Jim Mackey, chief executive of NHS Improvement, explains that successful Sustainability and Transformation Plans (STPs) will target long-standing “tricky” issues, show collaboration and be realistic.
In April, Mackey will be assessing clinical commissioning groups' (CCGs) STPs alongside Simon Stevens, chief executive of NHS England, in order to decide how the transformation fund will be allocated over the next two years.
Speaking at the King’s Fund in London, he said: “I think we’re very good at creating new forms of complexity, new processes, systems/hurdles to jump through. Focus on the small number of very obvious things. This is really about simplification. It’s about the things you’ve all been living with for probably quite a long time, and prioritising them.
“If all this is a load of really complex plans with heavy modeling we’ve actually all just missed the point,” he added, stating “there is a very big risk that we will avoid the issues because we’re very good at it. So please don’t let that happen”.
He also urged that health leaders “really don’t try to stitch each other up,” revealing that he’s seen places where the leadership has been decided without the main provider being involved, which he branded “absolutely bloody ridiculous”.
In terms of working out the 44 STP footprints Mackey said that in some areas there were “some really obvious nice natural communities that have existed forever” but in one or two areas people still don’t feel comfortable, and a few very big, strategically important providers are serving multiple STPs, which also needs to be worked out.
“I think this is really all about relationships and getting the conditions right at the beginning… recognising that might mean your institution can’t win everything” and that "you’re not doing the job if you’re not finding things to disagree about,” he said.
On selecting leaders, he said to make sure you have a leader who will not avoid the difficult, obvious issues “because we can smell that 100 miles away”, and avoid picking people “who are clearly not up for the challenge”.
On Friday, Simon Stevens, chief executive of NHS England and Mackey will look at the list of leaders – which are about half NHS/local authority providers and half commissioners – and “decide which of them we don’t think can do it”.
Mackey’s key tips:
· Do not go and create new problems, when actually you need to solve something else
· Don’t suggest a new payment mechanism, such as getting rid of performance development reveiw (PDR), or changing the GP contract. This isn’t about fixing those things.
· Accountable care organisations (ACOs) may be an obvious solution in some places, but Mackey is not expecting ACOs to be everywhere
· Pick four or five critical things and make sure you have a chance of fixing them in the time frame
· The STP should not disrupt or get rid of other collaborative arrangements that are already in place
· Think things through in terms of the needs of your population, and any risks
· If a problem is a lack of energy, think about how you will generate energy and support around the STP changes
· Email Simon Stevens or Mackey if you are struggling to talk about the “tricky issues”
· Similarly contact Stevens or Mackay if NHS England or NHS Improvement are “getting in the way” of creating plans