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Sustainability and Transformation Plans (later, Partnerships)

New, integrated health and care systems submitted their first Sustainability and Transformation Plans (STPs) in October 2016.


2014's Five year forward view for the NHS in England had focused on integrating services across health and social care through ‘new partnerships with local communities, local authorities and employers’. NHS Shared Planning Guidance from December 2015 had asked these local health and care systems to jointly create 5-year, ‘place-based’ Sustainability and Transformation Plans (STPs) for how the changes set out in the Forward View would be implemented.

STP footprints

On 15 March 2016, NHS England published the 44 STP ‘footprints’ that NHS providers, Clinical Commissioning Groups (CCGs), Local Authorities, and other services had formed to deliver their local plans. The footprints varied by geographic and population size, and number of constituent organisations.

King’s Fund analysis of the national implementation of STPs identified that there had been challenges with developing the footprints, for example where a provider’s services were split across multiple STPs. The planning guidance had asked local leaders to make proposals for their STP footprints, but national NHS bodies intervened regarding geographic boundaries in some areas. Local authority involvement also varied considerably across footprints.

Sustainability and Transformation Plans

After initially producing draft plans, the 44 health and care systems submitted their 5-year plans in October 2016.

The STPs were wide ranging and included proposals for changes to many aspects of health and care – from redesigning primary and community care to reconfiguration of some services in acute hospitals. Some commentators questioned the credibility of the assumptions underpinning many of the plans, including expectations for reductions in demand for acute hospital services and projections for financial savings.

Later developments

The boundaries for the original STP footprints changed significantly after 2016.

When NHS England published ‘Next Steps on the Five Year Forward View’ – an update on the Five year forward view – in March 2017, it began referring to sustainability and transformation partnerships rather than plans, but continued using the acronym STP.

Next Steps also stated that STPs could evolve to become Accountable Care Systems (ACS) in return for greater freedom. ACSs later became known as Integrated Care Systems (ICS) and, in January 2019, the NHS Long Term Plan stated the expectation that ICSs would cover the whole country by April 2021.


NHS England.
Five Year Forward View and Next Steps on the NHS Five Year Forward View [webpage].
NHS England; 2014.

NHS England.
Delivering the Forward View: NHS planning guidance 2016/17 – 2020/21.
NHS England; 2015.

NHS England.
Sustainability and Transformation Plan Footprints [webpage].
NHSE; 2016.

Alderwick H et al 2016.
Sustainability and Transformation Plans in the NHS: How are they being developed in practice.
The King’s Fund; 2016.

Alderwick H, Ham C.
Sustainability and Transformation plans for the NHS in England: what do they say and what happens next?
BMJ; 2017.

NHS England and Improvement
The NHS Long Term Plan.
NHS England and Improvement; 2019.