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Birmingham praised for exposing savings, not reform-based, STP pressures

Birmingham praised for exposing savings, not reform-based, STP pressures

🕔25.Oct 2016

Birmingham city council’s defiant decision to publish its draft Sustainability and Transformation Plan (STP) before being checked by national NHS officials is being seen as an important moment in the relationship between councils and government, particularly in respect of closer working between health and social care systems.

Kevin Johnson looks at what the experts are saying, including exclusive analysis from Darren Wright

Peter Hay painted a bleak picture of the future for services in the city in an interview with the Local Government Chronicle (LGC) last week. Birmingham city council’s strategic director for people pulled no punches when explaining why the council had increased its projected overspend to £35m in order to invest in a “public pound solution” to the problem.

He said the sustainability and transformation plan (STP) in the city would fail to deliver the health and care system reform so urgently required as it had focused almost entirely on achieving NHS savings.

Mr Hay predicted that the system would soon collapse unless the government intervenes and brings forward better care funding planned for the last two years of this parliament.

Report: Council discharges early and publishes major health plan.

The LGC suggests that Birmingham’s decision to publish its STP plan yesterday, despite a request by NHS England for proposals to be withheld until they had been checked by national officials, appears to be an act of defiance, borne out of frustration that the process had become dominated by NHS priorities and had shifted too far away from its original intention of finding a genuinely integrated, long-term approach to ease relentless pressures on both health and social care services.


Darren Wright, Director of Inside Outcomes, analyses the draft STP exclusively for the Chamberlain Files.

With the release of the Birmingham and Solihull Sustainability and Transformation Plan (STP) we are beginning to see some substance around the plans to develop health and social care services over the next five years. Birmingham and Solihull should be applauded for making these draft plans publicly available against NHS England’s advice.

There are several things that we can see in the plans that have potential to have a significant impact on how we relate to the NHS and Birmingham and Solihull Councils.

The most glaring issue is ‘Birmingham’ does not mean Birmingham. It might come as a surprise to many outside of the insular world of the NHS but the creation of Clinical Commissioning Groups (CCGs) caused a peculiar geographical anomaly for Birmingham.

In the creation of the Sandwell and West Birmingham CCG we have the odd situation that areas such as Ladywood, Handsworth and Perry Barr are not included in the Birmingham and Solihull plans. I doubt many residents of the Jewellery Quarter naturally align their view of Health and Social Care services with those of West Bromwich residents; in NHS planning terms, they are very much residents of the Black Country.

In a sense this might not make a great deal of difference to Birmingham residents but it highlights one of the key difficulties of making this plan a reality. A significant element of the plan focuses on the need to work better to prevent ill health.

Since the most recent changes to the NHS the responsibility for provision of Public Health sits within local Councils. Developing Public Health services will pose a significant challenge to Birmingham City Council if they need to match plans in Solihull on one side of Hagley Road and then match Sandwell on the other.

This artificial border runs right through some of the communities that have the poorest health outcomes in the city. It is difficult to see how maintaining this situation benefits anyone that lives in the west of Birmingham.

The detail of the plan treads the well-worn path of needing to reduce the number of NHS organisations, provide more care in the community or at home and to manage demand for hospital care. Many of these things have been the key themes of previous strategic plans that were adopted with much fanfare in years gone by. Which demonstrates that as a City we’ve recognised the persistent problems for decades but had little traction in addressing them.

The biggest challenge to the Birmingham and Solihull system will be how it turns somewhat disparate plans into actual change. The real opportunity is in trying to make the connection between Council-led social care and the NHS as seamless as possible.

The STP, as it stands, reads as a very loose collection of current initiatives and embryonic projects. The projects, as they are set out, sit very much in their traditional silos.

Each Council takes on social care, hospitals manage their bit and the Clinical Commissioning Groups tinker with Primary Care. The binding theme seems to be optimistic cash savings rather than a narrative for a better functioning system.

This highlights one of the key flaws in the STP process. Does Birmingham and Solihull have a Sustainability and Transformation Plan because it was told to have one or did it recognise the benefits of doing things differently?

Are the components of the plan there because they are the best practice or are they there because there was a request for things to go in an STP?

I imagine the answer is a little bit of both. Some of the initiatives in this plan would not be there if we had the opportunity to start with a blank page. The financial reality of trying to provide crucial services means that we will never have the luxury of starting with a blank page.

There will be points of contention in making this plan work. There will be resistance from GPs as the process of rationalising real estate becomes a reality. Altering the model of pharmacy with less money will no doubt be slower than anyone anticipates. The significant changes to the way the largest hospitals operate will require a carefully crafted message.

Making this a reality becomes more difficult through having two different plans that run through the City. We have yet to see the Black Country STP but there is a real possibility that we reinforce that such things as post code lotteries exist within our City.

The need to get us, the awkward patients, the use services “more appropriately” and take control over our own health requires us to be taken on this journey. Letting us see the draft plans is a good start but we will only buy into this properly if we can see whether the point we are aiming for is more than a balanced budget.

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