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

Workforce costs in a south of England region will be cut by more than £30m through changes to the nursing skill mix including greater use of “generic support workers”, according to a newly published STP document.

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.

Full story in The HSJ 17 November 2016