Feedback from trusts suggests that the factors underpinning success appear to be:

  • a 'comfortable' main footprint which matches a 'natural’ footprint for the local system in which local system players are used to working, rather than an STP footprint which feels artificial – for example, too big or cuts across the key footprints that system players are used to working in
  • good long standing relationships that often predate the establishment of STPs, or investment in relationship building to overcome tensions
  • a senior leadership team committed to prioritising 'the system' alongside institutional working and which is not distracted by significant organisational challenges such as large financial deficits or performance issues which can prevent key partners having the capacity to contribute at the 'system table'
  • appropriate investment of time and resource in system level working, from individual institutional senior leaders, but also from a growing team working for and at the local system level.

Key features of advanced systems (at all population levels):

  • a clear system vision, strategy and plan and a culture where system level working is the 'way we do things round here' which also sits comfortably with the required institutional level focus
  • clarity, therefore, on exactly what will be done at system level and what at institutional level
  • increasingly influential system level governance structures and approaches. In the most advanced systems we are beginning to see structures that:
    • oversee integrated commissioning across health and care
    • bring all relevant providers together in a single forum (with similar fora for other key partners)
    • involve trust non-executives, CCG lay members, councillors as far as possible and embrace public challenge and scrutiny
    • are beginning to move towards a single health and care leadership team in a local system (including embracing joint positions such as a single person acting as CCG accountable officer and council chief executive or director of social services).
  • an increasing blurring between commissioning and provision with commissioning often becoming more strategic and more integrated with other commissioning in the footprint
  • a move to trust boards’ increasingly choosing to manage budgets at a system level, often involving moving beyond separately managed, CCG and provider finances towards a single system approach for particular services to make better use of the collective resource – and to maximise the level of sustainability funding available to the system as a whole
  • rapid development of new, integrated, care models
  • development of new organisational forms beyond the traditional silos e.g. trusts creating joint ventures with GP federations; trusts owning GP practices; trusts becoming integrated care providers
  • development of new, system level performance metrics.