An STP in the right direction?

 Sheila Marriott 1 Dec 2017 East Midlands STP

In meteorological terms, today is the first day of winter, the time of the year associated with increased pressure on the whole health and social care system; pressure most keenly felt in hospital emergency departments and inpatient wards, the gauge of how much capacity there is, or not, in the system at any one time.

It’s clear that winter pressures are no longer limited to the three months between now and the end of February, nor even if you add on one or two weeks either side, as might have been the case a few years ago.

Unprecedented levels of patient demand, persistently high staff vacancy rates and the longest and deepest squeeze on funding in the history of the NHS have combined to create a climate in which spring or even summer strains are the norm, too. 

Across the East Midlands, as elsewhere in England, local partnerships of commissioners and providers of health and social care – known as Sustainability and Transformation Partnerships or STPs – are now starting to implement multi-year plans to reform health and social care services in their area to meet future demand on the system, bring about effective integration and improve people’s health and health outcomes. 

Financial strait-jacket 

They’re having to lead and facilitate this transition not only while continuing to do the vital fundamentals of their day job but also in a financial strait-jacket, without the prospect of receiving the levels of recurring funding that most observers, including the RCN, believe is truly needed to turn their vision into a reality.

Reducing the number of acute hospital beds and investing the resulting savings in alternative services delivered more appropriately in people’s homes or neighbourhoods is one of the objectives that most STPs are working towards. Care, comfort and convenience for the patient and cost-efficiency for the taxpayer, they say. It’s a valid point. 

In the East Midlands alone, at least 850 acute hospital beds – and possibly more – are in line to be closed before 2021 to help achieve this re-balancing act, according to the plans of the five STPs in Derbyshire, Leicestershire and Rutland, Lincolnshire, Northamptonshire and Nottinghamshire.

But how sustainable is this element of a plan that, by definition, has sustainability as a driver? Surely, sustainability shouldn’t just be measured in financial terms?

Hazard warning lights 

It’s too early to say, of course, but the hazard warning lights are definitely flashing. In Leicestershire, for example, the hospital trust couldn’t afford to wait until winter to deploy a so-called ‘September Surge’ of action to try to address its poor A&E performance. 

More recently, the STP in Leicestershire and Rutland has indicated that its revised plan, due to be published soon, will entail ‘less change to hospital bed capacity than had been initially proposed.’ In the circumstances, this sounds eminently sensible.

Every STP has established or is establishing a Local Workforce Action Board, and these will be the forums in which we and our fellow trade unions will scrutinise future plans for their potential impact, good or bad, on nursing and patient care.

We’ll be using these opportunities to remind the STP leaders that, as far as hospital bed closures are concerned, they must not happen unless or until they have passed the test set by NHS England on sufficient alternative provision having been established and demonstrated.


Sheila Marriott

Regional Director

Regional Director, RCN East Midlands

Page last updated - 16/10/2018