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Friday 15 September 2017

STPs – making your voice heard

By Alison Moore

MiP's first webinar for members examined how Sustainability and Transformation Partnerships will affect managers' working lives, and how MiP can support them through the process.

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With STPs becoming the key driver of change in the NHS in England, MiP’s first-ever webinar for members, held on 12 September, was designed to examine how STPs will affect managers’ working lives and what the union can do to make sure members are fully engaged in the process.

MiP chief executive Jon Restell started the 45-minute session by outlining the “very fluid situation” with STPs, where the ground is continually shifting and there are huge variations in progress between different areas. The most advanced areas are already moving beyond STPs towards accountable care systems (ACSs), while others are moving much more slowly.

This varied picture presents challenges for trade unions, Restell explained, as does the fact that STPs affect all types of NHS organisation, whilst previous changes tended to affect only one part. “It does have a kind of breadth to it that I don’t think that we’ve seen before,” he said.

No single voice

Restell said the picture is particularly complicated because the Lansley reforms mean there is no single voice to consult with on the issues STPs were designed to tackle – half a dozen national bodies might be involved in workforce issues, for example. “There’s no ring to rule them all,” he joked. “We’re not living in a world where you can strike a deal which gets replicated throughout the service.”

He stressed that while some unions have opposed STPs, MiP takes a neutral stance, seeing them as a mechanism which could result in good or bad outcomes. ‘We’re saving our gunpowder for the outcomes of this planning process,” he said.

“One of the key risks is that it becomes another reorganisation of management structures,” Restell added. “We have a real fear that a lot of what is going on is a restructure which is effectively happening under the radar without any ‘tidying up’ through legislation. That makes it even harder to represent members.”

High impact on managers’ jobs

A poll of MiP members taking part in the webinar found that more than half thought STPs will have a high or very high impact on their jobs, emphasising the importance of MiP being able to support members, both as managers and employees, through the STP process.

Responding to questions from participants, Restell explained the priorities for trade unions over the last six to nine months: arguing for proper funding and investment in STP change plans; pressing STP leaders to engage with staff and give them a leading role in managing change; getting STPs leaders to talk to unions at the appropriate level; and agreeing protection for terms and conditions.

“Funding and investment for the many changes planned is going to be absolutely critical,” said Restell. “Most of these plans have an air of unreality around them when it comes to capital investment. From the staff side the message has been very clear: there needs to be a set amount of money to invest in the change plans.”

Engagement with unions and staff has been patchy, he added, and there’s an additional problem in working out how to engage with what might be system-wide changes. “There are some emerging structures to allow this to happen at system level,” he said.

Nationally, Restell explained that MiP has been involved in discussions with NHS England about how to ‘derisk’ change and make staff more confident that terms and conditions will be protected. There has also been national guidance on engagement – with the emphasis on early engagement rather than waiting for formal consultation – and discussions at national level about access to NHS pensions for staff who move to non-NHS bodies.

Transformational change

MiP national officer Pete Lowe said many members are caught up in other transformational changes running alongside STPs, such as the introduction of new models of care. He cited the example of Dudley where, as well as the STP, CCGs are facing other significant changes as part of a vanguard.

“For individual members of NHS staff it comes down to asking: what’s the impact on my job? The starting point for all the [MiP] officers is how we can protect that individual member of staff,” he said.

Providers often feel they are kept at arm’s length from much of the STP process, and Lowe expressed concerns that issues are too often viewed in narrow “silos”. Many CCGs have also been facing rapid reconfiguration with increasing impact on members. “It feels like continual churn… it starts with people making that phone call because they are feeling unsure about the impact of change,” he added.

Lowe questioned whether existing consultation processes allow staff to influence what is happening, or whether STP leaders and employers are just going through the motions. He advised MiP members to contact their MiP national officer as early as possible if they want to influence the direction of change.

Challenges for CSUs

MiP national officer Jo Spear discussed the position of members in Commissioning Support Units (CSUs) and arm’s length bodies like NHS England, who are increasingly being told their work will be aligned with STPs. How this will affect staff remains unclear. “What does it mean if your employer is going to align your work with an STP? Do you then need to be consulted about the STP?”, she asked.

CSUs are in a “very challenging situation”, she warned, with members asking legitimate questions about how being linked to an STP might affect the future of their CSU or lead to them being seconded to work elsewhere as ACSs are set up. In the southern region in particular, there are also related steps to align the work of NHS England and NHS Improvement which could also affect members’ jobs, she added.

Restell said there is a conflict between the regulation of individual NHS organisations and the collective nature of STPs, warning that some organisations could run into regulatory trouble as they try to achieve the STPs’ aims.

A patchy picture

Spear described a highly variable picture: in some areas NHS organisations are sticking to a highly competitive model, while others pursue a more collaborative approach. Attitudes to engagement are also mixed, she said: in London, some employers have been very organised about engagement; but in the south-east coast area, engagement has been more “presidential” and unions are “swimming upstream” when they try to get STPs to prioritise the impact on staff.

But both Spear and Restell highlighted the very real challenges for unions, which tend to be well organised at employer and national levels, but aren’t configured to engage at the STP level. They agreed that unions may need to “kick the door down” to ensure they can negotiate at the right point.

Restell also explained how the MiP reps initiative, which has seen the first eight MiP reps take up their positions this year, will help to boost MiP involvement at the right levels for STPs. “The two really key messages from us are about getting active, and sharing best practice,” he concluded.

You can watch the full webinar online. MiP is planning a series of members’ webinars – get in touch at info@miphealth.org.uk to let us know what you’d like us to discuss.

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