What are Sustainability and Transformation Partnerships (STPs) and Integrated Care Systems (ICSs)?

STPs/ICSs are partnerships between NHS commissioners, NHS Trusts, Local Authorities and the voluntary and community sector, designed to break down barriers between the organisations that pay for services and those that provide them, between primary and secondary care, between physical and mental health, and between health and social care.

They are designed to bring all these organisations and sectors together to share responsibility and leadership, with the aim of improving care for patients while also achieving financial sustainability.

The background

The 2012 Health and Social Care Act led to major changes to the NHS, including creating over 200 Clinical Commissioning Groups (CCGs). CCGs decide which providers (NHS Trust or otherwise) to ‘commission’ for the benefit of their local populations. They are allocated most of the NHS budget, and have had considerable autonomy over how to spend this money. This system incentivised NHS Trusts and other service providers to compete with each other to secure contracts.

However, NHS leaders became concerned that this had created a fragmented system that was making it more difficult to provide joined-up care for patients and spend its limited resources efficiently. It also believed that it was preventing them from moving care out of hospital and closer to home. As a result, in 2016 with the publication of the ‘Five Year Forward View’ strategy, NHS England divided the country into 44 Sustainability and Transformation Partnerships (STPs).

How do STPs/ICSs work?

STPs bring together local NHS organisations (including CCGs and NHS Trusts), local councils, voluntary sector organisations and others to plan how to improve the health and social care of residents in their area. 

In some areas, STPs have already evolved to become integrated care systems (ICSs), a new form of closer collaboration where NHS organisations and local councils aim to reach all key decisions by consensus.

This collaborative approach has many benefits. But it also presents a challenge: STP/ICS leaders do not have direct authority over the whole system and so must carefully build relationships and understanding across all the organisations involved.

There is no exact description of how an STP/ICS should operate. However NHS England recently published a brief outline of Integrated Care Systems (ICS), including an assessment framework they’ll be judged against. This may lead to ICSs having greater autonomy.

While a legal framework for STP/ICS is not yet in place, the focus of healthcare in England is shifting away from CCGs to STPs and now ICSs. 

Going forward

The NHS Long Term Plan set a target that every area will be part of an ICS by 2021 and said that NHS England will in most cases expect there to be a single CCG per ICS. 

The NHS Long Term Plan and its accompanying ‘Mental Health Implementation Plan’ set expectations that key initiatives will be planned and coordinated at the STP/ICS level, including those that could significantly improve adult community eating disorder services. You can find profiles and links to the most recent available information about each STP and ICS on the NHS England website here.