Reorganising the NHS: Another Initiative Destined to Fail?

Posted on December 13th, 2017 by Leanne-Marie McCarthy-Cotter

Crick Centre Research Associate Leanne-Marie McCarthy-Cotter conducted research at the Hospital Consultants and Specialists Association to examine the potential of Sustainability and Transformation Partnerships as a new way to provide healthcare services in the UK. Here she reports on the key findings of the project and their wider significance for future healthcare policy.

At a time when the National Health Service (NHS) is facing one of the most challenging periods in its history, where demand is growing, waiting times are rising, pressures on services is increasing, and strain on hospital doctors and other front-line health staff is soaring, it is acknowledged by many that something needs to be done to change how the NHS works.

Sustainability and Transformation Partnerships (STPs) represent a significant change in the way that the NHS in England will plan and run its services. They are perceived by many to be the creation of systems and structures that could provide a more coherent and holistic approach to health and social care, with decisions taken to reflect the specific challenges faced by individual local areas.

However, the process surrounding the formation of STPs seems to be a lesson in poor policy making. Whilst there are several issues that my research has highlighted (which are outlined in full within ‘STPs: Destine to Fail or the Rod to Better Care?’) one that is of particular note is that there has been insufficient consultation and engagement with clinicians. Below we will look at this problem, and link it to what we found when we survey hospital doctors to gauge their experience and views of STPs.


What are STPs?

Sustainability and Transformation Plans (STPs), announced in NHS planning guidance published in December 2015, are five-year plans specifying how local areas will work together to implement the Five Year Forward View and achieve financial stability by 2021.

STPs represent a significant change in the way that the NHS in England will plan and run its services. England has been divided into 44 geographical “footprints” made up of NHS providers, Clinical Commissioning Groups (CCGs), Local Authorities, and other health and care services. These organisations are expected to collaborate to create “place-based plans” that respond to the challenges in each geographical footprint. The average population size of a footprint is 1.2 million people.

The plans are required to cover all aspects of NHS spending and achieve financial balance for the NHS. They are expected to set out how the local area would implement national priorities, such as: improving cancer care; introduce seven-day services; improving quality and developing new models of care; improving health and well-being; and improving efficiency of services.


There Has Been a Lack of Consultation and Engagement

Given the radical nature of the changes that STPs are being tasked with achieving, it would appear clear that this successful integration of health and social care provision depends on full engagement and effective collaboration between healthcare planners, clinicians, professional organisations and local communities. However, the level of consultation and engagement with hospital clinicians regarding STPs (and their successor Accountable Care Systems) has been extremely poor.

We found:

  • Hospital doctors feel that they do not have enough information regarding STPs
  • Hospital doctors are unhappy with the lack of engagement and consultation
  • Hospital doctors have not been involved with the STP process
  • 85 per cent do not know their STP lead
  • 86 per cent do not know how to engage with their local STP
  • 93 per cent were not involved in producing their local STP
  • 95 per cent feel they have not been consulted nor had sufficient involvement in the process
  • 96 per cent feel that STPs are not being created in a transparent and open manner.

As a result of poor engagement, many clinicians have not been properly informed why these plans are being introduced, the perceived problem(s) that they are setting out to solve, what they may involve, or how their views and expertise can be threaded into the process. Lessons from all previous large-scale transformations show that clinicians’ support or opposition is a vital factor in the success or failure of change programmes in the NHS.


What do Hospital Doctors Think?

We found:

  • The majority of Hospital Doctors that we surveyed feared that STPs would have a negative impact.
  • 62 per cent believe that STPs will have a “negative impact” on the delivery of care to patients. Only 11 per cent believe there will be a “positive impact.”
  • 56 per cent expect STPs to result in job cuts and further understaffing.
  • 77 per cent believe that STPs are a measure to introduce cuts to the NHS.
  • The foremost negative impacts expected were around funding implications, increased workload and understaffing, increased bureaucracy, and service reconfiguration failure.
  • Clinicians are undecided whether they support STPs. 51 per cent stating “not sure,” 2 per cent expressing “strong support,” 10 per cent expressing “support,” 19 per cent responding “do not support,” and 18 per cent “strongly do not support.”

Destined to Fail?

In theory STPs offer tremendous potential for organisations across the health and social care systems to work together to develop health policies suited to local needs. STPs present an opportunity to introduce major improvements to the quality and effectiveness of NHS services. However, without an integrated process of consultation and engagement with NHS staff and the public, they are likely to miss their key objectives. The current method of development is undermining a sound principle, and eliminating any chance of success. As with any policy it is not possible to predict everything and guarantee success, however we are at a cross roads with STPs, where it is very clear that if adjustments are not made a sound idea may be destined to fail.


Author Bio


Leanne is Head of Policy for HCSA, and Research Associate at Crick Centre. You can email her at

About this research: Findings are based on a survey of 454 Hospital Consultants and Specialists Association Members. The full report, along with a set of policy recommendations, can be found at:

This article gives the views of the author, and not the position of the Crick Centre or the Understanding Politics blog series. 

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