NHS plans could bring benefits but we"re barred from telling the public

I work in programme management in the NHS for a commissioning support unit: we support GPs’ clinical commissioning groups and other organisations on matters such as finance, IT, service transformation and change management. Recently I’ve been supporting our local system to develop a sustainability and transformation plan (STP) – bringing NHS bodies together with councils and community providers, and producing a five-year plan to improve care and find the very ambitious savings required of us.

The benefits of STPs could be huge. The whole system is short of money, and we have a growing and ageing population with increasingly complex needs. To have any chance of sorting this out, we must bring health and social care services together – and STPs have sparked some real collaboration. People who have been plugging away at different aspects of the same problem for years are now working together, and there’s huge enthusiasm.

We had a difficult start, though, because NHS England made up the policy on the hoof. Late last year, work had started across England on initial plans: by April, we were to submit plans to transform and connect the IT of NHS and social care bodies within our “footprint” areas. Then at Christmas, we were suddenly asked to produce an STP by June.

There was no clarity about how STPs were to line up with the initial plans, and in some areas their footprints aren’t coterminous – which is daft. NHS England’s guidance was fragmented, emerging in bursts while we worked, often leaving us little time to respond to new requests. Still, we hit the deadline, expecting a written response in July; but as of late August, we haven’t heard back. NHS England are constantly telling us to work “at pace and at scale”. It would be helpful if they worked at the pace that they expect of us.

A second big challenge with STPs is their lack of a formal structure or leadership. Volunteer chief executives lead STPs alongside their day jobs, and the organisations involved report to their own boards – which have a legal responsibility to protect their own bottom lines. Plans that are good for the whole system can lead to individual organisations losing income, which may put boards in conflict with STP ambitions. The government should create formal structures that will enable STPs to appoint full-time leaders, make the necessary strategic decisions and, crucially, move money around the system to where it’s needed.

System-wide reforms may also involve controversial changes such as closing A&E departments. It’s an NHS England requirement that there’s strong public and patient engagement before these decisions are finalised: when we don’t get people’s buy-in, the result is protests, judicial reviews – and delays that we can’t afford.

We need to start consulting on our plans, having an open conversation with the public. But NHS England tells us that we can’t publish our STPs – presumably because it’s worried about negative headlines. I think we have a duty to tell the public about the plans, and NHS England says we must move “at pace”; yet we’re barred from explaining our plans. That’s a problem.

STPs are helpful in driving collaboration; in integrating health and social care; in creating a climate for change. But they need the right management structure to make system-wide decisions, along with the freedom to publish and consult as they see fit. I’d like to hear much stronger signals from NHS England that they’re committed to this model; that it won’t be swept away in yet another round of top-down reforms. Then people will recognise that this is for real, and commit themselves to the agenda – and we’ll be able to use reforms to make the savings asked of us, even as we improve services for patients.

If you would like to write a blogpost for Views from the NHS frontline, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

Do you work in the NHS? Please take our survey and tell us whether bullying is a problem and how it affects your work

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

NHS plans could bring benefits but we"re barred from telling the public