Sustainable & Transformation Plans (STPs) have now been prepared for 44 separate ’footprints’ in England. On 21 October they were presented to NHS England and the other agencies and this Note addresses the choice that STP Leads face in planning the forthcoming engagement and consultation tasks.

Three factors impinge upon the approach that the NHS and local authorities might adopt:

1. Whilst some STPs are effectively a consolidation of existing known initiatives, most of which have been subject to extensive dialogue with local stakeholders, others envisage new solutions and radical changes not previously discussed.
2. A policy decision by the NHS not to publish the STPs has caused a backlash from Councillors and MPs who believe this has prevented effective engagement. They also argue that the lack of transparency undermines public confidence.
3. Confusion and contradictions have emerged when Ministerial commitments to consultation have been followed by more ambiguous signals.

Given the range of expectations, STP Leads will naturally be concerned to build consensus around their plans. Local Authorities have a pivotal role here, but are, of course under enormous financial pressure. In its September Guidance, Engaging Local People, NHS England made it clear that it required a long list of stakeholders to sign up to the plans.

“It will only be possible to achieve these goals by working together. This means patients, the public, carers, clinicians, stakeholders and individual local health organisations (such as GPs, hospitals and local authorities) joining forces to agree a plan to improve local health and care services”.

This clearly signals a commendable desire to include a wide range of interests in planning ahead for health and social care and raises expectations among the named organisations, and others, that important dialogues should be taking place.

So how will that now be done?

STP Leads can take one of four different approaches:

Option One: Supplementary dialogue with key stakeholders

This means sitting down with local Councils, healthcare providers, public and patient groups to discuss the details of the STP plans as submitted in October. The advantage is that this can be a better informed dialogue – as most of the participants had not been able to see the documents or share the detailed analysis therein. The disadvantages are that it may re-open disagreements about the transparency of the process and highlight differences of view between various parties. It may indeed make local consensus more difficult and take time.

Option Two: An immediate public consultation on the STPs

Where there is a local appetite for much greater and deeper involvement, this is an attractive option. The main advantage is that, at a stroke, it silences critics that complain that the process is secret and unaccountable; it also fulfils the precise commitment made by David Mowatt MP on 14 September – “When the STPs come back in October after being signed off, they will be consulted on.” Disadvantages include the timescale – leading up to the Christmas period, and the fact that not all STP documents are written so as to be generally comprehensible and meaningful.

Option Three: Announce a public consultation on the STPs to start in January or February

This fulfils the Ministerial commitments and also has the advantages of providing a high-integrity process for local people to give their views on a better designed consultation paper with time for adequate pre-consultation and communication. The disadvantage may be that critics of the STP process may use the delay to campaign against proposals that have not even been consulted upon. It also obviously adds to the timescale for radical changes.

Option Four: No public consultation on STPs – wait until potential service changes require S.14Z2 public involvement  

We recognise that this feels a sensible way forward for many ‘footprints’. The advantages are that it avoids controversial plans being subject to divisive debate and lets Managers move swiftly on to the implementation phase of STPs. Where financial deficits are a major problem, it may also ‘appear’ to offer the prospect of making savings quicker. But there are disadvantages which include:

• Almost-certain legal challenge based upon the S.14Z2 requirement to involve (whether by information or consultation)…over the development and consideration of proposals…
• Political embarrassment in appearing to break Ministerial commitments to consult over the plans.
• Loss of local goodwill making it more likely that Overview & Scrutiny Committees would demand more comprehensive consultations on proposed ‘service changes’ when they eventually emerge

Clearly local circumstances vary and this may influence STP Managers in their choice of engagement option. Much may depend upon the attitude of the local authorities. If they feel that elected Councillors have been fully involved in the process (and acknowledging that Councils provide the leadership for some of the STPs), there may be less of a case for formal consultation. If, however, key stakeholders have misgivings about the process, it is essential that steps are taken now to build greater confidence through improved and genuine dialogue.

• STPs contain many important and constructive ideas for developing our health and social care system. Many of these offer the promise of significant improvements in patient care.
• Inevitably however, there will be changes to NHS and allied services and some will be unpopular either with stakeholder organisations or the general public. Long-standing legislation acknowledges this and the Courts have enforced the requirements for involvement and consultation. The question facing STP leads is the extent to which these – and the commitments made by Ministers – amount to an obligation to consult on the plans themselves – rather than the service changes that emerge from them.
• In most circumstances, Option 1 followed by Option 3 is the Institute’s recommendation. Option 4 will be a big risk except where changes are unlikely to be controversial and prior engagement has been thoroughly undertaken.
• The Institute is happy to help clients & other STP Leads to assess the risks, design engagement strategies and make detailed plans for consultation where required. Contact Rhidian Jones on 01767 318350 or rhidianj@consultationinstitute.org.

Relevance

This Briefing is of relevance to Senior Managers from NHS Clinical Commissioning Groups, Foundation Trusts and other Providers. It also affects Council Leaders and Elected Members as well as members of Overview & Scrutiny Committees, Healthwatch and voluntary/community organisations with an interest in health and social care.

Further insights

• This Briefing was written by Rhion Jones LL.B, Programme Director of the Institute, assisted by active Institute Associates (including Nick Duffin and Paul Parsons) who are working with various STPs.
• The Institute has been invited to develop a streamlined consultation process that might enable STP Leads to fulfil legal and operational requirements to a shorter timescale. We expect this to be ready within one month, but applicable only when certain pre-existing conditions are satisfied.
• The Institute runs public training courses on a wide range of consultation and engagement issues and offers full and partial Quality Assurance for important consultations. Contact Martin Roach on martinr@consultationinstitute.org or 01767 318350.