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STP WATCH: neighbouring NHS 'footprint' to save millions by cutting number of registered nurses

Keeping an eye on forthcoming NHS changes that may also affect or influence plans for our area:

A neighbouring Sustainability and Transformation Plan (STP) area - or 'footprint' - has declared its intention to cut its workforce costs by £34,200,000.

The Buckingham, Oxfordshire and Berkshire STP area's newly published document states that the three counties are going to introduce more 'generic support workers' across health and social care and employ fewer registered nurses.  The document calls for "...skill mix changes to support a more flexible workforce".

A report in the Health Service Journal says that a projected workforce growth for the footprint of 4,526 full-time equivalent staff will be reduced to an increase of just 978 - despite admitting staff will face "...approximately fifteen per cent more patients".

Among those 'generic support workers' will be healthcare assistants and physicians associates.   They also hope to save a further £17,800,000 in their spend on agency staff by setting up an STP-wide staff bank - these are generally nurses who do not want full-time jobs but need to work fill-in shifts at hospitals.

We are constantly being told that the STP project teams will not be a permanent part of the NHS' organisation.  But this neighbouring STP footprint - known, apparently, as BOB - is planning to set up a board that will meet monthly to 'hold the three health economies to account' as they try and implement the new plans.  

Statutory responsibilities will remain with the clinical commissioning groups and with the hospital trusts and, presumably, with the local authorities - but there will be an executive for the all three counties that will be commissioning health provision.  One of their targets will be a saving of £60,200,000 by preventing an expected three per cent growth in commissioning specialised treatment services - see below.

This is beginning to look more and more like a major restructuring of the NHS organisational model set-up by the Lansley reforms during the coalition government.  Inserting an extra layer into the organisational hierarchy will get very close to reintroducing the Strategic health Authorities that the Lansley restructuring abolished.

These plans came in the same week as research published in the British Medical Journal Quality and Safety Journal found that diluting the nursing skill mix increases the risk of patient death. The study revealed that for every 25 patients, substituting one registered nurse with a non-nurse increased the possibility of the patient dying by 21 per cent on an average ward.

One anonymous comment published on the Health Service Journal website says: "Mid Staffs anyone? It beggars belief that despite all of the evidence demonstrating the value of [registered nurse] time and the improved safety and quality of care - when faced with austerity they all cave in."

FAQ:  What are specialist services?  They are treatments centralised in relatively few hospitals serving a large enough area with enough patients enough patients with rare disorders so that expert teams can be recruited and can develop their skills.  They include services from renal dialysis to treatments for rare cancers and life threatening genetic disorders.  NHS England spends £15.6 billion on funding specialised services.

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