Sustainability and transformation partnerships in London: An independent review

A policy briefing is available for LKS staff to share in their organisations.  Produced by the JET Library at Mid Cheshire Hospitals NHS Foundation Trust.  Feel free to reproduce it (with acknowledgement).

What does this mean for libraries? 

• Understanding the challenges for STPs in London may provide opportunities to work collaboratively across the patch and link with senior management to provide evidence to progress STPs.
• Consideration of bigger footprints for specialist services could have implications for library services in London.
• Identifying leaders to promote services such as current awareness and LKS evidence searches and showcase LKS support for innovation and change, through running simple KM events to encourage knowledge sharing, e.g.  randomised coffee trials and knowledge cafes.

Source: Kings Fund

Link to main document 

Date of publication: October 2018

Summary of driver: This report was commissioned by the Mayor of London to report on the progress of the 5 STPs in London. It identifies key developments, highlights examples of integrated working and barriers to progress and makes practical suggestions for dealing with these challenges.

Engaging local people

Title: Engaging local people: A guide for local areas developing Sustainability and Transformation Plans

What does this mean for libraries? 

• LKS can be an information hub on STPs for patients/carers on site, as well as connecting with public library colleagues.
• LKS staff could provide support for public consultation events with a view to identify challenges and providing information services to support these.
• Opportunities to showcase how LKS can support innovation and change, such as knowledge management skills and running simple KM events to encourage knowledge sharing, e.g randomised coffee trials and knowledge cafes

Source: NHS England

Link to main document

Date of publication: September 2016 (updated June 2017)

Summary of driver: This document is aimed at the teams developing Sustainability and Transformation Plans (STPs). Local statutory bodies are responsible for engaging and consulting on their proposals, and this document recommends a shared approach across the STP footprint. It outlines the expectations about stakeholder involvement, in particular patient and public participation. It suggests a process for engagement and highlights key principles for engagement and consultation. The document will be useful for STP communication and engagement leads and will help governance teams.

Integrating care: contracting for accountable models by NHS England

A  Policy Briefing aimed at healthcare professionals is available for LKS staff to share in their own organisations. This has been produced and shared by the JET Library, Mid Cheshire Hospitals NHS Foundation Trust. Please feel free to reproduce it (with acknowledgement to JET Library) for your own purposes.

Impact on library policy/practice: 

Possible knowledge management opportunities whilst working with managers, commissioners, transformation teams and other healthcare leaders to support organisations and staff whilst undergoing these changes.

Current awareness / linking into other organisations and disseminating that information- condensing the amount of information available/ do once and share.

Source: NHS England

Link to main document

Publication format: PDF

Date of publication: August 2017

Summary of driver: 

The Five-Year Forward View and the Next Steps update published in March 2017 described a movement towards integrated care delivered through collaboration across health and care systems. It also introduced the concept of Multispecialty Community Providers (MCP) and Primary and Acute Care System (PACS) vanguards.

Key features of driver

• Sustainability and Transformation Programmes (STPs) are a way of facilitating this collaboration among local leaders and clinicians
• Eight areas are ready to go further and become Accountable Care Systems (ACSs) – they will have greater freedom and control over the operation of their local health system and how funding is deployed More ACSs will be added later as STPs mature
• Some areas also want to establish Accountable Care Organisations (ACOs). ACOs are where the commissioners in that area have a contract with a single organisation for the great majority of health and social-care services. This is a long and complex process and most places are looking to become ACSs first
• A few areas – particularly some of the Multispecialty Community Providers (MCP) and Primary and Acute Care System (PACS) vanguards – are on the road to establishing an ACO. An ACO model simplifies governance and decision making, brings together funding streams and allows a single provider organisation to make most decisions about how to allocate resources and design care for its local population.
• ACOs will need to demonstrate a number of features viz:
  • A focus on delivering concrete service improvements
  • A compelling vision of the benefits to be delivered
  • A robust and sustainable financial model
  • Consistency with STP/ACS plans for the future
  • High levels of engagement and support among health-and-social-care leaders
  • Sufficient commitment from primary-care providers
  • Robust system plans to commission, procure, fund, establish and oversee the ACO
  • Clear plans to identify, mitigate and manage risk
• Three main contractual approaches through with accountable models can be established in practice:
  • Virtual. Practices, local community service providers and commissioners enter into an “alliance agreement,” which would overlay existing commissioning contracts
  • Partially-integrated. Commissioners re-procure, under a single contract, all services that would be within the scope of a fully-integrated model except for core General Practice
  • Fully-integrated. Commissioners re-procure, under a single contract, all of the ‘in scope,’ services including core General Practice

Primary audience: Clinical commissioning groups, local community service providers and other commissioners, health and social care staff.

Date last updated: September 2017

Due for review: September 2018

Group member responsible: LK

Hot topic: Accountable Care Organisations

A Word version of this briefing aimed at health care professionals is available for LKS staff to share in their own organisations.  Please feel free to reproduce it (with acknowledgement) for your own purposes.

Impact on library policy/practice: 

• LKS teams may be affected by changes to organisational structures as a result of the emergence of Integrated Care Systems, Integrated Care Partnerships and Accountable Care Organisations (ACOs).
• There may be an opportunity to deliver evidence and knowledge to managers, commissioners and transformation teams as health care services undergo this change.
• As organisational boundaries blur and take a ‘whole population’ approach, LKS may be required to adapt their service delivery models accordingly.
• If healthcare moves away from a competitive structure and towards a collaborative one, there will be many opportunities relating to knowledge management that could support the sharing and dissemination of good practice, innovation and organisational knowledge.
• LKS will have to consider how the negotiation and procurement of resources needs to adapt to reflect the changes in organisational structures.
• There is a clear role for technology in supporting the emergence of these news systems that presents an opportunity for digitally enabled LKS.

What is an Accountable Care Organisation?

An Accountable Care Organisation (ACO) or Accountable Care System (ACS) brings together a number of providers (e.g. acute hospital care, general practice, mental health, social care, ambulance services and pharmacies) to take responsibility for the cost and quality of care for a defined population within an agreed budget (1).

ACOs have been proposed as one way of overcoming fragmented responsibility for the commissioning and provision of care in the NHS.  They could in principle offer an organisational structure that draws together previously siloed or competing providers into a network with a shared sense of purpose and financial interest (3).

Next Steps on the Five Year Forward View (5) describes ACOs as “an evolved version of an STP” and states that ACOs “provide joined up, better coordinated care”.  It published the names of nine geographical areas that are likely to emerge as ACOs in 2017/18.

What can we learn about ACOs from elsewhere?

ACOs have evolved recently in the United States and they build on a much longer history of integrated care systems such as Kaiser Permanente and Intermountain Healthcare (1).

In the UK, three ‘Vanguard’ schemes stated their intention to explore the potential of the ACO as an organising structure in the NHS: Northumbria, Northamptonshire and Salford (3).

The first wave of Integrated Care Systems (formerly shadow Accountable Care Organisations) are currently assuming accountability for local operational and financial performance in:  South Yorkshire and Bassetlaw, Frimley Health and Care, Dorset,  Bedfordshire, Luton and Milton Keynes, Nottinghamshire, Blackpool and Fylde Coast,
West Berkshire, Buckinghamshire, Greater Manchester (devolution deal), Surrey Heartlands (devolution deal) (8).

What are the challenges involved?

• Relationships: Establishing strong relationships between the leaders of participating organisations and the clinicians who deliver care;
• Technology: Accelerating the implementation of electronic care records to help predict avoidable hospital admissions and to coordinate discharge planning;
• Finance: New ways of commissioning and paying for services need to be established across traditional organisational boundaries (1).
• Legal challenge: The proposed  changes to regulations and consultation on the draft ACO contract have resulted in two legal challenges from 999 Call for
  the NHS and JR4NHS. (7)

Further reading

1. King’s Fund, 2016, Accountable Care Organisations explained
2. King’s Fund, 2014, Accountable Care Organisations in the United States and England
3. National Health Executive, 2016, Accountable care organisations: the future of the NHS?
4. Nuffield Trust, 2016, Accountable Care Organisations: The winners and losers
5. NHS England, 2017, Next Steps On The NHS Five Year Forward View
6. House of Commons (2018) Accountable Care Organisations
7. Kings Fund (2018) Making sense of integrated care systems, integrated care partnerships and accountable care organisations in the NHS in England
8. NHS England (2018) Integrated care systems (ICSs)

Primary audience: LKS staff and their wider organisations

Date last updated: February 2018

Due for review: May 2018

Group member responsible: VT

44 Regional Sustainability and Transformation Plans (STPs)

Impact on library policy/practice: 

• The opportunity to link with senior management and find out what information they need to progress their STP.
• Ideal opportunity to promote time saving services such as current awareness and LKS evidence searches.
• Possibility of collaborative purchasing opportunities with other LKS both within and outside relevant STP footprint for resources purchasing to deliver financial savings and fitting in with Knowledge for Healthcare.
• Opportunities to showcase how LKS can support  innovation and change, such as knowledge management skills and running simple KM events to encourage knowledge sharing, e.g randomised coffee trials and knowledge cafes
• LKS can be an information hub on STPs for patients/carers on site, as well as connecting with public library colleagues.
• Possible provision of LKS for the Local Workforce Action Boards.

Source: NHS England

Link to main document 

Publication format: Website, 44 STPs as pdf

Date of publication: All STPs were published in Oct/Nov 2016

Summary of driver:

NHS organisations and local councils are developing shared proposals to improve health and care. Working in 44 geographical areas covering all of England (called ‘footprints’), the plans are led by senior figures from different parts of the local health and care system.

The proposals are designed around the needs of whole areas, not just individual organisations, following discussion with staff, patients and others in the communities they serve.

The latest thinking is set out in 44 Sustainability and Transformation Plans (STPs). These can be viewed below, alongside details of who is leading work in each footprint area.

• North
• Midlands and East
• London
• South

Primary audience: All

Date last updated: 23rd March 2017

Due for review: 23rd March 2018

Group member responsible: TP

NHS Operational Planning and Contracting Guidance

Link to main document:

Publication format:  PDF

Date of publication: 22/09/2016

Summary of driver: This document outlines how NHS operational planning and contractual processes will change to support Sustainability and Transformation Plans (STPs) and the “financial reset”. STPs are a different way of working and are seen as the way forward with partnership behaviours and reducing silo working.

Key features of driver:

• Streamlining of the annual round of NHS planning and contracting.
• Move away from annual contracts towards two year contracts as default
• Priorities and performance assessment – lists nine “must do” priorities, originally listed in 2016/17 and will remain in place for 2017/18 and 2018/19.  These must be delivered within the financial resources available each year
• Developing operational plans and agreeing contracts for 2017-19
• Finance and business rules – submission of local finance plans illustrating achievement  financial balance within available resources
• Specialised services and other direct commissioning- new framework enabling STPs to contribute specialised care to population based health services and outcomes
• Commissioning in the evolving system – continued evolvement of CCG ‘s role
• System-wide set of changes in order to ensure NHS can deliver the right care in the right place with optimal value
• Working with local government/patients/communities and creating wider partnerships with the third sector

List of annexes to support guidance.

• Annex 1 – The Government’s Mandate to NHS England 2020 goals
• Annex 2 – The CCG Improvement and Assessment Framework
• Annex 3 – NHS Improvement Single Oversight Framework
• Annex 4 – October Guidance on STPs
• Annex 5 – NHS England and NHS Improvement approach to establishing shared financial control totals
• Annex 6 – General Practice Forward View Planning requirements
• Annex 7 – Cancer services transformation planning requirements
• Annex 8 – Mental health transformation planning requirements

Primary audience: NHS/healthcare senior management, local government, third agency staff, public health staff, commissioners.

Impact on library policy/practice:

• LKS already work collaboratively across boundaries- opportunities to expand and push to national as well as show in-house how collaborative and partnership working can benefit organisations. Initiative in working closer with LKS colleagues in relevant STP footprint
• Opportunities to create and strengthen links with CCGs’ as their role evolves and increase
• Support the Government’s Mandate to NHS England 2020 goals for the NHS to be the world’s largest learning organisation via the provision of resources to enable staff to deliver the required recommendations
• Support/ provide evidence requests for information on service reconfiguration/collaboration, operational topics / efficiency savings

Date last updated: November 2016

Due for review:  November 2017

Group member responsible: LK

10 big questions for STPs. One big question for LKS

Source:  Knowledge for Healthcare blog post by Imrana Ghumra and Sue Lacey Bryant

Link to main document:  

Publication format:  Blog post (Knowledge for Healthcare)

Date of publication: 12^th May 2016

Summary of driver:

This blog post discusses the Sustainability Transformation Plan (STP) as outlined in the NHS Five Year Forward View Shared Planning Guidance.

STPs will be the driver for change and transformation in healthcare between 2016-2021. Priorities and requirements have been rounded up into ’10 big questions’.

Links to relevant information such as the 44 STP footprints, a more detailed briefing of the ’10 big questions’ and an introductory presentation and action planning grid are embedded in the blog post.

The post rounds up with one BIG question for LKS- how can we help?

Key features of driver:

Local Workforce Action Boards (LWABs) have been set up and  are responsible for delivering 4 key pieces of work, starting with an action plan that covers the ’10 big questions for STPs’ which as listed below.

• How are you going to prevent ill health and moderate demand for healthcare?
• How are you engaging patients, communities and NHS staff?
• How will you support, invest in and improve general practice?
• How will you implement new care models that address local challenges?
• How will you achieve and maintain performance against core standards?
• How will you achieve our 2020 ambitions on key clinical priorities?
• How will you improve quality and safety?
• How will you deploy technology to accelerate change?
• How will you develop the workforce you need to deliver?
• How will you achieve and maintain financial balance?.

Primary audience:  All healthcare and NHS senior management, all NHS staff, local government, Health Education England, DoH.

Impact on library policy/practice:

• The opportunity to link in with senior management and highlight their information needs and find out what information people need to move forward with their STP.
• Ideal opportunity to promote time saving resources such as current awareness and LKS evidence searches.
• Possibility of collaborative purchasing opportunities with other LKS both within and outside relevant STP footprint for resources purchasing to deliver financial savings and fitting in with Knowledge for Healthcare.
• Once STP is finalised continue to maintain and feed new relationships with senior management and LKS colleagues.
• Opportunities to showcase how LKS can support  innovation and change, such as  knowledge management skills and running simple KM events to encourage knowledge sharing, e.g randomised coffee trials and knowledge cafes
• LKS can be an information hub on STPs for patients/carers on site, as well as connecting with public library colleagues.
• Possible provision of LKS for the Local Workforce Action Boards.

Date last updated: May 2016

Due for review: May 2017

Group member responsible: LK