STP: Stop, Think, Please….

How have STPs gone so badly wrong?

Roy Lilley, health policy analyst, writer and broadcaster


I’m pretty sure it was never meant to be like this.  
I said they were such a good idea.  I was a fan.
The idea that local people could get together, have the opportunity to sit down and sort out what health care could, should and would look like, in what they agreed was, ‘their area’.
The freedom to plan, shape the future in this way, might only come once in a career. 
I said they got off on the wrong foot.  Quiet, private moments of brainstorming and thoughtfulness were badly handled and deliberately misconstrued by the malevolent, as them forging secret plans.
I said, be patient, wait.  There are statutory consultation requirements.
Now we discover they have been paying out a small fortune to management consultants, to do the job they were supposed to be doing.
Now I say, with regret; how have STPs gone so badly wrong?
How have senior, sensible people let this opportunity slip through their fingers.  Why have experienced people, who should know better, not done better, than just reinvent the past.  They are reduced to system management and cuts. Consultants and same-old.
Why is it that professionals, truly focussed on reimagining healthcare, can’t work together?
I understand some STPs are being obliged to improve their clinical engagement… gimme strength. It’s a fundamental!
I hear rows about GPs having ‘no say’; STPs turning into a club for hospital chief executives… local authorities all but excluded.  Healthwatch reduced to watching and the public don’t have the first clue what to expect the future of their healthcare will look like.
If half of what I hear is right… it is 100% not what it should be.
To repair some of the public-facing damage NHSE will recruit a communications professional… to do what?  Perhaps they should advertise for a decorator, to paper over the cracks?  The damage has been done.
Wherever I go I hear about… plans.  Plans disputed, argued over.  Cockamamie ideas that primary and community care has the capacity, facilities, staff and wherewithal to do the heavy lifting for secondary care.
Really bonkers plans… close 300 beds.  Work it out; an average length of stay of, say, five days, means; every five days there’s a turnover of 300 people.  
There are 73, five day cycles in a year… times 300.
That means over 22,000, probably frail, elderly people, extra, for GPs and community staff to take care of… on top of everything else.  Genius idea…and even if I’m only half right; it’s no way to look after yer granny.
And let’s not forget people with dementia and mental health needs… everyone else seems to.
Now the talk is for more money and more beds.  Why have STPs gone so badly wrong?
STP planning is being done, in the main, on top of the day job.  Who has the time or resource to populate committees and endless meetings?  The hospitals.  Hence, it is probably true, they are dominated by secondary care.
Most STP chairs are parachuted in and chief executives ‘appointed’.  No sense of local ownership, no elections.  Recreating the heavy handed, topdown relics of the past. 
Let’s not make any bones about it; STPs exist to deliver more for less.  Undeniably, there are efficiencies at the margins but STPs will never find them.  
System management means; sending 100 people somewhere different in the system, oblivious to the fact that the places they leave behind will be filled by another 100 and then another hundred.
STPs can’t deal with demand, they can only play with the flow created by demand.  Demand is too far upstream for NHS dominated STPs to deal with; housing, work, the environment, diet, lifestyle, poverty, education.  And, the cycle of change takes too long for STPs, who need cash rattling in the tin by 2020.
Some of our austerity driven NHS is so damaged it’s beyond STPs to repair. Even the United Nations condemns our approach to austerity.
STPs?  Shuffling stuff.  Circling the wagons.  Pretending less is more.  Recreating the Jurassic Park, management model of the 80’s and 90’s.
Where is nimble, flair, innovation, inclusive, collegiate, agile, daring, bright, thoughtful, clever, erudite, elegance, mastery, inventiveness, smart.  
Where is together and connected?  Why have STPs gone so badly wrong?
STP; Stop, Think, Please…

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