STPs and ICSs – what’s next and do they matter?



By Alex Kafetz

Do STPs matter and if so how can I engage with them?  This was the topic of the latest in ZPB’s breakfast series, where we bring together many organisations from the world of health tech, pharma and clinical services to discuss and debate questions that matter to them.

I’ve written before on the ZPB website about some of the myths around the moves in this country towards more integrated care.  At ZPB we see accountable care organisations as a theory of change where an area that has segmented their population, designed outcomes for these based around the triple aim (health, care, cost) and agreed on some kind of finance pooling to achieve these outcomes. And the leaders in this area organise care – in the broadest form – social care, mental health, social support, health prevention – in a patient-centred way rather than around the bricks and mortar of hospitals. The finance pooling is key to this, so money is spent on the triple aim not maximising income for one part of this system, which is often the hospitals.

And sustainability and transformation partnerships (STPs) are the NHS’s national programme to be able to do this, with the 14 integrated care systems (ICSs) simply areas of the country that are doing this a bit quicker  and with some funding from NHS England, and have more control over their finances than other regions of the country.

So having agreed on this, breakfast participants discussed the following in the context of their business strategy:

  1. It’s a common assertion that the 2012 act fragmented the system and the Five Year Forward view is about putting it all back together.  However counter-intuitively, for most people around our breakfast table, who want to do business or form partnerships with the NHS, the changes are actually making things more fragmented. After 2012, it was quite easy to size the market there were c150 NHS trusts and c200 clinical commissioning groups (of course some might sell to mental health trusts, local authorities and community providers etc.)

  2. Now, because organisations are coming together more organically, and STPs have no legal footing, much more local knowledge and insight is needed. So the market is dividing and fragmenting as the systems come together.

  3. For example, we highlighted one area where seven CCGs have coalesced into a joint commissioning alliance which follows the STP footprint and have pooled buying resources.  So a market which was seven is now one and follows the STP.

  4. Whereas a nearby STP has six CCGs, five of which commission together as a unit, but one (with a much larger population) operates alone.  So that market, which was six is now two and doesn’t follow the STP footprint.

  5. This means organisations need to spend much more time to understand each locality at a deeper level, who the buyers might be and at what scale.

  6. ZPB helps our clients to do this.

  7. There was broad consensus that STPs are here to stay and need to be taken seriously. Significantly, over the summer NHS England won two legal challenges which while in practice were actually about two specific ACO-type contracts, the market saw these as a test case for the future of new care models. We also discussed that most ‘new money’, including the provider sustainability fund and the transformation fund, is going to be discharged through the STPs – so if you subscribe as a sales strategy to follow the money, you need to be engaging with STPs.

  8. Finally, we couldn’t ignore the new 10-year plan and that we know that integration of care will be central to this, and that STPs will certainly remain central in the short-term.  As part of the plan, NHS England has been asked to recommend legislation when lots become available in April once we’ve exited European Union so this could include some kind of legal footing for integrated organisations.  The view was that even with a change of government, it was likely Labour would support the direction of travel in the short to medium term (with a possible evolution of language) and participants who had attended the recent Labour conference noted this was the mood at events they went to.

So the conclusion was that it would be a business risk to ignore STPs and continue to treat customers in primary or secondary care as islands, impervious to the changes going on around them. We look forward to bringing together interested parties to continue the deliberations.

If you would like help with understanding the changing nature of the NHS, including the role of STPs, ICSs and ACOs or to attend the next ZPB breakfast on the topic, please email me via alex.kafetz@zpb-associates.com