The Royal College of Nursing’s leader for London has warned that a lack of sufficient funding and staffing is the “elephant in the room” for plans to transform the way care is delivered in the capital.
He said the ambitious plans, which form part of a national programme, could only be achieved by providing the funds necessary to transform care rather than trying to deliver change “on the cheap”.
“There are huge questions still to be asked of the plans themselves”
Bernell Bussue, regional director for RCN London, has written a blog outlining his concerns about the development of plans drawn up by sustainability and transformation partnerships across the capital.
The NHS and local councils that form the country’s 44 STP areas across England have now developed draft proposals designed to both improve care and save money via further integration of services.
The capital has five STPs – covering North Central London, East London, North West London, South East London and South West London.
Mr Bussue praised some of the overarching aims of the plans, nationally, such as moving more care into community settings and the integration of services. But he warned there was a risk to both patient care and the nursing workforce without proper resources.
He described STPs as “local responses” to the £30bn gap in England between funds needed to maintain NHS services, and what the government was proposing to spend by 2020-21.
“Put simply, STPs outline how this funding gap is going to be bridged, namely by transforming the way care is provided,” he said.
He noted that the transformation outlined in STPs in London and nationally aimed to move care into the community, reduce reliance on acute services and prioritise prevention and early intervention.
“It is hoped that this will not only deliver the savings required, but also produce better outcomes,” he said.
“However, there are huge questions still to be asked of the plans themselves, particularly when it comes to protecting patient care and the nursing workforce,” said the union leader.
He acknowledged that the plans did contain “innovative ideas” aimed at addressing the needs of both today and the future, and had a “welcome focus” on trusts collaborating, instead of competing.
“But still… the elephant in the room remains the chronic underfunding of the social care sector and the fragility of the NHS and social care workforce,” warned Mr Bussue.
“Until the government acknowledges this, and provides the appropriate resources, the safe delivery of STPs in the capital will be close to impossible,” he said in his blog.
He added: “Whilst RCN London support the desire to change the way care is delivered, it must still be emphasised that this can only be achieved by providing the funds that are needed to transform care rather than trying to deliver such big transformational change on the cheap.”
He highlighted that the five STP “footprints” across London had a combined funding shortfall of £4bn.
He also noted that three of the capital’s more “financially challenged” STPs – North Central, North West, and South East – had been placed into a Capped Expenditure Process (CEP).
CEPs are designed to contain spending and differ from existing financial controls by focusing on systems, including both commissioners and providers, rather than individual organisations.
Mr Bussue called CEPs a method through which NHS England and NHS Improvement could put even tighter spending controls on providers deemed to be “overspending”.
His comments follow a recent joint report by two leading think-tanks, which he said had added weight to growing concerns that the STP plans could damage, rather than transform, patient care.
Last Tuesday, the King’s Fund and the Nuffield Trust published a report, commissioned by the Mayor of London Sadiq Khan, to provide up to date analysis of the development of London’s STPs.
The report was based on each of the London STP plans that were published in October 2016, plus follow-up interviews with a senior representative from each of the five areas in August this year.
It questioned some expectations in the plans, for example, those regarding demand for hospital beds, the scale of savings that could be achieved and source of investment to kick-start new models of care.
Across the four STPs able to include some early estimates, the reported impact of their combined savings plans was to reduce whole-term equivalent staffing numbers between 2016-17 and 2020-21 by 1.4%, or slightly more than 2,000 staff.
This included 3,800 fewer registered nurses, midwives and health visitors and 600 fewer hospital doctors and dentists, which would be partially off-set by more primary care staff and some STPs seeking to increase numbers of healthcare support staff working in the community.
“Unfortunately, the report’s findings mirror some of our concerns in the region,” said Mr Bissue. “STPs are too light on detail, lack credibility and leave patients and the health care workforce in the dark about the future of their services.”
“The report’s authors go onto question where the community capacity will come from when there is no evidence of additional investment and go onto state that ‘current workforce pressures suggest it may not be possible to recruit the staff needed’,” he said.
“It is estimated that 3,800 registered nurses, HCAs, and midwife posts will be lost,” he said. “In London, there are a record number of vacant nursing posts.
“We need more nurses, not less. A reduction in nursing posts is unacceptable and there is no doubt it will directly impact the safe delivery of care,” he added.
“I also want every assurance that our heroic doctors, nurses and health and care professionals get all the support they need”
On the back of the report, Mr Khan called for a greater role in providing oversight of the STP plans for the capital.
The mayor also said he wanted “key assurances” from the government, including on sufficient investment, hospital capacity, and clinical workforce support, before he would give support for any changes to NHS services in the capital.
Mr Khan said: “Any plans around the future of NHS services in London must be given proper investment, and must not have an adverse impact on health inequalities, social care or hospital capacity.
“I also want every assurance that our heroic doctors, nurses and health and care professionals get all the support they need to realise these plans, and that Londoners and patients are properly consulted,” he added.