STPs explained

What you need to know about sustainability and transformation plans

If you and your colleagues are delivering care in England, whether you’re employed in the NHS or independent sector, it’s likely your working arrangements could be affected by sustainability and transformation plans (STPs).

They’re being developed as a way of implementing the NHS Five Year Forward View for England (2016-2021).

The programme aims to bring together local health and care leaders, organisations and communities to develop plans for their areas that improve quality, health and wellbeing and make efficiency savings.

Each of the 44 plans for health and social care services is at a different stage. But what’s certain is that members, reps and staff are or will be dealing with change in structures, systems and working arrangements, wherever they’re based.

The RCN position

The RCN supports the aims of STPs, but only if the reality matches their ambitions. 

Around the UK

Integration in health and social care is an explicit policy goal of all UK governments.

Northern Ireland

Northern Ireland has had an integrated health and social care service since 1974.


In Scotland, all adult social care, community health and some hospital services were integrated in 2016. In some parts of Scotland, children’s services are being integrated too.


The Welsh Government is committed to integrating health and social care. Proposals for local government reform, which encourage regional level commissioning, will facilitate this.

STPs must provide assurances

Get prepared

You’re the face of the RCN and you can represent members in the development and implementation of plans, with the support of RCN staff.

Get involved

Seek out key stakeholders. This could be through your joint consultative and negotiating committee, a planned consultation event, or getting yourself invited to a relevant meeting.

Ask questions

Use your Ask. Listen. Act. booklet to get started. Integrating Health and Social Care Across the UK: Toolkit for Nursing Leaders will also be helpful.

Talk to members

Many members are unfamiliar with the terminology or high level strategic discussions, but most directly affected will have heard about changes. Keep talking to members, capture their learning and share yours with them.

Work with your officer

You have the RCN’s full support. Your regional office will be sharing intelligence and experiences with their colleagues nationally.

Act now and work together

RCN steward Rachel Morris took urgent action in response to an STP being set up in her area.

She says: "Working with other reps and unions I’ve set up and currently chair a county-wide staffside council to work with other health and social care unions to make sure staff and patients’ views are considered.

"Northamptonshire County Council announced changes that will have an impact on secondary health partners across the STP footprint. We’ve been led to believe that staff at the council have not been fully consulted on changes.

We must protect patients

"The Northamptonshire STP has been rated as four – needing significant improvement – so we’ve no time to lose. We’ve invited the local workforce lead to our next meeting along with local HR directors and the lead for Health Education East Midlands.

"We need to work together. We must protect patients, ensure the services are fit for purpose, and protect national terms and conditions."

Find out more

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