The sudden prominence of Sustainable Transformation Plans (STPs) in 44 areas of England throws into sharp focus the challenges faced by the NHS in a period of rapid change.

It has to conduct at least three simultaneous dialogues

• There is the routine, on-going continuous engagement on operational and day-to-day delivery of our diverse health service needs – made even more complex by its growing interdependence on community services and social care issues. Whether through tough monitoring of hospital services (incl. perception measurement via the Friends & Family test etc.) or by using Patient Participation Groups (PPGs) to discuss Primary Care, these forms of engagement can be the first early-warning of things going wrong.

• Substantial service change is subject to formal consultation, but much of the really valuable dialogue takes place as clinicians, patients and other stakeholders work together to work out the possible options for the future. Co-production is becoming a popular approach, for it means that what’s offered to the public in those consultations have the credibility of having involved those who might be affected and are less likely to be seen as take-it-or-leave-it proposals for change. Given the scale of the changes likely to affect patient pathways, these projects are immensely important.

• Planning for the future also needs an organised dialogue. Everyone agrees that Managers on their own cannot produce STP plans that will be ready to implement, and the Guidance requires them to be “having conversations with local people and stakeholders”. We know local authorities are already involved but it will take time for all those who should be part of the STP process to become plugged into the exercise.

But who, in each Area, should be involved? Local Healthwatch groups have a statutory status, as do members of Health & Wellbeing Boards. But these different dialogues may call for rather different voices to be heard. It will not be a case of the usual suspects showing up at different forums; dare we use the phrase ‘horses for courses’?

We have these thoughts in mind as the Institute plans one of its Health Special Interest Group Meetings on September 27^th in Birmingham. These informal but valuable sessions are free-to-members on a first-come, first-served basis, and we have decided to put the whole issue of STP-related engagement top of the agenda.