NHS England has said it is working with the regional developers of a controversial sustainability and transformation plan to ensure “they will put in place the right skilled workforce to ensure high quality care”, following suggestions that it would lead to a dilution of registered nurses versus support staff.
A draft of the Buckinghamshire, Oxfordshire and Berkshire West (BOB) STP, published last week by Reading Council, included the aim of making £34m savings from staffing costs through “reduction of nursing grade input” and an increase in the use of “generic support workers”, such as healthcare assistants.
“We continue to assist the STP with their plans as they are developed”
NHS England spokesman
The draft STP stated that its workforce plans would mean that an otherwise-projected workforce growth of 4,526 whole-time equivalent staff would instead be an increase of just 978. It forecasted that over the period the area’s health service will experience a 15% increase in “patients”.
The draft was revealed as further evidence that nursing skill mix, as well as nursing levels, affect care quality and safety was published earlier this month, which specifically linked skill mix to patient mortality.
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Responding to the potential for concern about reducing input from registered staff, a spokesman for NHS England South said the plan was a draft and had not yet been formally agreed or published.
He said: “NHS England, together with Health Education England and NHS Improvement, have been working with STPs to review the submitted plans and will be providing feedback as they prepare to publish their latest versions of what are developing plans.
“At this stage, proposals within the plan have not been ‘signed off’ and we continue to assist the STP with their plans as they are developed,” he told Nursing Times’ sister title Health Service Journal.
“This includes key aspects such as ensuring they will put in place the right skilled workforce to ensure high quality care for patients,” he added.
“Our aim is to ensure that our future nursing workforce is better equipped and supported to work flexibly”
Central Southern and West CSU
A spokeswoman from the Central Southern and West Commissioning Support Unit, speaking on behalf of the STP developers, said qualified nursing numbers were expected to increase by 2020-21.
However, she said the plan was also looking at “skill mix opportunities to ensure people are working to the top of their licence and we are optimising nursing time spent on direct patient care”.
She added: “We anticipate that current challenges associated with the recruitment and retention of nursing staff generally, but particularly within some specialist areas, will prevail in the short to medium term.
“Therefore, our aim is to ensure that our future nursing workforce, which is highly valued, is better equipped and supported to work flexibly across our various healthcare settings,” she said.
NHS Improvement, which is also involved in overseeing and assuring STPs, declined to comment on the BOB proposal specifically. NHS Improvement’s executive director of nursing Dr Ruth May said only that registered nurses were “the backbone of the clinical care patients receive”.
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She said her job was to “make sure we are doing what we can to support them to deliver safe, high quality care”.
“Healthcare assistants, pharmacy technicians, rehabilitation assistants and other professionals all play a vital role in the NHS workforce”, she said, adding that she would be working with local nurse leaders on the developing STPs.
Meanwhile, the Care Quality Commission said: “We expect that all plans address the care and quality gap highlighted in the Five Year Forward View and that any changes proposed have been subject to a careful analysis of the risks and benefits, based on experience and evidence.”
The Department of Health declined to comment. Health secretary Jeremy Hunt told Health Service Journal last month that he thought the number of substantively employed nurses in the NHS should continue to increase, and pledged to hold the NHS to account over ensuring services were safely staffed.