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Prevention is better than cure: tips for effective sustainability and transformation plans

Posted by: , Posted on: - Categories: Care and support, Communities, Information sharing, Integrated care

"Sustainability and transformation plans (STPs) are becoming a type of ‘planning catch-all’ for the NHS," says Ewan King in his latest blog for Social Care News. The Director of Business Development and Delivery at the Social Care Institute for Excellence (SCIE) explains how STPs are likely to contain everything from plans to stabilise NHS finances to actions on tackling cancer and diabetes. Given their breadth and complexity, Ewan offers his four top tips to create focused, genuinely effective plans...

Ewan King: 'The deep involvement of local citizens, social care and voluntary providers in shaping STPs [promotes] a [shared] vision for integrated health, care and support.'
Ewan King: 'The deep involvement of local citizens, social care and voluntary providers in shaping STPs [promotes] a [shared] vision for integrated health, care and support.'
The ambition – as ever – is admirable. But what are the essential ingredients for a genuinely effective STP? Will they incorporate the best practices emerging in health, social care and within communities, or will they look only to the NHS? Here are my four top tips based on SCIE’s experience.

1. STPs should chart the next phase of the integration of health and care. That was the vision for new models of care which many regard as the essential ‘building blocks’ for STPs. The best emerging practice in social care, such as personalised home care, supported living and reablement, should  feature strongly in the plans because you need the very best of both health and social care, jointly led and delivered.

From what we have seen so far, there is still some way to go. We hear too often that local authorities and the voluntary and private sectors are being excluded from decisions. In many cases, I think planners struggle to join up the myriad plans for acute hospitals and GP practices, with a similar plethora needed to deliver better community-based care.

2. Focus STPs on prevention. Stopping or delaying our deterioration in health and wellbeing in the first place. It is at the heart of the NHS Five Year Forward View and, by extension, STPs. And it is where care and support can have a real impact. Some of the very best care models - initiatives like local area coordination and Age UK’s Personalised Integrated Care model - focus on keeping people well and independent for longer in their own homes. Yet these kind of initiatives, which are crying out to be scaled up as part of the STP process, don't yet feature strongly enough.

3. Co-produce plans with local citizens and wider stakeholders across the community, voluntary and care sector. They bring insight into what actually works, plus resources to deliver. In Leeds for instance, the deep involvement of local citizens, social care and voluntary providers in shaping the STP has ensured that a vision for integrated health, care and support is more prominent. This approach is not universal. A recent Nuffield Trust report raised concerns about the lack of citizen involvement in STPs. At least new guidance from NHS England provides suggestions of how to do this well.

4. Learn and share. Use the best available knowledge about what works (and doesn’t work) in terms of commissioning and delivering sustainable care. SCIE’s prevention resource provides examples and models of emerging practice – such as community navigation schemes, social prescriptions and reablement. Many of these initiatives could be reflected in STPs.

STPs provide an opportunity to develop a more integrated system of health and care. If we are to make the most of that opportunity, we must fully engage with local citizens and the wide range of stakeholders who can contribute to its effectiveness.

Further information

SCIE’s work on STPs and integration

SCIE’s prevention resource: emerging practice and research to support commissioning decisions

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  1. Comment by Mr R W Ebley posted on

    All involved organisations need ISO 9001 including the government

  2. Comment by Jennifer Bell posted on

    Good to read this thanks.
    I ran a project called Connect at Upper Eden Medical Practice, Kirkby Stephen, Cumbria. External evaluation showed promising results yet the project had to fold because it's funding ended and though they were very keen to see it continue, our local Clinical Commissioning Group couldn't provide continuation funding. I was employed by Mind then, now work for the NHS - I want to join with others to make these changes happen. I see lack of understanding and then lack of trust and maybe a bit of fear of the funding grim reaper can get in the way of the statutory and voluntary sector working efficiently together. Also the hierarchy of the NHS and some other organisations can create a sense of expert/ novice that makes it hard for 'participants' to speak up. In our area we're embarking on the Integrated Care Team plans via 'Success Regime'. Has anyone out there got any tried and tested system or advice to help all 'players' to connect and be part of the big change?
    My instinct is that we need to ask people what they want to change about then work with him/her to find the way through. Surely we all want to live good lives, spending time with people we like and love whilst being as fit and healthy as we can be?
    I think we're still missing the point ie. as long as we spend our time and millions of our increasingly scarce pounds redesigning 'services' that we think our populations need, with very little consulting, we continue to risk forcing our populations to become fairly passive recipients of care...whether they like it or not!

  3. Comment by Brian J. Cowie posted on

    Similarly to Jennifer, above, I was running a small charity called Alcohol Support in Aberdeen, until funding was withdrawn in April. Although we believed that prevention was better than cure, and that we were providing value for money (our SRoI study showed a conservative 4:1 return), the local ADP, who had been put in the position of having had 23% reduction in their own funding had to take the decision to withdraw all funding from our services, thereby closing the charity, with the loss of 16 jobs, all of which were filled by dedicated, experienced and qualified practitioners. This left only one service provider in the City to cover the Alcohol and Drugs issues, with restricted funding and having to take on the existing clients from ASL on top of their already stretched work load.
    My feeling is also that the scourge of competitive tendering in the Third Sector is serving only to take services out of the hands of experienced local charities, and feed them into the sphere of what I call 'commercial charities'. This being that they are ruthless in their treatment of staff and clients alike, in order to force down wages, cut terms and conditions, cut corners in client care, all in order to line the pockets of the 'Executives' who are reaping the benefits of exorbitant salaries on the back of a so called charity. What happened to 'not for profit'?
    It is time to take a long hard look at how charities are managed and how they are able to undercut experienced providers, then snatch the work out from under the noses of people who have dedicated decades of work to providing tailored services for their clients, giving good quality work, and rewarding their workforce accordingly. All too often, at the end of a three year stint, yet another 'charity' pops up and pulls the rug out from under a service, leaving service users confused and unsettled, taking liberties of reducing wages and conditions for the workforce, taking the Third Sector further down the spiral of decline.
    Of course, there are too many voluntary organisations out there with the ability to come and go as they please. Anyone can set up a charity, raise funds for 'granny's bunion support' or some such, and use the money as they please, so the charity commission needs to review what is actually happening in this way, and somehow limit these to a sensible level, without so many duplications of purpose and perceived need. Where Government funding becomes so depleted that so much depends on monies raised outwith to keep the work flowing and people cared for appropriately, all these little pockets of funding sitting in separate piggy banks would amount to a really useful funding stream if it were being distributed in the right way.
    Since being made redundant, I have been doing agency work, which has also been an eye opener for me. I have seen so much duplication and cross overs of work, where one charity is providing nursing care, one going shopping, one coming in to clean, and all for the same client residing in supported accommodation; surely this is overkill. Those who shout loudly enough get all the support, whilst those who just soldier on are not given any support at all, but are left to live in dismal isolation.
    We can and must make some changes to ensure that staff as well as clients are given a fair deal, appropriate care and support and recognition.