February 24, 2016, by Public Social Policy

Changing NHS Planning `footprints’ – the re-emergence of the Strategic Health Authority…?

by Professor Ian Shaw

Since the implementation of the NHS and Social Care Act 2012, the size of the planning area or `footprint’ have largely been decided by the Clinical Commissioning Groups (CCGs). This was part of Lansley’s plan to devolve commissioning to groups of GPs. In reality the planning footprints for CCGs have generally been around the local  District General hospital (DGH), with one of the CCGs acting as `lead commissioner’ for the rest. However, as the challenges of balancing budgets gets harder within the context of fixed and dwindling resources and cost improvement requirements this planning footprint was seen as unsustainable.


A requirement for new `Sustainability and Transformational Planning Footprints’ (STP) have been imposed by NHS England. Local Health and social care services have been required to identify the best footprint for them to `scale up’ planning in order to become more sustainable. The credibility of the STP footprint and the footprint plan that emerges will be crucial in accessing new transformation funds coming from the Department of Health. Monitor has also been `chipping in’ with a discussion document `Considerations for determining local health and care economies’ . The picture for Derbyshire for example looks like becoming a single footprint across Derbyshire and Derby City.


I wrote in November last year that the 2012 health reforms were themselves being reformed . This development supports and reinforces that view.  The need to go back to bigger planning structures to remain sustainable also means that the CCGs are becoming less relevant and that their clinical freedoms curtailed. The changing footprint will need a degree of `policing’ and performance management – anticipate the reintroduction of the Strategic Health Authority (though it won’t be called that). The bureaucratic structures in the NHS are now multiple and the lines of accountability are confusing as the 2012 structures remain in place though the new structures take over the planning function.


The other `footprint’ on the horizon is devolution. The NHS budgets are set to be devolved to Local Authorities in `Power House’ planning areas – such as a single footprint for Derbyshire and Nottinghamshire.


We live in `interesting times’ for health services and NHS planning is set to get more interesting still…

Image courtesy of Tony Roberts 





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