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. 

  • STPs could help improve the health of the nation if they prevent ill health, join-up services and deliver care in more appropriate settings. However, the RCN fears they may be used as a smokescreen for savings, and that services may be cut without good alternative arrangements being made.
  • The plans may mean changes for staff who may have to work across sectors or different organisations. These could offer opportunities, such as new roles and more autonomous working. But if financial considerations come first, the plans could result in unsafe nurse staffing levels and skill mixes.
  • The RCN will oppose any reduction in the number of registered nurses because of the impact this would have on patient care.
  • Many STPs are being rushed through without proper consultation with staff and local communities. This must change.

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

  • There must be clear evidence to support changes, including how STPs will improve patient safety, quality of care, workforce and finance. Equality impact assessments are also essential.
  • The plans must be made public and shared with staff, unions, reps and local communities. Early and meaningful engagement is needed.
  • Involve nursing staff because they know what works best for the services they deliver and the people they care for.
  • Plans must be properly funded. We support efficient care delivery but must see evidence that improving care is the priority.
  • Service redesigns must show how resources will be re-used in other parts of the health and care service.
  • There must be no significant closure of services without a clear plan for delivering patient care in other ways.
  • Each plan must have a workforce strategy that deals with staffing levels, skill mix, training requirements, transfer and protection arrangements. It must be discussed and agreed in partnership with staff and their reps.
  • Each plan must give staff security in relation to their employment status, continuity of employment, terms and conditions, pension entitlement and training needs. This must be developed in partnership with staff and their reps.
  • Equality must be properly considered and recorded. An evidence-based equality analysis means better quality decisions can be made on behalf of communities.

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.

  • Understand the implications for members locally. Check out the RCN's webpages on STPs
  • Read your local plan carefully. Does it provide assurance about the areas we’ve highlighted? Who are the decision makers and stakeholders?
  • Identify next steps and ways of working. Where are they in terms of planning and implementation? How are the decision makers engaging with unions? How and when are they consulting?

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."

Read next...