STPs – the challenge of history and baggage

baggageWhen I first joined a PCT from the rather closeted and specialist realms of communicable disease health protection, I was a bright-eyed enthusiast for the potential of a new organisation and configuration. I lapped up the promise and the vision repeated in every Department of Health policy paper and re-hashed by every healthcare think tank and commentator. I was relatively young in a career and my short experience of NHS management included very little involvement with the preceding history.

I quickly found myself amidst a group of rather more cynical NHS ‘lifers’ who had grown up in the service. They could remember the old days and weren’t always so taken with the potential I thought I could see. Of course by the time it was clear that the Health and Social Care Act of 2012 really wasn’t going to get shot down (as I’d naively hoped, despite more experienced heads assuring me it was here to stay), I was also beginning to look more like an old cynic than the next generation of CCG enthusiast recruitments popping up around the building.

This year, another generation is upon us. Sustainability and Transformation Plan footprints (STPs) are the latest manifestation of the need to manage and drive integrated care and the delivery of the Five Year Forward View. STPs are likely to involve the same mix of enthusiasts and cynics as every other approach to system change before them. Others are far better qualified than I to comment on why they offer a better hope or what is different this time around.

But there is a crucial and continuous thread STPs need to grasp, as Vanguards, Demonstrator Sites, and all the other ideas before them also needed to grasp: full and effective partnership between social care and health

This is where the involvement of those with history can become double-edged.

In areas where there are long established relationships that have been effective, the STPs are likely to benefit from a head start. There is already a measure of trust between leaders, cultural misalignment is not so keenly felt and networks are already primed to get to work on new challenges.

However, for STPs where there is history of less effective relationship (or no relationship at all), the challenges are obviously greater. There is some inbuilt cynicism in the system that has either stopped trying or stopped believing that progress can be made or there is unspoken assumption that one voice or other will get lost in the mix.

In response, systems need to be explicit about their history in a way that is heard by all parties and helps construct a new foundation and a hope for change. Being honest about the reality of existing relationships can be more helpful than pretending there is no history and that it will somehow be different this time. Our experience suggests that having a common language of relational dynamics helps this honesty – the discussions start to happen in the room rather than being whispered outside it. Deeper understanding of the relationships also allows partners to think about effective influence beyond formal structures and meetings.

Without the time, space and tools to do this, there is real danger that STPs fail to live up to any hoped-for potential. Effective relationship is urgently needed and for many systems, so is help. Relational Proximity® is proving to be a reliable catalyst for change.