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The blueprints for local services that could change your working life

Sustainability and transformation plans hit the headlines in August, raising concerns that these ‘secret’ arrangements will lead to deep cuts in NHS services across England. For many nurses, this will be the first time they have heard of STPs. So what are the plans and what do they mean for the nursing workforce?

Sustainability and transformation plans (STPs) hit the headlines in August, raising concerns that these secret arrangements will lead to deep cuts in NHS services across England. For many nurses, this will be the first time they have heard of STPs. So what are the plans and what do they mean for the nursing workforce?

The first thing to grasp about sustainability and transformation plans is that they are hugely important. STPs are intended as blueprints for the future of the NHS in England, helping health economies to deliver improved and more consistent care at a lower cost. Hundreds of thousands of nurses could see their working lives affected.

The plans are being drawn up by local health and social care leaders and involve NHS organisations and local authorities across 44 geographical areas. Successful reorganisation of services is regarded as essential to NHS

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Sustainability and transformation plans (STPs) hit the headlines in August, raising concerns that these ‘secret’ arrangements will lead to deep cuts in NHS services across England. For many nurses, this will be the first time they have heard of STPs. So what are the plans and what do they mean for the nursing workforce?

The first thing to grasp about sustainability and transformation plans is that they are hugely important. STPs are intended as blueprints for the future of the NHS in England, helping health economies to deliver improved and more consistent care at a lower cost. Hundreds of thousands of nurses could see their working lives affected.

 

The plans are being drawn up by local health and social care leaders and involve NHS organisations and local authorities across 44 geographical areas. Successful reorganisation of services is regarded as essential to NHS England’s battle to save £22billion by 2020-21.

Centralisation, closures

The details of the first drafts of STPs have not been made public in all areas, but common themes are likely to be the centralisation of some services, including emergency services and maternity, closure of beds in community hospitals – and in some cases whole hospitals – and a potential reduction in the number of mental health sites.

Some areas may opt for ‘elective centres’, which are separate from hospitals offering emergency care. There will be a focus on ‘scaled up’ general practice, and better out-of-hospital services provided in people’s homes, combined with a focus on keeping people well, often aided by technology such as telehealth.

Few nurses have been involved in developing STPs for their own area. Indeed, there has so far been little involvement or engagement with the public or staff groups in the development of these plans. Nuffield Trust chief executive Nigel Edwards suggests they have been developed at breakneck speed in a ‘slightly secret’ atmosphere, which may leave the public unprepared for the extent of the proposed changes.

Unpleasant surprise 

‘Some of this is going to come as an unpleasant surprise for people on the receiving end,’ says Mr Edwards. 

RCN England devolution and integration project lead Janine Dyson says: ‘Nurses and other clinicians have limited input into STPS, which is frustrating. This lack of involvement could mean that unexpected consequences of the plans, such as reduced access to services for some patients, which clinicians might have spotted won’t be detected early.'

NHS England says no changes will be made without local engagement and, where required, consultation.

Money-saving?

But will STPs bring about the changes – and financial savings – they are designed to? The Nuffield Trust has pointed out that reconfigurations of this kind often don’t save much money.

Many of the proposals will have to go to public consultation and will be fiercely opposed. With a small majority – and no doubt many outraged MPs – the government will not find it easy to stand behind emergency services and maternity reconfigurations or bed losses in community hospitals.

Mr Edwards points out that implementation will require considerable managerial and clinical effort at a time when many already feel stretched. He warns that some projects in STPs will also need more capital investment than is likely to be available.

No training investment 

Improving out-of-hospital services will require many more nurses and other staff – but the community nurse workforce has declined in recent years, and a recent King’s Fund report on district nursing found increased workloads is compromising quality of care. 

Ms Dyson says the investment in training that could have driven an increase in nursing simply hasn’t happened. ‘Unless we start training people yesterday, it is not going to be ready in 6-12 months’ time when the STPs are meant to be implemented,’ she says.

Queen’s Nursing Institute chief executive Crystal Oldman welcomes the focus on out-of-hospital care coming through in STPs – and the career opportunities that could offer some nurses – but warns workforce expansion is needed.

Good news, bad news

‘Most patients do want to be cared for in their own homes and don’t want to stay long in hospital,’ she says. ‘But we need to have the right nurses in the right place with the right skills.’

Building up community services will also take time – and during this time people will still need to access the old model of care, meaning there will be a period of additional costs.

The plans could lead to staff cuts in some settings, suggests Mr Edwards. ‘It’s good news and bad news for nurses,’ he says. ‘There will be some headcount reductions in some places, but also opportunities for extended roles in others.’ Whether nurses in axed services will have the inclination or skills to fill gaps that open up elsewhere is far from clear.

Financial imperative 

Aims of the STPs include stress prevention and early intervention to reduce hospital admissions. ‘That takes a real shift in attitudes, behaviour and culture,’ says Ms Dyson. While there is a great deal said about how this needs to happen, the details of how it will happen are often lacking, she points out.

Where patients can be kept at home, they are likely to receive health and means tested social care. Explaining to people that they need to pay for an element of their care could be difficult – especially if there are generic health and social care workers delivering both sides of this.

Better quality and more integrated care are aims that everyone in the NHS can sign up for. However, the imperative for STPs is also financial – and here the evidence is that good quality care closer to home, and reconfiguration of acute hospital services, do not necessarily save money.

In addition, if services are centralised, some plans will require investment in staff and buildings. Staff moving to new roles may need additional training.

Ms Dyson says nurses will be central to many of the new care models, so their active participation in the planning and implementation is crucial. ‘Do the leaders of STPs understand the value that nurses bring?’ she asks. ‘In order for these plans to work, I believe nurses are the most important part of the jigsaw. If they are not valued, invested in and consulted, then delivering these plans will be far more difficult.’

What STPs will mean for nurses

  • Changes to hospital services could mean some nurses have to work out of a different location. For example, emergency services nurses could see services centralised. However, some emergency services could turn into urgent care centres where nurses or nurse practitioners provide the bulk of the care. These changes may require nurses to develop advanced skills.
  • Nurses working in the community could see more opportunity, as out-of-hospital services are strengthened. However, those based in community hospitals might be required to deliver more care in patients’ homes as beds are axed. They will need to be able to work autonomously, and to be able to assess risk to patients.
  • More community nurses could find they are working in closer proximity to other healthcare professionals, in multidisciplinary teams focused around GP practices or groups of practices.
  • There could be some blurring of the divisions between roles and new job titles. Many nurses will be expected to work more closely with social care colleagues to get patients out of hospital quickly, but there may also be pressure to minimise the number of visits to one patient. There are concerns that generic workers will emerge, who will be cheaper to employ than nurses. NHS and other public sector organisations will also be looking to reduce costs by sharing facilities.

 


Alison Moore is a freelance health writer

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