A new report by health think-tank the King's Fund has concluded that Sustainability and Transformation Plans (STPs) do offer "the best hope to improve health and care services" despite widespread - and largely valid - criticism of the initiative.
Currently, health and care organisations in 44 'footprint' areas across England are working with communities to develop local blueprints for improved health, care and finances over the next five years, in a new approach that seeks to ensure that services are planned by place rather than solely around individual institutions.
Central to this are the design and delivery of STPs, which must show clearly how each area will pursue the 'triple aim' set out in the NHS Five Year Forward View - improved health and wellbeing, transformed quality of care delivery, and sustainable finances.
However, The King's Fund's new report, which is based on interviews with senior leaders in four STP areas, has found that involvement of local government has thus far been patchy, there has not been enough time to adequately involve clinicians and frontline staff, and that both patients and the public have been "largely absent" from the process.
There was also evidence that NHS England had told STP leaders to keep plans under wraps until they had been approved, including refusing Freedom of Information requests from outsiders wishing to see the proposals.
The whole process is confused, muddied by unclear or changing deadlines and instructions from national NHS bodies and a lack of governance structure or formal authority for STP leaders, the report notes.
Nevertheless, despite these issues the think tank insists that STPs remain the best means of securing significant and sustainable improvements to services. As such, it is recommending that, going forward, governance is improved and that all components of the health and care system as well as the public are involved in the plans.
"The introduction of STPs has been beset by problems and has been frustrating for many of those involved, but it is vital that we stick with them," said Chris Ham, chief executive of The King's Fund.
"For all the difficulties over the last few months, their focus on organisations in each area working together is the right approach for improving care and meeting the needs of an ageing population. It is also clear that our health and care system is under unprecedented pressure, and if STPs do not work then there is no plan B."
Mirroring this standpoint, the Royal College of Emergency Medicine also stressed that while it is concerned by the findings, it agrees STPs may represent the best way to reform the provision of care in the UK if properly structured.
"Furtively producing plans without involving those who are – or should be – at the heart of the NHS; the patients, is wholly unacceptable and will not result in effective or sustainable services," warned Dr Tajek Hassan, president of the College.
"It is imperative that patients, along with those charged with delivering future services – the staff, must be engaged and involved throughout the process to ensure that the patient's best interest are at the heart of STPs, and not the need to balance the books".
An STP fund of some £2.1 billion has been set aside for the financial year 2016/17, which will rise to £2.9 billion in 2017/18 and to £3.4 billion in 2020/21, to underpin the work.