New London health care structures ‘yet to make a positive difference’, says King’s Fund report for Mayor

New London health care structures ‘yet to make a positive difference’, says King’s Fund report for Mayor

Sustainability and Transformation Partnerships (STPs), may be little-known, but as the NHS structures now overseeing health services across London they are powerful. And their record is variable at best, according to a hard-hitting report commissioned by Mayor Sadiq Khan from the King’s Fund think tank and published this week.

The London STPs were set up in 2016 as part of an England-wide restructure, bringing NHS organisations together with local authorities to manage and improve health and care services and to address “financial sustainability”.

Covering the five areas – North Central, North East, North West, South West and South East London – that have been used for NHS planning in the past, they cater between them for almost nine million residents. But progress on getting health and care systems working together has been slow, the King’s Fund report says, with the capital trailing behind other areas of England.

Challenges include London’s “complex and cluttered” systems – 32 clinical commissioning groups and 36 provider trusts alongside 33 local authorities, the Mayor of London, the London Health Board, London Health and Care Strategic Partnership Board and the Healthy London Partnership – and rushed implementation leading the STPs to be seen by many as a “toxic brand” set up to implement cuts.

Early proposals to cut hospital beds have now been dropped in the face of London’s growing and ageing population continuing to put pressure on services, but STP leaders have still had to spend much of their time on “strengthening relationships with organisations within the footprints, and addressing gaps in staff and public engagement” and they need to do more to demonstrate their impact, the report says.

With no statutory basis or formal authority to bring about change, STPs have also had to work within the 2012 Health and Care Act system, which dismantled strategic health authorities, including NHS London, and enshrined purchaser provider separation and competition between health organisations.

“STPs have yet to establish themselves as collaborations that can make a positive difference to the populations they serve. As coalitions of the willing, their impact hinges on the ability of partner organisations to find common cause”, the report finds.

Commenting on the report, King’s Fund chief executive Professor Sir Chris Ham highlights a major role for the Mayor in providing capital-wide leadership, including work on public health and more commitment from London’s local authorities. “Above all, each STP must develop a compelling vision that is widely shared and understood – and focused on using resources to improve health and care,” he concludes.

The future for London’s STPs remains uncertain. The imminent appointment of a new regional director for the NHS in London may prompt a fresh look at capital-wide strategies and structures, and the New Year will see new five-year plans responding to the Government’s pledge of £20.5 billion extra for the NHS by 2023/24, though the pledge does not include vital funding for social care.

Above all, London remains significantly exposed to Brexit, with 11 per cent of health workers and 13 per cent of care staff coming from Europe.

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