Sustainability and transformation plans correctly identify problems with the current care system, but do not provide enough detail on how these changes will be implemented explains Robin Vickers, Director Public Sector and Healthcare KPMG in the UK.
When I read the 44 sustainability and transformation plans (STPs), recently produced by local care economies, a key theme emerged. All the plans outline the need to move care out of the NHS, to improve patient experience and make services sustainable. But, although it’s true, this is rarely followed by an explanation of how it could be achieved.
In my opinion this means NHS STPs are only half way there. They’ve identified at a high level the problems that need to be addressed. But, they’ve rarely built a thorough case for change, or detailed what that change needs to look like.
Often there is little understanding of the baseline expenditure across sustainability and transformation. Or indeed, what demand actually looks like; or, what it might look like in the future. Without that, I have little confidence the NHS STPs which have rightly been identified, will actually be delivered.
I believe it is crucial that local care systems align on precisely what they are going to do differently in the future and what the operating model will be to deliver this plan. Otherwise we could risk having a typical top-down approach that changes very little.
The precise solutions will naturally vary depending on local areas and local need. But I believe they will need to include scaled up primary care; locality hubs providing a range of services close to home; a single point of access to the healthcare system; and a supply chain model, with primary care at the center and smooth provision of the right care to the right patient at the right time.
It will all need to be grounded in the right incentive structure – rewards being granted for keeping people healthy rather than treating them when they’re sick – and an organisation with accountability to and for a population.
None of this will be easy. It requires change across the NHS care system. General practice will have to scale up; community and mental health will have to align with GPs to become sustainable; and hospitals need to be aware that they can’t solve every problem.
These conversations will be complicated, but support is available. At KPMG, we are developing services specifically designed to help local care leaders agree on what the future of out-patient hospital care should look like. We will help shape a shared understanding of what the problems are – backed by our expert research and by extensive data – and, equally, what the approaches should be.
We can then help develop detailed designs for those solutions. We help bring the future state to life, employing user-centred design principles to understand what the approach needs to look like for an A&E user, respiratory patient, a mum with a young child or for someone reaching the end of his of her life.
We want to help local leaders close the gap between thinking and doing. In this way, we believe we can help them deliver the health and care system we all want – one which is efficient but also meets the needs of our modern society.
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