Doctoral student writing

National Health Service Sustainability and Transformation Plans: Competing Models of Care Provision?

  • School: Nottingham Business School
  • Starting: 2018
  • Funding: UK student / EU student (non-UK) / International student (non-EU) / Self-funded


Since the 2000 NHS plan ‘modernization’ informs NHS policy; in 2016 NHS England guidance planning called for a five-year forward-view in collaborative Sustainability and Transformation Plans (STPs). Forty-four area foot-prints - place-based STPs (e.g. Nottingham and Leicester) identify policy priorities for a defined area and develop transformations to meet these priorities, but crucially do so within financial balance. The proposed doctoral project will provide original research to reveal the potential for STPs to introduce locally focussed high-performing health care whilst learning from and anticipating difficulties associated with this aim. There are two thematic research questions: Firstly, how will the re-configuration of local health care and diffusion of new care models develop following the recent imposition of the imperative of financial balance? As amalgamations of local area NHS organizations, STPs require collaborative collective governance and accountability, but how is this sustainable in the competitive framework established under NHS modernization?

Secondly, how will STPs impact on local management and local workforces?  STPs anticipate Local Workforce Action Boards designed to re-shape the workforce via the introduction of associate nurses, physician associates, and community paramedics. What are the likely consequences for established patterns of management, work and employment, staff retention, pay, job security and work experiences? To what extent will the management and organization of the NHS HR function be reformed to become part of the STP innovation process?

Viability of Project Design and Project Methodology. The comparative evaluation of two east midlands STPs will examine planning, execution and progress across two-foot print areas. This will examine the planning assumptions behind the diffusion of the STPs and assess the consequences of them for broader hospital and NHS decision making on service delivery, the management of employee working time, and associated behaviours through a mixture of qualitative and quantitative research at Trust level and occupational level. This approach allows interrogation of the connections between the impact of new business and care models on trust services and the management and organization of these services in terms of patient experience and the potential impact of these innovations on the working lives of NHS employees.

The initial stages of the doctoral research will secure access to STP leaders and managers and conduct further desk research and fieldwork on local stakeholder views on the STPs.  To be achievable, meaningful, original and viable within academic and practitioner communities, research of this type must secure NHS ethical from Trusts and Local Authorities; the first two months of the project will address these methodological requirements. Compilation of interview questionnaires and on-line survey questions for managers and clinicians will follow this to cross reference with the NHS staff survey. The fieldwork with be piloted to refine research design; fieldwork interviews will then be conducted with STP leaders, HR directors and clinicians, for example those in A&E and urgent care centres who will be at the forefront of transformation.

Description of Project’s Expected Outcomes. The research design anticipates significant outcomes relevant to policy, practitioner and academic interests, specifically Health England, hospital managers and new capital providers which may participate in the diffusion of STPs and associated business, care and ownership models into the established NHS. For these policy makers and for NHS stakeholders the project outcomes will provide informed understanding of the implications which follow continued NHS modernization in STPs. The aim is to learn from successes and failures to promote more successes whilst identifying the potential for failure earlier in the planning and implementation process. Outcomes will also inform medical officers, strategic managers and human resource managers who will have to manage the diffusion and implications of new business, care and ownership models in the NHS.

The impact of project outcomes will be most rapid in the NHS and particularly in the case study organizations enabling them to assess the strengths and weaknesses of new business and care models associated with STPs and the bids for contracts which support them. The outcomes of the doctoral project will inform the public and stakeholders who want assurances that the impact of these developments on the NHS workforce, seen by many users of the NHS as its key assets, will not be negative. Outcomes will be disseminated in policy relevant academic journals, collaborative practitioner, financier and NHS management practitioner focussed workshops and seminars.


Professor Ian Clark

Entry qualifications

An applicant for admission to read for a PhD should normally hold a first or upper second class honours degree of a UK university or an equivalent qualification, or a lower second class honours degree with a Master's degree at Merit level of a UK university or an equivalent qualification.

International students will also need to meet the English language requirements - IELTS 6.5 (with minimum sub-scores of 6.0). Applicants who have taken a higher degree at a UK university are normally exempt from the English language requirements. A research proposal (between 1,000 and a maximum of 2,000 words) must be submitted as part of the application.

For more information please visit the NTU Doctoral School – Research Degrees webpages.

How to apply

How to apply

Applications are accepted all year round.

Download an application form here.
Please make sure you take a look at our application guidance notes before making your application.

Further information on how to apply can be found on this page.

Fees and funding

This is a self-funded PhD opportunity.

Guidance and support

Further information on guidance and support can be found on this page.

Still need help?

Ian Clark