Sustainability and transformation plans mean another huge redisorganisation of NHS

At the 22 March Calderdale & Kirklees Joint Health Scrutiny Committee meeting, a representative of the stealth-privatising quango NHS England (NHSE) said they will be looking at the sustainability of our hospitals Trust in the context of the wider footprint (West Yorkshire and Harrogate). He said that

‘There are some services that need to be configured and delivered differently’.

In my opinion, this is a euphemism for:

“Loads of service cuts will be made and the entire system of organising the NHS in West Yorkshire & Harrogate will be turned upside down and shaken vigorously until it is unrecognisable.”

In response to a question from Cllr Adam Wilkinson about “what conversations are going on nationally” about how to cope with pressures outside the Clinical Commissioning Groups’ control – including the “worry” that our hospitals Trust “is still going to be unsustainable after the reconfiguration”, with a £9.5m/year funding shortfall (aka “deficit”) in 2020, the NHSE West Yorkshire Locality Director Brian Hughes explained that NHSE’s 5 Year Forward View was the main national response to such pressures – mainly the projected £22bn NHS funding shortfall by 2020.

Mr Hughes then explained that a recent development of NHSE’s 5 Year Forward View is the establishment of “more networked models” and “the development of sustainability and transformation plans across geographies”.

Decoded, this means that wider geographic areas will share services between them, replacing services that are currently provided within each area.

Mr Hughes said:

“Within the West Yorkshire context, what we’re doing at the minute is looking at a strategic 5 year plan both at a local level and in West Yorkshire – we talk about 6 and 1 plans, where there are 6 primary sustainability and transformation plans which recognises these local footprints… [there is one for Calderdale and one for Kirklees]… there are 6 plans and then an overarching West Yorkshire plan with a recognition that there are some services that need to be reconfigured and delivered differently and what we’re doing through the summer is working with these 6 areas and the 1 plan to try and build a sustainable and transformed system which recognises the challenge around resources and also around staffing resources as well.

And what we’ve also got in this system is the W Yorks Association of Acute Trusts which is a collaboration or agreement across the providers across West Yorkshire to start looking at some of those challenged areas as well as thinking differently about what services needed to be provided and how they will be provided to local populations.”

None of the Councillors showed any interest in this vital information or asked anything about it and its possible implications for the future of our hospitals and their services.

The 44 Sustainability and Transformation Plans have been urgently ordered by NHSE boss Simon Stevens (who was previously a boss of the global health company United Health and is now on a mission to impose the company’s cost-cutting, treatment-denying, profiteering systems on the NHS).

Simon Stevens the NHS Privatiser_n

At their Extraordinary General Meeting on 16 March, Kirklees Councillors (apart from JHSC members) voted unanimously to support a motion that the Council rejected the hospital cuts proposals and would instead come up with a plan for place-based health services. This motion – written by a Council adult health & social care officer – is code for support for the Kirklees Sustainability and Transformation Plan. So Kirklees Council – knowingly or unknowingly – passed a motion that can be read as supporting the Sustainability and Transformation Plan. This could come back to haunt them.

Because the Sustainability and Transformation Plans are to urgently cut NHS spending – and therefore services – in line with the projected £22bn NHS funding shortfall by 2020.

If NHS England doesn’t like a Sustainability and Transformation Plan, it and the new hospitals regulator NHS Improvement will step in and enforce the cuts they want

If Sustainability and Transformation Plans don’t deliver the cuts NHSE wants, NHSE and the hospitals competition enforcer/regulator NHS Improvement (that from 1 April 2016 replaces Monitor and the Trust Development Authority, and was designed by global management company KPMG for a fee of £1m) will step in and direct changes to be made in a particular area.

The Sustainability and Transformation Plan therefore represents a massive reassertion of central control; foundation trust autonomy has gone.

This means that decisions about what happens to our hospitals in Huddersfield and Halifax will not be made in Kirklees and Calderdale and it makes a further mockery of the pretence that the hospital cuts proposals currently out to public CONsultation are in any way shape or form the outcome of local clinicians’ local knowledge.

It also means that Save our A&Es campaigners’ attempts to stop the hospital cuts proposals from being carried out have to be part of a broad national campaign to restore the NHS and free it from the depredations of NHSE, NHS Improvement and whoever the nominated leader of the West Yorkshire Sustainability and Transformation Plan (STP) turns out to be.

In the Greater Manchester STP “footprint”, the nominated leader is the unelected Chief Exec of Manchester City Council – the one who was happy to jump on George Osborne’s Devo Manc  (along with the Council Leader) without bothering to consult the Councillors. In the Birmingham and Solihull “footprint”, the nominated leader is Mark Rogers, unelected Chief Exec of Birmingham City Council. Mark Rogers says the plans will give them the opportunity to make “pretty seismic changes”.

Failure to produce an STP would mean that NHS “providers” would not be eligible for a share of the Dept of Health’s £1.8bn bailout fund for this year. This bailout cash forms part of the £3.8bn NHS funding frontloaded in the government’s spending review.

Richard Vize, writing in Guardian Healthcare Professionasl Network, tells us this means:

“…by the summer, we may well have some specific details on service cuts and closures…If […] not, this latest planning process will have failed…The financial crisis is now so severe that it is all but impossible to see a good outcome…

The central bodies are therefore likely to have little compunction in directing changes to be made in a particular area if the sustainability and transformation plan is deemed inadequate. For this reason, the plans represent a massive reassertion of central control; foundation trust autonomy has gone.”

Calderdale Clinical Commissioning Group refused to publish their draft STP plan

NHSE ordered all Clinical Commissioning Groups to come up with a draft 5 Year Forward View Sustainability and Transformation Plan draft by 29 January 2016. This is in addition to the usual requirement that all NHS organisations produce individual operational plans each year.

In early February I asked Calderdale Clinical Commissioning Group for their draft STP plan and received a brush-off reply from their Communications and marketing officer.

Writing in Our NHS on 23rd March, health reporter Caroline Molloy explains:

“Most of the political and NHS establishment seems keen to assure us that the last thing the NHS needs is more reorganisation.

But the cash crisis is resulting in some sweeping changes to what the NHS actually offers across the country, well off Westminster’s radar.

Guardian columnist Polly Toynbee suggested at a Kings Fund meeting yesterday that these politically imposed £22bn cuts plans (as set out in Stevens’ Five Year plan and the 44 new STP ‘footprints’ set up to deliver them) “are beginning to look like a reorganisation so big you can see it from space” (as David Nicholson famously said of Lansley’s 2012 Health Act).”

Calderdale Council Health & Wellbeing Board discussed Sustainability and Transformation Plan on 17 March

In a typically bland press release that obscures all these issues, Calderdale Council today announced that on 17 March the Calderdale Health and Wellbeing Board discussed the West Yorkshire and Harrogate Sustainability and Transformation Plan.

The STP needs to be ready by June, and Calderdale Council, NHSE and “other partners” will meet in April to see how the STP “covers all those elements that are important to Calderdale”, according to Cllr Janet Battye.

In Calderdale Council’s Through the Looking Glass version of the STP, it will cover:

·         Prevention, with an emphasis on obesity and diabetes;
·         Local priorities to reduce demand and improve people’s health;
·         How to increase investment in “out-of-hospital” services including GP services;
·         How to deliver 7 day services  and weekend access to GP services;
·         Actions on priorities including improving cancer outcomes; increasing investment in mental health services by making they are as valued as  physical health services; transforming learning disabilities services and improving maternity services and
·         Returning the local health system to financial balance.

Here is the bit of the JHSC meeting video that includes Brian Hughes’ info on Sustainability and Transformation Plans – around 53mins 15 sec.

Info here (page 8) about the fact that our hospitals Trust doesn’t have a sustainable future,  even if all the proposed “Right Care Right Time Right Place” hospital cuts are carried out.

Sustainability and Transformation Plan guidance is here

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