Sticky Toffee Pudding

and Secret Plans


As 44 local Sustainability and Transformation Plans (STPs – previously our favourite acronym for Sticky Toffee Pudding) move rapidly through authorisation and emerge into the glare of publicity, looking across the programmes several things strike you.

The first is the need to secure savings and improvements in outcomes on such a scale that services must change in a major way.  At the same time, people must be brought along and confidence maintained.  This is a tricky balance – guarding against complacency while avoiding panic.

The second is culture.  Specifically, staff, and especially clinical staff.  To deliver your STP inevitably means their jobs will change, and this needs to be framed as an opportunity.  It also means being honest about the scale of the challenge and inviting staff to be part of a solution which is greater than their own organisation. 

Many will have experienced a dominant culture in which there is a clear line from board to ward and tight control between each level.  Now STPs, with multiple providers across the footprint, must raise the horizon for staff - above and beyond their own employer and “how we’ve always done things”.  This is the central challenge.

For STP leaders, the communications challenge is as great as the technical or the analytical challenge.  So what would we advise?

Through previous iterations of change, an approach based on firm, authoritative leadership and obsessive control of message have served senior managers well.  Being in “transmit” mode works.  There is a strong body of evidence from across the public sector about keeping people informed as a driver for institutional approval.  That case is made.

The third thing which strikes you is about trust (of patients and staff).  There is a counter-current in public perceptions.  Alongside a focus on managing message - call it “spin” “framing” or whatever - there has been a 20-year reduction in trust and confidence in institutions of all kinds.  Particularly public bodies.

It would be naïve to think the NHS is not part of this.  And, while intentions have been good, the public perception of STPs as secret plans all about cuts means there is work to do.

So what are the priority actions?

The first and most important is to find mechanisms to genuinely listen to ideas and feedback, and demonstrate how concerns have been heard and workable solutions on taken board.

Co-design is not just about creating better solutions.  It is also a better way of bringing people along.

For STPs it is especially important because of the need for staff to work across organisational boundaries, and work differently – e.g. acute consultants working in community setting, general practice as care navigators, more multi-disciplinary working.  All the hard stuff which is under the bonnet of all STPs.

Finally, you need to reassure the public: there may be changes but there are no secret plans.