Sustainability and Transformation Partnerships

Sustainability and Transformation Partnerships
Name	Sustainability and Transformation Partnerships
Type	Health system planning entity
Region	England
Established	2015

Sustainability and Transformation Partnerships are collaborative health planning arrangements created in England in 2015 to coordinate service redesign and resource allocation across local systems. They aimed to bring together NHS bodies, local authorities and partner organizations to plan integrated care, workforce strategies and capital investments. The partnerships linked strategic planning across hospitals, community care and commissioning, aligning with national initiatives and regional health bodies.

Background and purpose

The origination drew on discussions among leaders from NHS England, Department of Health and Social Care (UK), Royal College of Physicians, Association of Directors of Adult Social Services, Local Government Association, King's Fund, Health Foundation, and Nuffield Trust about sustainable models of care. The model referenced prior reorganizations including the Lansley reforms, the Health and Social Care Act 2012, and lessons from Five Year Forward View and Long Term Plan (NHS) policy documents. Stakeholders such as British Medical Association, Royal College of Nursing, Faculty of Public Health (UK), Care Quality Commission, Monitor (NHS) and NHS Improvement contributed to design debates. The purpose was framed against pressures seen in A&E (Accident and Emergency) services, Royal Marsden Hospital, and major trusts like Guy's and St Thomas' NHS Foundation Trust, seeking to address capacity constraints exemplified by casework at Addenbrooke's Hospital and St Thomas' Hospital.

Formation and governance

Formation involved local leaders from Clinical Commissioning Groups, NHS Trusts, Foundation Trusts, County Councils in England, Metropolitan Boroughs, Clinical Senates, and entities such as Health and Wellbeing Boards collaborating with the Care Quality Commission. Governance arrangements typically included boards with representation from chief executives like those from Cambridge University Hospitals NHS Foundation Trust, chairs drawn from organisations similar to Manchester University NHS Foundation Trust, and non-executive directors mirroring models at Great Ormond Street Hospital. Legal structures interfaced with frameworks like the Localism Act 2011 and procurement rules under EU procurement law (pre-Brexit referenced by European Union (Withdrawal) Act 2018 contexts). Oversight engaged senior officials from NHS England regional teams, finance leads akin to those at NHS England Finance Directorate, and strategic partners including Public Health England and Skills for Health.

Scope of services and transformation objectives

Partnership plans encompassed acute care reconfiguration exemplified by services at Royal Blackburn Teaching Hospital, community services referencing NHS Community Trusts, mental health integration involving Mind (charity), and primary care coordination with Royal College of General Practitioners. Objectives included reducing elective backlogs observed at Frimley Health NHS Foundation Trust, shifting care from hospital to home similar to initiatives at Liverpool University Hospitals NHS Foundation Trust, and integrating social care pathways akin to models piloted by Islington Council with Whittington Health NHS Trust. Workforce initiatives paralleled workforce strategies used by Health Education England and training programmes linked to NHS Graduate Management Training Scheme. Transformation targeted metrics like emergency admission reductions seen in pilots at Northumbria Healthcare NHS Foundation Trust and readmission improvements modelled on work by Guy's and St Thomas'.

Funding and performance metrics

Funding drew on NHS allocations via NHS England, pooled budgets with contributions from local authorities in England, transformation funding akin to Sustainability and Transformation Fund (NHS) mechanisms, and capital bids in competition with projects such as New hospital (UK) schemes. Performance metrics used historic measures from NHS Outcomes Framework, activity indicators from Hospital Episode Statistics, and financial controls resembling those enforced by NHS Improvement. Targets included reductions in Diagnosis-related group-style costs, elective waiting time improvements comparable to targets at Royal Free London NHS Foundation Trust, and patient experience measures aligned with surveys administered by Care Quality Commission and Healthwatch England. Evaluation employed methodologies from National Institute for Health and Care Excellence modelling and impact frameworks used by King's Fund.

Criticisms and challenges

Critiques came from organisations like the British Medical Association, Royal College of Psychiatrists, UNISON, and Royal College of Nursing alleging governance opacity and accountability gaps similar to controversies around Sustainability and Transformation Fund (NHS). Challenges included fragmentation risks noted in analyses by Nuffield Trust and Health Foundation, workforce shortages flagged by Health Education England, and legal procurement complexities referencing cases before High Court of Justice and debates in House of Commons Health Select Committee inquiries. Local authorities such as Birmingham City Council and Manchester City Council voiced concerns about social care funding impacts similar to disputes seen around Adult Social Care charging reform discussions. Implementation difficulties mirrored past reorganisations like those after the Health and Social Care Act 2012 and political scrutiny from figures including MPs on the Public Accounts Committee.

Notable partnerships and case studies

Notable local examples included footprints resembling projects at Cambridgeshire and Peterborough Combined Authority with Cambridge University Hospitals NHS Foundation Trust, programmes akin to North West London Collaboration of CCGs involving Chelsea and Westminster Hospital NHS Foundation Trust and Imperial College Healthcare NHS Trust, and regional plans parallel to initiatives in Greater Manchester Combined Authority with participation from Manchester University NHS Foundation Trust and Salford Royal NHS Foundation Trust. Case studies highlighted work comparable to Royal Wolverhampton NHS Trust reconfiguration, integrated care pilots similar to Torbay Care Trust models, and mental health integration reflecting efforts by Tees, Esk and Wear Valleys NHS Foundation Trust. International comparison referenced models like Accountable Care Organizations in the United States, and integrated care systems in Scandinavia such as collaborations in Region Skåne.

Category:Health care in England