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STPs: NHS workforce changes must be discussed openly

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Nursing staff around the country may have started to see and hear a new acronym being bandied about over recent months.

“STPs” – standing for sustainability and transformation plans – are the current embodiment of long-standing ambitions from NHS leaders to both make services more efficient and also move away from acute models in favour of more community provision.

“People don’t like the feeling that they are being lied to, deceived or ignored – and that goes for both patients and staff”

In January this year, NHS England gathered together local health and social care organisations into 44 groups to cover geographical population “footprints” around England.

Their plans, or STPs, are now starting to emerge – though mostly in draft form at this stage. There is already much mention of words like integration and partnerships, with ambitions to join services and teams up in a new way – or an old way that was how it was before the last set of reforms in some cases, no doubt.

The inherent danger, as usual with such things, is that acute services are earmarked to be shut down but the replacement community solution never materialises. There is, after all, a worse shortage of nurses in the community sector than in hospitals.

Plus, words like efficiency, productivity and sustainability tend to strike dear into the hearts of hard-pressed healthcare workers because they are inevitably aligned with cuts to services, money or workforce.

“There is also an element of confusion over who has ultimate ownership for overseeing the plans”

But there are also other, more subtle problems with communication around STPs, which is the point I really want to deal with here.

The danger is, for me, anyway, that fear of negative comments and criticism will lead those writing up STPs to do what the NHS usually does in these situations and try and either hide or fudge what’s happening by engaging in a game of smoke and mirrors with the public and the press.

As a result, their plan is revealed as wholly positive and the “way forward” without even a mention of the risks and the likely negatives, or that there might be a choice in what happens – despite an inevitable consultation process being undertaken.

This tends to lead to an explosion of local anger and a “save our local hospital” campaign. Strangely enough, people don’t like the feeling that they are being lied to, deceived or ignored – and that goes for both patients and staff.

Honesty would be a much better policy, I think – perhaps naively. Yes, tell people what needs to happen and why, but don’t sweep everything else under the carpet.

But it feels like NHS leaders are already a bit on their heels on this one, given that the national and local press recently got wind of STPs and immediately branded them as “secret plans” to cut services. There was nothing especially secret about the move, but somehow it hasn’t felt like people are being particularly open about them either.

There is also an element of confusion over who has ultimate ownership for overseeing the plans – is it the Department of Health or one of its arms’ length bodies NHS England, NHS Improvement or Health Education England.

This has increasingly become a problem relating to any new potentially controversial health policy in England. For example, a journalist phones up to ask about something and gets told that it’s the responsibility of one of the other bodies and then when they phone that organisation they are told that it’s the original body after all. Confused? So are we.

“Let’s break with NHS tradition and have an honest and open discussion about STPs”

Many of the STPs probably contain practical and forward-thinking ideas for providing services in future, but they will also inevitably lead to shake-ups in the way things are done that alarm people if approached in the wrong way. They must also be done for the right reasons, rather than simply to save a bit of money.

For example, Nursing Times ran a story earlier this month on one of the draft plans, namely the Buckinghamshire, Oxfordshire and Berkshire West STP. The plan featured ambitions to save costs on workforce through changes to the nursing skill mix, including greater use of “generic support workers”, which naturally sparked some criticism.

My concern is that, instead of addressing the issues arising from such an idea, perhaps adapting or rethinking them, those drawing up the STP will just subtly re-word it in the final version so that it sounds less dramatic but is still essentially the same plan.

I realise some difficult and awkward decisions and discussions are likely to be necessary, given the straightened financial times we find ourselves in. But let’s break with NHS tradition and have an honest and open discussion about STPs. Please!

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