NHS sustainability and transformation plans

There will be an Opposition Day Debate on NHS sustainability and transformation plans on Wednesday 14 September 2016. This House of Commons Library page provides a summary of the issues and links to Parliamentary and press coverage.

Health financeHealth services

Last fetched 23 May 2026 · commonslibrary.parliament.uk

Briefing

Summary

In December 2015 NHS England and its partner organisations (NHS Improvement, Care Quality Commission (CQC), Health Education England (HEE), National Institute of Health and Care Excellence (NICE), and Public Health England (PHE)) published NHS shared planning guidance 2016/17 – 2020/21, which outlined a new approach to planning health and care services across regional areas rather than around individual institutions.

As in previous years, NHS organisations are required to produce individual operational plans for 2016/17 but, in addition, every health and care system has to work together to produce a multi-year Sustainability and Transformation Plan (STP). The STP must show how local services will develop and become sustainable over the next five years – ultimately delivering the NHS Five Year Forward View vision.[1] STPs will cover the period October 2016 to March 2021.

To deliver these plans NHS providers, Clinical Commissioning Groups (CCGs), Local Authorities, and other health and care services have come together to form 44 STP ‘footprints’. These are geographic areas in which organisations will work together to develop plans to transform the way that health and care is planned and delivered for their populations. In particular, health and care organisations within these geographic footprints will work together to narrow the gaps in the quality of care, their population’s health and wellbeing, and in NHS finances.

Information on the 44 different footprints is available from NHS England: https://www.england.nhs.uk/wp-content/uploads/2016/02/stp-footprints-march-2016.pdf

Initial STPs had to be submitted to NHS England by a 30 June deadline, with a view to implementation starting in “Autumn 2016”. The Government have said that these initial STP submissions are for local use and there are no plans to publish them centrally, although local areas may publish them if they so choose. Footprints will be expected to submit a final plan in October 2016. The arm’s length bodies that developed the NHS Five Year Forward View – NHS England, NHS Improvement, the Care Quality Commission, Public Health England, Health Education England and the National Institute for Health and Care Excellence – plan to publish STPs “once they are final”.[2]

In the last few weeks, the BBC[3], the Guardian[4], and others have reported widespread concerns about changes to local health services resulting from STPs. In response NHS England has committed that any changes proposed in the STPs will be consulted on – see for example, this statement from NHS England on 26 August 2016:

https://www.england.nhs.uk/2016/08/stp-statement/

Responses to PQs about consultation on STPs state that: “Where plans propose service changes, formal consultation will follow in due course in line with good practice and legislative requirements. The arm’s length bodies will be holding conversations with each area to assess their plans for local engagement.” [5]

STP guidance

Delivering the Forward View: NHS Shared Planning Guidance 2016/17 – 2020/21[6] stated that planning by individual NHS institutions will increasingly be supplemented with planning for local populations (referred to as “place-based planning”). It included the following keys points regarding STPs:

STPs will cover the period between October 2016 and March 2021.
Every health and care system is to identify their own geographic “footprint” and create their own STP, a “blueprint” for accelerating implementation of the Five Year Forward View.
Areas must submit their STPs by June 2016 and these will then be subject to an authorisation process.
Where collaborative and capable leadership can’t be found, NHS England and NHS Improvement will help secure remedies through “system oversight”.
The STPs must cover all areas of CCG and NHS England commissioning responsibility including primary care, hospital and community based services. Plans for specialised services will be led from 10 collaborative commissioning hubs.
The STP must also cover better integration with local authority services, including, but not limited to, prevention and social care, reflecting local agreed health and wellbeing strategies.

STPs are intended to show how local services will develop and become sustainable over the next five years, part of delivering the Five Year Forward View vision. The NHS Five Year Forward View (FYFV), published in October 2014, identifies three key drivers for change across the NHS: health and wellbeing, care and quality, and funding and efficiency. It sets out a new central-local partnership to support and stimulate the creation of new care models that can be deployed in different combinations locally across England. The FYFV also set out a range of financial scenarios for the NHS and called for £22 billion of efficiencies by 2020/21 – implying productivity improvements averaging 2.4% per year. Further guidance for STP areas was published by NHS England in May 2016, and is available here:

https://www.england.nhs.uk/ourwork/futurenhs/deliver-forward-view/stp/support/

On 16 February 2016, NHS England and its partner organisations wrote to local health and care leaders to set out steps for developing Sustainability and Transformation Plans (STPs). NHS England state that they will invest £2.1bn in a Sustainability and Transformation Fund in 2016/17. Of this total, £1.8bn of funding has been allocated to the sustainability element of the fund to bring the NHS provider trust sector back to financial balance.[7] It is envisaged that the Fund will rise to £2.9bn in 2017/18 and to £3.4bn in 2020/21.[8] Quarterly release of sustainability funds to NHS trusts and NHS foundation trusts will depend on achieving recovery milestones for (i) deficit reduction; (ii) access standards; and (iii) progress on transformation.

STPs and existing plans at regional and local level

NHS England state that STP footprints “are not statutory bodies, but collective discussion forums which aim to bring together health and care leaders to support the delivery of improved health and care based on the needs of local populations. They do not replace existing local bodies, or change local accountabilities.” [9]

The letter of 16 February also set out how STPs would interact with existing plans at the local and regional level, acknowledging that STPs will not be the right size for all planning. It also noted that for areas with devolution plans crossing STP boundaries “further discussion will be required”:

As with the current arrangements for planning and delivery, there are layers of plans which sit above and below STPs, with shared links and dependencies. For example, neighbouring STP areas will need to work together when planning specialised or ambulance services or working with multiple local government authorities and, for areas within a proposed devolution footprint that cross STP boundaries, further discussion will be required in working through the implications. Other issues will be best planned at Clinical Commissioning Group (CCG) level.[10]

Statutory requirements for patient and public involvement in health service reconfiguration

Under section 14Z2 of the NHS Act 2006 (as amended by the Health and Social Care Act 2012) clinical commissioning groups must make arrangements that secure the involvement of people who use, or may use, services in:

planning the provision of services;
the development and consideration of proposals for change in the way those services are provided – where the implementation of the proposals would have an impact on the manner in which the services are delivered or the range of services that are delivered;
decisions to be made by the NHS organisation affecting the operation of services.

Providers of NHS-funded services have a separate but similar legal duty regarding the involvement of service users under Section 242 of the NHS Act 2006.

NHS England’s statutory guidance on planning and delivering service changes (November 2015) provides further information on these duties.

NHS sustainability and transformation plans

Health financeHealth services

Last fetched 23 May 2026 · commonslibrary.parliament.uk

Briefing

Summary

Information on the 44 different footprints is available from NHS England: https://www.england.nhs.uk/wp-content/uploads/2016/02/stp-footprints-march-2016.pdf

https://www.england.nhs.uk/2016/08/stp-statement/

STP guidance

STPs will cover the period between October 2016 and March 2021.
Every health and care system is to identify their own geographic “footprint” and create their own STP, a “blueprint” for accelerating implementation of the Five Year Forward View.
Areas must submit their STPs by June 2016 and these will then be subject to an authorisation process.
Where collaborative and capable leadership can’t be found, NHS England and NHS Improvement will help secure remedies through “system oversight”.
The STPs must cover all areas of CCG and NHS England commissioning responsibility including primary care, hospital and community based services. Plans for specialised services will be led from 10 collaborative commissioning hubs.
The STP must also cover better integration with local authority services, including, but not limited to, prevention and social care, reflecting local agreed health and wellbeing strategies.

https://www.england.nhs.uk/ourwork/futurenhs/deliver-forward-view/stp/support/

STPs and existing plans at regional and local level

Statutory requirements for patient and public involvement in health service reconfiguration

planning the provision of services;
the development and consideration of proposals for change in the way those services are provided – where the implementation of the proposals would have an impact on the manner in which the services are delivered or the range of services that are delivered;
decisions to be made by the NHS organisation affecting the operation of services.

Providers of NHS-funded services have a separate but similar legal duty regarding the involvement of service users under Section 242 of the NHS Act 2006.

NHS England’s statutory guidance on planning and delivering service changes (November 2015) provides further information on these duties.