Across London, there are five STP ‘footprints’ with a combined funding shortfall of £4 billion. Three of the capital’s more financially challenged STPs (NCL, NWL, SEL) have been placed into a Capped Expenditure Process (CEP), a method by which NHS England and NHS Improvement can put even tighter spending controls on providers deemed to be ‘overspending.’
The transformation outlined in the STPs in London – and across the country - aim 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. 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.
On Tuesday, RCN London attended the launch of a report into STPs in the capital by the King’s Fund and the Nuffield Trust. The report was commissioned by the Mayor of London Sadiq Khan and set out to provide up to date analysis of the development of London’s STPs.
Unfortunately, the report’s findings mirror some of our concerns in the region. That 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.
According to the report, the major plans to moderate people’s reliance on acute services and reduce bed capacity are ‘not credible’ and that generating more savings through even greater efficiencies are ‘likely to be unachievable’.
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’. After speaking to all but one of the STP leadership across London, it is estimated that 3,800 registered nurses, HCAs, and midwife posts will be lost. 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.
The plans across the capital do contain innovative ideas aimed at addressing health need today and into the future and there is also a welcome focus on providers collaborating, rather than competing. But still, as was pointed out at the launch of the report, the elephant in the room remains the chronic underfunding of the social care sector and the fragility of the NHS and social care workforce. Until the government acknowledges this, and provides the appropriate resources, the safe delivery of STPs in the capital will be close to impossible.
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.