In a report on the progress of the STP process, thinktank Reform called for greater competition in the NHS, allowing smaller providers to bid for elements of larger contracts and for commissioners to ensure the purchaser-provider split is maintained.
The Conservative-linked thinktank also called for directly elected leaders to be put in charge of STPs to provide political legitimacy for the reforms they are seeking to implement.
In its analysis, based on interviews with NHS and local council officials, Reform said the 44 local STPs had so far demonstrated partial success towards delivering the Five Year Forward View, but progress was being stalled by a lack of engagement, inconsistent visions by national NHS bodies and a lack of authority within STPs.
The authors said there had been insufficient involvement of local authorities in the process. STP boards, they said, viewed eliminating financial deficits in the short term and acute sector reconfiguration as their priority over comprehensive and proactive change to minimise demand.
The report identified limited involvement of clinicians and the public and inconsistent political support as well as inconsistent messages between and within the two national lead organisations NHS England and NHS Improvement.
The lack of executive authority was also identified as a problem, with STPs, as ad hoc collaborations rather than legal entities, unable to establish their role.
The thinktank said that elected STP leaders - either local mayors or elected health and care commissioners - could provide the legitimacy STPs need to make controversial decisions.
The report said there was a danger that collaboration and new care models could further monopolise the NHS and called for a balance between integration and competition. It said just 1.3% of GP contracts had been put out to tender last year, which prevented new care models expanding.
Commissioners, the report said, should maintain the purchaser-provider split, develop outcomes-based commissioning, regularly renew contracts, allow smaller providers to bid for parts of larger contracts, and decommission services not delivering outcomes.
It also called for STPs to design local health outcomes for which all organisations within the footprint are accountable.
Report co-author Kate Laycock said: ‘As recent weeks have shown, the NHS desperately needs ideas that reshape local services and ease the burden on over-pressed hospitals. STPs can do it but only if ministers give them full control of local health and social care, under one directly elected individual. Without that, the high hopes for STPs will be disappointed.’