Sustainability and transformation plans: the 'biggest change ever'

With health services continuing to feel the strain, collaboration will give nurses, doctors and other care staff ‘the best chance of success’, according to England’s chief nursing officer Jane Cummings

With health services continuing to feel the strain, collaboration will give nurses, doctors and other care staff ‘the best chance of success’, according to England’s chief nursing officer Jane Cummings.

Sustainability and transformation plans form part of a bid to bring NHS providers together
Picture: iStock

The collaboration she’s referring to is that between organisations, in the form of sustainability and transformation plans (STPs) for local health and care sectors. This is not the moment to ‘sit on our hands, nor to instigate big-bang changes’ she argues, but engage in decisive, well debated and locally owned improvements.

STPs will cover the period between October 2016 and March 2021

NHS England

STPs feature in the NHS shared-planning guidance to implement the Five Year Forward View and represent an attempt to bring together NHS providers, clinical commissioning groups (CCGs), local authorities and other healthcare services.

They cover 44 areas across England with the aim of improving health and care outcomes between 2016 and 2021, by focusing on health and well-being, better care and stronger NHS finance and efficiency. However, plans across the 44 ‘footprint’ areas are at different stages, with NHS England hoping the public and health service staff will lead their development.

'Lack of transparency'

RCN England director Tom Sandford says, however, the college has serious concerns over how STPs are being developed, which in many cases is with ‘an unnecessary lack of openness and transparency’. 

He adds: ‘The RCN expects that any changes to services and staff roles should be in the best interests of patients and be based on enabling the delivery of quality care, not financially driven. 

‘The RCN requires that each STP establishes a partnership forum at STP level. Current employers in each STP area must involve their local staff side. These are urgent and necessary actions.’

Every area has an STP lead, who could be from a CCG, NHS trust or local government organisation and some STP leadership teams include clinical representatives.

April 2017

The earliest month that additional funding becomes available to ‘compelling and credible’ STPs

NHS England

A transformation fund created by NHS England is supposed to help local regions deliver on key targets for services in areas such as cancer, mental health and better care for patients closer to home and, from April, STPs will become the single application and approval point for local organisations to access NHS transformation funding.

Shifting plans

Healthcare experts at the King’s Fund say that STPs represent a shift in how the NHS in England plans its services and their research suggests that local leaders have found it difficult to meaningfully involve everyone working in the health and care system, particularly clinicians and front-line staff, in developing the plans.

A group including senior nurses from NHS England and NHS Improvement has been set up to monitor them. According to an NHS Improvement spokesperson, group members are assessing the workforce elements of STPs and will offer guidance on workforce-related issues when required.

But Unison head of health Christina McAnea echoes the RCN concerns: ‘Unions are in the dark about STP proposals for staff, as in most places we haven’t been included in discussions.

‘Any reorganisation of services will lead to staff anxiety when all they want to do is concentrate on helping people get better, not wondering if they will have a job in the future.’

Example of progress

Avon and Wiltshire Mental Health Partnership NHS Trust is involved in two local sustainability and transformation plans (STPs); the trust’s deputy chief executive officer and director of nursing and quality Andrew Dean is the organisational lead for one and supports the chief executive with the other.

He says: ‘It is clear the NHS is under severe financial pressure and is having difficulty navigating a way to continue to be sustainable, which is why the STP process is so important in the healthcare system. The principle is to break down organisational and professional boundaries and develop systems that are centred around the patient – a radical rethink from fitting patients into healthcare systems.

‘Nurses must be at the forefront of this innovation, given that they are the largest profession delivering direct care to patients and arguably the profession with the most holistic view of patients’ needs.  

‘It is clear that new ways of working and potentially new types of workers will be an output from STP work; but nurses and nursing should not lose their place in the healthcare system because of the current shortages and challenges the profession faces. STP working is a way to redefine the nursing agenda to the benefit of patients and the healthcare system if delivered within the principles set out.’


In November, NHS Providers published a report that includes results from the organisation’s largest survey of NHS trust chairs and chief executives. It shows that only 27% of leaders are confident they have the right staff numbers, quality and skill mix to deliver high-quality healthcare and just 22% are confident about having the right staffing levels in six months’ time.

'Compromised position'

Unite national officer for health Sarah Carpenter says: ‘The STPs are potentially trying to look at things the right way, through integration, but there is no evidence it saves money – it is always going to cost more to do things better.

‘It puts senior managers in a compromised position as they are being asked to deliver the impossible with absolutely no resources. We are concerned that unintelligible plans for the local health economy, which may have been drawn up by management companies, could move us away from national terms and conditions.’


‘footprint’ areas with STPs across England

NHS England

A spokesperson for the RCN south west England region gave an insight into what is happening regionally: ‘STPs could see the biggest change ever to nursing whether it is in the acute, primary, community, independent or GP sectors.’

She warns that the RCN is already concerned about the challenges being faced by the range of groups involved in the STPs in south west England.

‘On the one hand, there are various chief executives from different organisations vying for power and on the other there are some local authorities, charities and private companies who aren’t engaged at all. 

‘The RCN is making sure we attend all STP social partnership forum meetings and are seeking places on local workforce action boards.’

The RCN spokesperson adds that the college is trying to gain access to lists of participants on STP clinical development groups so they can link members together and find out where there is no nurse representation. 

‘We need to be mindful about what this means for nurses and patients in this crucial development stage and we need to make sure nursing is represented so we can exert influence.’

Across the UK

Northern Ireland

A public consultation on proposed criteria for reconfiguring health and social care services launched by health minister Michelle O’Neill closed in early February. The criteria, if adopted, will be at the heart of informing decisions about changing healthcare services where their delivery needs to be improved or where continuation in their present form is unsustainable.


A health and social care delivery plan published in December 2016 sets out several actions the government says are needed. An important aspect of the plan is the strengthening of regional planning and delivery of services. New arrangements should be in place this year.


All health boards are required to have integrated medium-term plans for how resources will be used most effectively to address areas of population-health need and improve health outcomes and quality of care.

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