狠狠撸

for more information visit us at -
www.hempsons.co.uk
Governing for transformation:
STPs and governance
Professor Paul Stanton
paul.stanton@southminster-ca.co.uk

Necessity is the mother of
transformation
? System already creaking: coincident austerity:demand pressures
? Historic failure to invest in prevention > growth in lifestyle associated illness
? The compounding impact of deprivation on physical and mental health
? Short termism of former NHS leadership > inadequate preparation for
profound, inexorable & accelerative demography led demand escalation
? Failure to invest wisely in mutually supportive health and social care provision
> ‘structural iatrogenesis’ (Stanton, Strategic Leadership, 2006)
? “England has an inappropriate model of health and social care to cope with
the changed pattern of ill health from an ageing population” Ready for Ageing 2014
? “People are living longer … strong association between increasing incidence &
increasing age for most diseases (cancer, heart disease, dementia etc), population
change will be the biggest driver of H&SC need over the next decades” NESHA,2008

21st Century demography led
demand escalation
? Impact on age profile of inpatient population – complex co-morbidities - not
acutely ill but with no viable discharge options
? Back loaded escalation – 1930s to ‘twilight of the post war baby boomers’
? Increase 75+ by 2032 = 57%: 2039 85%: 85+by = 2032 82%: 2039 127%
? Increase 90+ by 2032 90%: by 2039198% - more people 90+than now 85+
? Extreme local variation: 85+ by 2032: Lichfield 139%: Barking 23%
? Local population need, not central diktat > ‘fit for the future provision’
? Minimise avoidable admissions – proactive frailty management
? Optimise Ambulance contribution: & assertive outreach to care homes
? Reversing EOL in hospital deaths - “should this trend continue, fewer
than 1 in 10 people will die at home by 2030” Health Select Committee 2014

The Five Year Forward View
? “England is too diverse for one size fits all … Doing more of the same is
not an option … local choice between radical alternatives”
? “Action is needed on three fronts: Managing Demand; Delivering Care
more efficiently; Securing additional funding.
? Less impact on any one of them will require compensating action on the
other two” FYFV 2014
? “It would not be prudent to assume any additional NHS funding over the
next several years” Stephens, July 16
? Rising demand, escalating deficits, lack of ‘system wide urgency and
focus’ > STP process
? Laudable intention – profound centrally driven process shortcomings
? Support the intention – refine and strengthen the process

Sustainability and Transformation
- from planning to implementation
? “The impact of ‘place’ is complex and multidimensional … How overall
policies are translated at area & community level requires local knowledge,
history & experience that no high-level analysis can provide”. (KF 2015)
? Many STPs by passed provider Boards (and ? ‘Governing Bodies’ ?)
? Clear sighted principle based Board appraisal of STP process adequacy
and outcome relevance - an essential aspect of local ‘governance’
? “Ownership one level down – not management one level up” Carver -
Expression of your statutory ‘duty of care’ to your local population
? The calibre and independence of local STP leadership?
? Robustness of modelling and evidence base that underpinned conclusions?
? Cost saving/postponement or need led/transformative – capital costs

? Statutory public and patient involvement – ‘a problem postponed …”
? Retro fitting due process ‘The Judge Over Your Shoulder’ - ‘Real
Involvement’ – in collaboration with H&SC partners
? Promote inclusion of all NHS and wider provider and commissioning
stakeholders – the law of unintended consequence
? Local government/ H&WB Boards involvement patchy
? Primary care: Ambulance Services; mental health and learning
disabilities
? Voluntary sector – Leeds 150+ focused on frail elderly + BME sensitive
+ carer sensitive
? Fostering ‘real involvement’ of front line staff and strong clinical voices -
harnessing the creativity and the energy of those who deliver care

? Predicated on ‘fit for transformational purpose’ central regulation
? Mixed picture: Default direction – support and guidance, forgiveness
? Radical rhetoric … “We are entirely open to the prospect that you choose to
abandon [payment by results] as the currency for deciding where funds should
go…. We’re not buying emergency clicks of the turnstile anymore, this is the way
we’re going to allocate funding on a programme basis across our population with
the agreement of all the organisations involved’, that’s absolutely fine with Jim and
me” Stevens, Oct 2016
? …jumping through the same old hoops
? “We want to back leadership momentum where we find it. For the
foreseeable future – by which I mean probably the rest of this parliament –
this supplements rather than replaces the pre-existing statutory
accountabilities.” Stevens, October 2016

The priorities for provider Boards
? Pragmatism – STP key in a funding lock
? Political adroitness – understand concerns of the blockers and the allies
? Measured altruism –
? “My organisation, right or wrong, is not what’s required from a new generation of leaders”’
Stevens, February 2015 – building ‘informed trust’
? “Salus populi suprema lex esto” [Let the good of the people be the highest law] Cicero
? “The startup of a new form of governance needs careful consideration and will take time”
Dalton, August 2016 - building ‘informed trust’
? Maintain unflinching grip on intra-organisational safety, quality & cost effectiveness
? Address Type A* problems and push forward with aligned improvement
? Type A = A problem whose resolution lies in the hands of the organisation itself: Type B = A problem
whose resolution lies in the hands of those who may be subject to influence; Type C = An insoluble
problem i.e. an unpalatable but inescapable fact of life.
Prioritise Type A; keep energy spent on Type B under review and if others prove
beyond influence, re-categorise problem as Type C. Don’t waste time on Type C!

The priorities for provider Boards
? “The application of collective wisdom to complex uncertainty” Stanton 2008
? A ‘risk sensitive’ Board culture – neither ‘risk reckless’ nor ‘risk averse’
? “In times of major turbulence in external environments, a Board’s collective risk
oversight must be strengthened. Different & potentially much more difficult
issues arise in the identification and measurement of risks. Past experience is
an uncertain or potentially misleading guide” Walker, 2009
? Competence, creativity, courage, currency and CLARITY
? “Excellence, is never an accident.
? It is the result of high intention, sincere effort, and intelligent execution;
? it represents the wise choice between many alternatives …
? choice, not chance, determines your destiny” Aristotle
paul.stanton@southminster-ca.co.uk

狠狠撸

PAS 狠狠撸s Governance for transformation

Recommended

More Related Content

What's hot (20)

Similar to PAS 狠狠撸s Governance for transformation (20)

PAS 狠狠撸s Governance for transformation