Spotlight on Sustainability and Transformation Partnerships
In simple terms, STP's exist to help stabilise and modernise our NHS services, to integrate health and social care services, but also to balance NHS budgets. They represent the biggest national move to join up care provision and the commissioning of services.
Locally, our STP covers the whole of Sussex and East Surrey, and the partnership brings together 24 organisations involved in the planning and provision of health and care services across the region. This includes all relevant NHS Clinical Commissioning Groups (CCGs are responsible for appointing service providers), acute hospital trusts, mental health, community services, and local authorities. You can find out exactly who is involved by looking at page 4 of the STP presentation.
The Sussex and East Surrey STP has now been running for two years. In recent months the STP has undergone organisational changes through the appointment of a new Executive Chair, Bob Alexander who was previously head of finance at NHS Improvement (NHSi), and the appointment of Adam Doyle as the accountable officer for a number of CCG's (i.e. Adam is responsible for ensuring that the CCGs exercise their functions effectively and efficiently; oversees improvement in the quality of services and the health of the local population, whilst maintaining value for money).
Understanding the management and governance structures of the STP is not an easy task. This is further complicated by the fact that the eight NHS CCG's within the Sussex and East Surrey STP have arranged themselves into three large clusters: East, West and a central corridor which runs from East Surrey in the North to Brighton and Hove in the South. The central corridor is known as the Central Sussex Commissioning Alliance (CSCA). Much like the STP, the CSCA Alliance is not a properly constituted NHS organisation and thus it is not aligned to any local authority boundaries; and ultimately does not report to elected representatives. Any decisions made by the Alliance must however be ratified by the constituent CCG's, namely Brighton and Hove, High Weald Lewes Havens, Horsham and Mid Sussex and East Surrey. Adam Doyle is the accountable officer for the Alliance.
To date, Heathwatch believes that our STP has failed to produce convincing plans that will balance the NHS budget locally, or secure the endorsement of local councils and elected representatives. In addition, the rhyme and reason for STP and CSCA management and governance structures remain something of a mystery.
There is however better news on patient and public engagement. The current phase of the Big Health and Care Conversation in Brighton and Hove has involved a series of engagement events, a summary report of which can be found on their website, with similar engagement exercises planned in other parts of the CSCA Alliance and the Sussex and East Surrey STP regions.
Further engagement with patients and the public is being planned. This will form part of Clinically Effective Commissioning (CEC), which is a complex process for reforming commissioning policies for a very wide range of clinical conditions. Clinically Effective Commissioning seeks to harmonise policies that define the criteria for treatment i.e. doctors and nurses across the STP will then use the same rules for offering or declining treatment. At best, this will remove the 'postcode lottery' element of entitlement to treatment but some also see this a mechanism for rationing treatment. We are likely to hear much more about Clinically Effective Commissioning in the coming months.
At national level Healthwatch England have been providing evidence to the Health and Social Care Select Committee about patient and public involvement in STP's across England, as well as seeing Imelda Redmond, the Healthwatch National Director provide her evidence here.
To take part in a Survey please go to Brighton & Hove's CCG Website
