The Sustainability and Transformation Partnership (STP) model is struggling to adapt to the unique situation found within London, according to a new report by the King’s Fund, commissioned by the Mayor of London.
The sheer size and population density of the capital presents unique challenges with implementing an STP approach, and this is only exacerbated by significant demographic variation across the city. This is in turn compounded by the large number of teaching hospitals, which tend to be established in their processes and reluctant to conform, and highly variable engagement levels from different parts of local government across the city. The report finds STPs are spending too much of their time trying to establish how to implement the constraints of the STP model in these conditions, limiting the time for achieving concrete improvements. The report also identifies that cities like London require more emphasis on prevention and public health, and this needs to be supported by local government.
In London, many duties that are typically the responsibility of STPs are actually happening at borough level through local collaborations. That these partnerships are developing is commendable, but the bottom-up approach has resulted in little coordination at city-level, and leads to duplication of work and inconsistency. Ironically the STP model also struggles to adapt to the environment of London at big-picture level due to the sheer size of London. The city is currently served by five separate STPs, and integration across the city will require higher-order partnership to bring together the work of these bodies.
The report identifies a number of strategic-level initiatives (London Health Board, London Health and Care Strategic Partnership, etc.) which aim to integrate care across the city, but suggests that more needs to be done to integrate these and prevent duplication and interference between these groups, in an effort to fill the “strategic vacuum in London resulting from the abolition of the strategic health authority in 2013”.