Superant || STPs, bricks, mortar and collab-etition: our round-up from #SWAGM16

STPs, bricks, mortar and collab-etition: our round-up from #SWAGM16

Last week we attended the South West Leadership Academy’s AGM (#SWAGM16) to hear a mix of six senior managers and CEOs present their thoughts on the South West of England’s six Sustainability and Transformation Plans (STPs).

It was an excellent event. Well organised, well attended, forward thinking and insightful. A round of applause from the team at Super Ant to @NHS_SWLA!

Here’s what the day got us thinking about…

Minimal bureaucracy vs entangled governance structure

Dr Margaret Heffernan kicked off the meeting with a range of observations and suggestions on the nature of leadership, accountability, hierarchy and bureaucracy across the public and private sectors.

A key message was:

bureaucracy + hierarchcy = silence

The silence being that of staff who know something should be done better but don’t speak their ideas.

Margaret presented the room with the challenge, “How few KPIs and targets can you live with?”

By the end of her presentation we were clear, bureaucracy + hierarchy can and does stop people speaking up and takes away from staff the feeling of truly owning and being responsible/accountable for the quality of their work.

Then, in a flash of unplanned irony, the first slide of the six STP presentations detailed the entangled governance structure of one of the STPs! Layers of hierarchy, sign off and committees. Every presentation had their own version. Bureaucracy in it’s most pure form.

Let’s be clear, governance of the STPs is crucial to their working. Without right and proper due diligence and sign off “here, here, there and over there” every decision the STP programme board makes is open to judicial review. A point made in NHS England’s recently published engagement guidance.

But, and this is a big but: however multi-layered and precise STP governance arrangements are, without in-depth and meaningful engagement with the public, the governance chart can look like a way of the NHS and local government only listening to themselves.

Communications and engagement professions must lobby internally for their respective organisation and STP partners to ensure that including public and patient opinions is a pillar of their governance structures.


An example of a STP governance framework.

Hang on, we are more similar than different

The similarities of the challenges and opportunities faced by the six STP footprints were striking. The format of six presentations on the bounce helped to cement this point in everyone’s minds. You could see the penny drop with the presenters and audience when they all realised Cornwall is facing the same issues as Gloucester (for example), and perhaps they could help each other learn in their STPs.

The similarities of the issues: workforce skill mix, recruitment, funding, public perception, outcomes, cost bases and more all feed through to the multiple communications and engagement challenges in each footprint.

Neighbouring communications and engagement teams have a great opportunity to learn from each other as they work on their respective STPs. Will STPs be the thing which brings cross-organisation and cross-border communications and engagement working to the fore once again?

Anyone remember the SHA communications and engagement groups? 😉

People love bricks and mortar

By nature of the challenge of converting to new models of care, (greater use of preventative and restorative care at home and in the community), STPs will seek to move patient services out of the traditional hospital setting. This inevitably will lead to ward closures and potentially whole building closures.

As was observed during the day the public are very emotionally attached to such buildings. The bricks and mortar under which they were born, had their broken arm put in a cast, have worked for 20 years. They are sources of pride and affection. Their role in the fabric of the community cannot be overstated.

This presents a range of communications and engagement challenges fit for their own blog post, many of which you’ll be acutely aware of. For us it prompted a few new questions too:

  • With most STP leaders being non-clinicians, can STP programme teams build a clinically led case for change?
  • Can the STP partner organisations react faster than the campaign groups and staff groups who will counter-brief the media against even the merest sniff of closures?
  • How do you maintain the visibility of the service if a significant proportion moves into the community? Put another way, if you shut the local cottage hospital and move services into the community using multi-disciplinary and mobile teams of healthcare professionals operating from satellite offices and using iPads, how can you show the public that services haven’t been cut?
  • Can you stop the whole STP being defined by one closure?

Staff engagement

Staff are the advocates and detractors of the plans, they are the face of the changing service and trusted by their patients and the public.

It was clear from the six STP footprints that a lot of work has already gone into the foundations of the STPs in the South West. The senior executives know this is the only show in town.

Since the AGM we’ve spoken to a number of friends and family in different roles in the NHS. Few of them knew about the STP in their local area. Perhaps this is unsurprising given the stage of the STPs.

As the media coverage of the plans increases, staff are likely to become curious as to what an STP is and how it might affect them. Staff briefings via the local paper are certainly not the way to build an engaged workforce.

Quite rightly the executives are all aboard the STPs. It is their job to lead and naturally they are ahead of the change curve on this. How the majority of staff are brought up to speed and taken through the change curve as kindly as possible remains a huge opportunity (and potential risk) for organisations.

Your colleagues will make or break the changes, they must be on-board for the STPs to work. How can your communications and engagement strategy ensure staff are given the latest STP news before they read about it in the local rag?


The finger was pointed at the Foundation Trust model for introducing the competition that is the most obvious structural and cultural barrier between NHS organisations collaborating on the scale the STPs need to be successful.

Trusting each STP partner organisation and moving from the combative approach to reputation management of “you think we’re bad, look over there!”, look set be big challenges for each and every STP at one time or another.


We’ve coined this term to sum up the challenge of collaborating in a STP where those you collaborate with are also competing with you for the same staff, services, funding and regulatory certification.

As collab-etition across the footprints comes to bear on the STPs, programme management teams and CEOs will have to consider, for example, how to balance the recruitment needs of their organisation against the wider STP’s needs.

In a collab-etitive environment can you get the right staff skill mix into the organisations that need them most? Will key staff be asked to transfer to poor performing services to get them back on track?

Can the detriment of an individual organisation really be accepted for the benefit of the wider STP/accountable care model?

The working in communications and engagement in a collab-etitive environment is going to demand strategic nous, a real knowledge of the system’s issues and concerns not just the organisation’s and the ability to look the problems in the face and have confronting conversations with stakeholders.

STPs are the only show in town and communications and engagement teams across England have a huge part to play. Good luck!

If you’re interested in how we can help you navigate these areas of STP communications and engagement drop us a line on