STPs: the answer to the systems problems or doomed to fail? Part 1

Sustainability and Transformation Programmes have quickly become the main vehicle for NHS change and the delivery of the Fiver Year Forward View. The plans see NHS and local councils coming together to deliver NHS change that is ‘place-based’ and built around the local population.

PB Consulting will explore the challenges faced by STPs in a series of blogs. These will cover – the challenge of maintaining the focus on public health; the challenges posed by the NHS finance structures; and winning the local hearts and minds of local population.

Below we look at the challenges faced in maintaining investment in public health:

Maintaining funding and focus on public health

The Five Year Forward View (5YFV) is absolutely clear on the need to deliver better healthcare through improved public health from the NHS:

“… the future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health. Twelve years ago Derek Wanless’ health review warned that unless the country took prevention seriously we would be faced with a sharply rising burden of avoidable illness. That warning has not been heeded – and the NHS is on the hook for the consequences.” NHS 5YFV.

The Wanless report set out the principles required to deliver a healthy population and took steps to define the role of the NHS within this in 2004. Successive Governments have had 13 years to get this right, or at least make steps towards it. Even during the years of consistent NHS budget growth, public health was an area that struggled to get adequate funding and prioritisation, a problem exacerbated by reductions in NHS Spending growth.

Looking at the main message behind the 5YFV, that the NHS needs to change the way it operates and deliver a healthy population rather than continuously trying to manage ill health, the challenge remains how NHS leaders will deliver this at a time of stretched budgets. This will require significant investment and prioritisation in public health initiatives, at a time when even acute care us struggling to meet demand.

The evidence from current spending trends is not positive. Last year the Kings Fund published analysis that showed that from 2015/16 to 2016/17 public health spending reduced by 9%. A recent Kings Fund report has shown that the current budget situation has seen public health, in particular around genito-urinary medicine (GUM) services, receiving less funding. Their report found that reduced budgets and pressure on the system had led to “cuts to health adviser posts and to prevention and outreach services, which not only affect individual patients but also put the general population at greater risk of infection.”

Second to this the responsibility for public health is now shared between local NHS and local government, with Public Health England with overall responsibility. This has led to a system that has multiple funding streams and confusion over who is ultimately responsible for local delivery, and more important local outcomes. Any changes that STPs propose to public health need to ensure that responsibilities are defined more clearly between central and local Government to ensure that funding is used as effectively as possible.

For STPs, and by extension the 5YFV, to succeed they will need to see a long term shift in behaviours that delivers a healthier population and puts less pressure on services. This is a long term goal that will require focus and resource in the short term.

For STPs this will require them to overcome the challenge of resource pouring into the acute sector, then primary care and finding public health getting allocated whatever is left over. NHS leaders will need to bold and ensure that public health funding is ring fenced and not eroded away by short term concerns and priorities. The long term success of the STPs will rely on their ability to deliver this.

Dan Jones, Associate Director