Region plans shake-up of nursing skill mix to save millions

The Buckinghamshire, Oxfordshire and Berkshire West sustainability and transformation plan says it will achieve the savings by the “use of generic support workers (across health and social care), reduction of nursing grade input, increased use of healthcare assistants and physicians associates and more flexible uses of emergency care practitioners and advanced nursing practitioners”.

It also reveals the first reported example of NHS regulators having a key role locally in the plans, with representatives from NHS England and NHS Improvement sitting on the STP’s delivery board.

The plan, published this week by Reading council, says the region can make £34.2m of workforce savings through ”skill mix changes to support a more flexible workforce”.

The document says it plans to reduce a projected workforce growth of 4,526 full-time equivalent staff to an increase of just 978 despite admitting staff will have to manage “approximately 15 per cent more patients”.

It also refers to savings of £1.25m a year through use of “new roles including generic support workers between health organisations and across health and social care” but adds these are “yet to be evaluated”.

Research published yesterday highlighted an increased risk of death as a result of diluting the registered nursing skill mix with more support staff.

The BOB STP is structured along three local health transformation programmes – Oxfordshire and Buckinghamshire, and the Berkshire West accountable care system.

The region will have a monthly board to hold the three health economies within its footprint to account. The board will ensure “system level financial delivery against local system control totals”, as well as “rigorous scrutiny of key performance targets” such as quality.

The board will include the leads of the three local programmes, along with the STP lead, programme and finance directors. It will sit below a quarterly oversight board but both will have the same chair, Professor Gary Ford, chief executive of the Oxford Academic Health Sciences Network, and a single senior responsible officer, David Smith, the current STP lead and chief executive of Oxfordshire CCG.

Statutory responsibilities will still remain with individual organisations, while a wider representative will sit on the oversight board including the six clinical commissioning groups, seven NHS trusts and 14 local authorities on the patch.

STP-wide initiatives will be planned and commissioned from a CCG commissioning executive, which HSJ reported last month will have delegated authority from the seven CCGs that feed into it. The plan confirmed the executive will “initially focus on specialised commissioning; ambulance services; NHS 111; mental health; and cancer”.

To better secure collaboration, STP partners will be asked to sign a memorandum of understanding and the STP is also “exploring a risk share agreement” across trusts and CCGs to minimise financial risk if one part of the system cannot fully deliver its plan.

While each local area has its own health priorities, the three will feed into overarching STP plans to:

• Save £60.2m from specialised commissioning by preventing an expected 3 per cent growth, though the plan admits “further testing” is required to make sure these savings are “real”. The document suggests the footprint plans to restrict the number of treatments currently available as it will offer “alternatives” to specialised treatments that provide “poor outcomes and are low value”.
• £34.2m of workforce savings including a reduction in registered nursing input and “increased use” of “generic support workers” and physician associates. It hopes to cut agency costs by £17.8m by creating an STP-wide staff bank.
• Review the sustainability of emergency and urgent care, obstetrics and paediatrics at Horton Hospital.
• “Deliver primary care at scale” by integrating primary and community care. STP leaders will consult with GP federations about how they can best work across the STP geography and expect all CCGs to also be commissioning primary care by next April.

The plans recognise that “political involvement” is a risk factor in implementing reconfiguration plans, adding “the closure or perceived reduction of services has already resulted in the formation of campaign groups with MP and local councillor support”.

Reading councillor Graeme Hosking said: “We need there to be a much clearer focus on the wider health and social care system, as well as local public health initiatives in places like Reading. Without proper acknowledgement or consideration of the vital role local authorities have to play, we remain to be convinced this is anything other than a crude cost-cutting exercise under the guise of transformation.”