Sustainability and Transformation Partnerships (STP): are children and young people being left behind?

Andrew Fellowes, Principal Health Policy OfficerAuthor Andrew Fellowes, Principal Health Policy OfficerDate 22 Aug 2017

With the summer break almost over and policy-makers and practitioners preparing to return to work, a picture of new and continuing priorities for the NHS is emerging, including continuing the Next Steps on the Five Year Forward View.

In July, the two leaders of the NHS in England, Secretary of State for Health Jeremy Hunt, and Head of NHS England Simon Stevens held a joint press conference to announce a significant boost to the Sustainability and Transformation Partnerships (STPs), demonstrating their commitment to continue structural reforms.

They jointly announced £325 million in capital funding to the fifteen best performing STP areas, signalling a clear intention to continue to drive through the transformation agenda in the absence of any new legislation. Stevens described this as “firing the starting gun on the first wave of major service upgrades and care redesign”. 

At the core of the STP programmes, and other current transformation programmes is a move towards place- and population-based health and social care systems. This means bringing together separate organisations into overarching framework responsible for delivering care to a whole population, reducing the existing barriers between commissioning and provider organisations.

Up to this point the development of STPs has been characterised by tension between the priorities of local system leadership and the requirements of national directives with the influence of local services, people and communities in shaping their development less clear.

This raises important issues about how STPs focus on structural and financial transformation through integration of services at population level will impact on efforts to improve children and young people’s health.

Within each STP, children and young people are a minority of the population, but a group with their own unique needs which require a distinct set of services organised on a separate basis to the adult health system, a set which requires different services and significant targeted investment. It is imperative that they are not marginalised or subordinated within transformation plans focused only on adult services.

For children and young people the results of this process is highlighted by an analysis of the 44 STPs by RCPCH that found only a small minority of published plans had explicitly focused on the implications for infants, children and young people.

While the broad scope of published plans means this lack of explicit focus on children and young people can be explained, a strategy to explicitly incorporate children and young people’s health must be part of the continued development of the STPs.

Not taking this approach would risk the long-term benefit of investment in children’s services being squeezed to meet the ambitious short term financial targets on STPs to save £22 billion by 2020/21.

It would jeopardise the importance of early intervention and prevention, ignore the need for investment to meet the needs of increasing numbers of children with complex needs, and undermine commitments to transform children and young people mental health services.

Ensuring STPs improve children and young people’s health requires a shared commitment from the national system leadership and local STPs themselves, and at the heart of this process must be the participation of children and young people, shaping the future of the health and social care system to take account of their needs, now and in the future.


For more information on these programmes see the NCB/CDC Health Alliance factsheet (below), which explains the plans in more detail.