Tag Archives: Denise McLellan

Sustainability and Transformation Plans in the English NHS

Sustainability and Transformation Plans (STPs) are the latest in a long line of approaches to strategic health care planning over a large population footprint. These latest iterations were based on a one million plus population, looked at a five year timescale, were led by local partners (often acute trusts, but sometimes, as in Birmingham and Solihull, by the Local Authority), and focused inevitably on financial pressures. The plans were published in December 2016 and now the challenge to the STP communities is further refinement of the plans and, of course, implementation.

The Health Service Journal (HSJ) reviewed the content of the STPs in November 2016 and highlighted three common and unsurprising areas of focus: further development of community based approaches to care (notably aligned to the New Models of Care discussed in the CLAHRC WM News Blog of 27 January; see also https://www.england.nhs.uk/ourwork/new-care-models/); reconfiguration of secondary and tertiary services; and sharing of back office and clinical support functions. More interestingly, the HSJ noted an absence of focus on social care, patient/ clinical/ wider stakeholder engagement and on prevention and wellbeing.

The King’s Fund has produced two reviews of how STPS have developed in November 2016 and February 2017. These have been based on interviews with the same sub set of leaders , as well as other analyses. Both have reached similar conclusions. Recommendations have included the need to: increase involvement of wider stakeholders; strengthen governance and accountability arrangements and leadership ( including full time teams ) to support implementation; support longer term transformation with money, e.g. new models of care, not just short term financial sustainability; stress-test assumptions and timescales to ensure they are credible and deliverable, then communicate with local populations about their implementation honestly; and finally, align national support behind their delivery, e.g. support, regulation, performance management and procurement guidance.

A specific recommendation relates to the need to ensure robust community alternatives are in place before hospital bed numbers are reduced. The service has received strong guidance about this latter point from NHS England in the last few weeks. Various other Thinktanks have also produced more or less hopeful commentaries on STPs, such as Reform, The Centre for Health and Public Interest and the IPPR; they all say they cannot be ignored.

Already, in March 2017, the context is shifting: yet again, ‘winter pressures’ have been high profile and require a NHS response; the scale of the social care crisis has become even more prominent; there is a national push to accelerate and support change in primary care provision.

Furthermore, the role of CCG is changing in response: some are merging to create bigger population bases which may or may not be the same as STP geography; some GP leaders are moving into the new primary care provider organisations; the majority of CCGs will be ‘doing their own’ primary care commissioning for the first time just as the pace of primary care change is increasing; some commissioning functions may shift to new care models such as accountable care arrangements. It is clear that for some geographies and services the STP approach could work, but more local and more national responses to specific services and in specific places will continue to be needed. All these issues will influence how the STPs play out in the local context.

— Denise McLellan

The Evolving Role of the CLAHRC in the Use of Evidence to Improve Care and Outcomes in Service Settings

If we are to use public funds to support research, there is an assumption that the outcome of that research will be improvements to the service. This exchange, however is problematic. CLAHRCs are set up to address this interface in a particular way, namely to evaluate service interventions. As well as generating new knowledge for the system, there is a wider aspiration of building a system-wide ‘habit’ of using evidence to drive service change and evaluating the output.

As part of the consideration of how CLAHRC West Midlands evolves, we would like to hear readers’ views as to how well it has done and what it should do in the future.

The use of evidence to improve practice in service settings has demand and supply side factors. The service has to want to use evidence, be supported to use evidence, and have the capacity to make changes in response. On the research ‘supply’ side, there has to be a suitable body of existing evidence, researchers have to have the skills and capacity to develop suitable research methods and to convey the outcomes in a usable form.

Even if all these factors co-exist, barriers, such as changed external environments, resistance to change, and timing issues, can thwart the exchange.

CLAHRC WM has tried to address this in a number of ways. It has created new roles:

  • Embedded posts: academic researchers jointly funded by service and research institutions, working on agreed projects within a service setting
  • Diffusion fellows: experienced practitioners supported to undertake research in a service area.

Patients and the public are central to driving the direction of research: their involvement at all stages of the research cycle means that topics are relevant to them and meet their needs. In addition, CLAHRC WM has employed a range of dissemination methods, both traditional and innovative, to share research findings. These include publishing summaries of evaluations completed, running workshops and, indeed, regular publication of this articles in this blog.

Service evaluation is not the only form of research being undertaken within service institutions, nor is CLAHRC WM the only source of evaluation support. With the current focus on integration, there is a question as to how CLAHRC WM could be better integrated within the service’s own research and development strategies. However, one has to be mindful that the budget for CLAHRC WM is tiny compared to the billions of health care spent in the West Midlands each year and therefore it has to take care to target its resources.

In future blogs we will look more closely at some of these issues, with interviews with those occupying embedded/ diffusion roles. Meanwhile, we would welcome your views and thoughts as to how CLAHRC WM should evolve in this regard, so please comment or get in touch; it would be much appreciated.

— Denise McLellan