This post is from The King's Fund Blog
As we highlighted in our recent report, the 44 sustainability and transformation plans (STPs) submitted by areas across England are ambitious visions that now need to evolve into credible plans that address the financial and operational challenges facing the NHS and its partners.
While the detail of each proposal varies – because each plan is designed to meet local needs – they all have something in common. Together, they represent a major transformational change in the delivery of health and social care in England.
The success of STPs will depend on high levels of collaboration across and between organisations that historically have little experience of working together to deliver change at the scale and pace that now seems essential. And with STPs bringing together as many as 32 organisations in an area, this is a real challenge.
In normal circumstances, change of this magnitude is more likely to succeed on an evolutionary basis where trust and experience can be built and used to shape future arrangements. But time is not on their side.
The plans were pulled together in a short period of time and will inevitably evolve over the next five years. Currently many plans don’t take account of issues such as the complexity of implementation, the views of patients and communities or the reality of future funding pressures. In addition, what’s emerging from our Organisational Development work with various STPs is a clear sense that many clinicians feel marginalised from the development of the plans. There is a real danger that without genuine and meaningful engagement with the clinical community and local authorities, these plans will go nowhere.
Making the move from ‘plans’ to successful implementation will require dedication, resources and above all else ‘extraordinary’ leadership, not just from individuals, but from the collective leadership within each STP. This is against a backdrop of a system that in recent years has not had the luxury of addressing the future but is working at the limit of its capacity to just about cope with increasing demand.
Extraordinary leadership is a quality that goes far beyond operational efficiency and financial management. It is in scarce supply. Extraordinary leadership can see beyond the day-to-day issues that drag the system away from the transformational change required and can keep the players in the system focused on the future.
When things seem uncertain, chaotic and complex, extraordinary leadership can work across boundaries, build relationships, deal with conflict and gain consensus to act. Extraordinary leaders have the creativity to work through situations ‘the plan’ did not foresee, are politically astute and emotionally intelligent. They understand how to work collectively and compassionately to create new and emergent solutions that keep the vision alive.
At the Fund, we are supporting STP leaders and others developing place-based care to immerse themselves in developing strong, flexible and collaborative relationships that can work with the turbulence that STPs will inevitably face. The speed with which STPs were created has meant that wider involvement has been limited so far. Our experience supporting collaboration with patients, communities and the third sector could help STP leadership teams to engage with all stakeholders to shape the implementation agenda.
As NHS England works with others to appoint STP leaders, they must consider whether candidates demonstrate the extraordinary leadership required for the task. This leadership must still be collective and not simply the responsibility of heroic individuals. Collective leadership can help to ensure that implementation is resilient and flexible, based on secure ‘anchor points’ that can sustain the plan as they hit inevitable issues. These ‘anchor points’ include an essential shared vision, commitment and political support both nationally and locally.
STP leadership will need to recognise that changes will evoke strong emotional reactions from staff and local communities, and will need to resist the temptation to see this as a problem but rather embrace it as an opportunity. STPs must establish an agreed way of doing things ’round here’ and stick to it. The coalition within each STP will quickly unravel if this agreement is not strong and robust.
Focusing on transformation within STPs will reap benefits in the future. But the cultural shift cannot be underestimated. Resources must be made available to support the extraordinary leadership that’s needed.