Debate: STPs

Every health and care system in England is being required to produce a multi-year Sustainability and Transformation Plan (STP), showing how local services in forty-four geographic ‘footprints’ will evolve and become sustainable by the beginning of the next decade, in order to deliver the NHS Five Year Forward View vision of better health, better patient care, and improved NHS efficiency.
STPs are expected:

• to address health inequalities and reduce avoidable illness by prioritising prevention;
• to reduce the variations in quality and outcomes of care by reshaping care delivery and using technology effectively;
• to use additional funding to make the NHS more efficient and eventually financially sustainable;
• to increase the development and uptake of integrated care models, including new structures such as Accountable Care Systems (ACS) and Accountable Care Organisations (ACOs).

The STPs do not replace existing local bodies, or fundamentally change local accountability, although the recently published ‘Next Steps’ update report by NHS England does propose them taking an active role in local decision-making. The main aim is to use them to bring together health and care leaders to support the delivery of improved health and care, based on the needs of local populations, and which offers more consistent care at a lower cost.

Whilst each STP will be different, many will include plans to centralise services, close smaller hospitals, upscale GP and other out-of-hospital services, reduce mental health sites, and increase the use of tele-health interventions.

The RCN has been attempting to engage at both national and regional levels with those responsible for developing these plans, but with mixed results. At the national level, via the Social Partnership Forum (SPF), we are seeking an agreement that would protect staff affected by changes resulting from the STP process. The national SPF has also generated guidance on supporting effective partnership for system change. The RCN also has worked with members across the UK to develop a UK-wide toolkit to support members providing leadership in strategic decision making roles or forums on integrated care.

At the local level our regional officers have been engaging with individual STP leaders, in order to find out what and how they are planning, and to provide evidence and insight, with some being more willing to engage than others. They are also seeking formal involvement of staff and their representatives in the process along with other trade unions in line with the SPF guidance.   

RCN England devolution and integration project lead, Janine Dyson, is quoted as saying, “Nurses and other clinicians have limited input into STPs, which is frustrating. This lack of involvement could mean that unexpected consequences that clinicians might have spotted, such as reduced access to services for some patients, won’t be detected early.”

From research undertaken by the Nuffield Trust, its Chief Executive, Nigel Edwards, has noted that STPs have been developed rapidly and in a somewhat secretive manner. This chimes with RCN evidence of many nurses still being only vaguely aware of them, if at all. He also notes that their implementation will require much staff effort, at a time when the NHS workforce is already stretched.

STPs, their development and implementation, will have a huge impact on nurses, and on the nursing profession. The practice of nursing itself is likely to be transformed. The implications for pre- and post-registration training are equally likely to be profound. Nurses should be at the forefront of their local plans, ensuring that the plans are implemented such that their stated aims, to maintain and improve patient care, are kept central and on course.