Table 2.
The micro-political issues of formulating and implementing STPs.
| Political issue | Descriptive | Underlying factors driving politics |
|---|---|---|
| Politics of purpose | Disputes about local health needs, the problems of the care system and the potential for system change | Differing philosophies of care |
| Differing meanings and values of ‘integration’ | ||
| Differing meanings and values of ‘the system’ | ||
| Politics of governance | Disputes about STP leadership and coordination, in terms of who hold roles and how they are enacted | Different views about the legitimacy of system leaders with the absence formal or statutory authority |
| Differing preference about the approach taken to system governance, planning and management (directive vs facilitative) | ||
| Different views about whose interests are served by system leaders | ||
| Politics of inclusion | Disputes around the extent of inclusion and representation in leadership and decision-making | Differing meanings and values of inclusion and democratic representation |
| Differing preferences about the approaches taken engagement and deliberation | ||
| Questions about the dominance of certain groups and the peripheral involvement of others | ||
| Politics of system architecture | Disputes about the redistribution of functional roles, responsibilities and resources | Differing preferences to maintain or challenge the status quo linked to threat to symbolic/functional status |
| Differing interpretations of fairness, risk and benefit | ||
| Differing preferences for new models of integrated working | ||
| Questions about the processes of decision-making and the extent of representative involvement | ||
| Politics of resource sharing | Disputes about the sharing of scarce financial, human, technological and physical resources that are linked to established models of care organisation | Underlying threats to control of key resources and symbolic/functional status |
| Differing preferences about the control of resource and decision-making processes | ||
| Differing interpretations of fairness, risk and benefit | ||
| Underlying threats to control of key resources and symbolic/functional status | ||
| Politics of prioritisation | Disputes about what transformation projects should take priority to resolve system issues | Differing interpretations of need |
| Different expectations around evidence and data | ||
| Different expectations about decision-making processes |