our experiences and learning. The STP process has exposed gaps in the capabilities and governance of our health care system, but it is also a forum in which we can bring key players together and tackle these issues. We just need to seize it.