So-called Sustainability and Transformation Plans: huge NHS cuts, increased privatisation and massive top down redisorganisation

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,

‘Some services will need to be delivered differently’.

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.”

Cllr Adam Wilkinson asked “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 2020/21.

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 regional 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 their cost-cutting, treatment-denying, profiteering systems on the NHS).

Simon Stevens the NHS Privatiser_n

At the 14th April Calderdale Clinical Commissioning Group Governing Body meeting, the Chief Officer Matt Walsh reported that:

“To facilitate West Yorkshire-wide working a full time Programme Management Office has been created and hosted by Wakefield CCG. The initial task will be to co-ordinate the development of plans that are focused on cancer, specialised commissioning and urgent and emergency care (including the mental health aspects of the Urgent and Emergency Care Vanguard Programme).”

On 16 March, Kirklees Councillors voted unanimously in favour of a motion – written by a Kirklees Council adult health & social care officer NOT by Councillors – that the Council rejects the hospital cuts proposals and should instead come up with a plan for place-based health services. A Kirklees Councillor who I asked about this didn’t realise that their motion contains many coded references to the Sustainability and Transformation Plans. So Kirklees Council – knowingly or unknowingly – passed a motion that can be read as supporting the Sustainability and Transformation Plans (STPs). This could come back to haunt them. Because the STPs are to urgently cut NHS spending – and therefore services – in order  to eliminate the NHS deficit in their area in 2016/17 and if they don’t they will be sanctioned by being refused any money from the Sustainability and Transformation funding pot.

This Sustainability and Transformation Plan funding is part of the extra £3.8bn NHS England got the government to cough up for the NHS in its 2015 Comprehensive Spending Review, as frontloading for the extra £8bn the government promised in 2015, that reduces the projected NHS funding shortfall by 2020/21 from £30bn to £22bn.

Except that it   turns out that only £1.8bn of this is new money from the Department of Health and the rest of the £3.8bn NHS England funding comes from taking money from other areas of the NHS budget.

Government commitment that STPs will increase NHS privatisation

The STPs will lead to increased NHS privatisation. A guide to how the private sector can benefit from the Sustainability and Transformation Plans says that:

“As has been acknowledged in the initial guidance, the independent sector should play a key role in helping individual footprints to meet the stated requirements for STPs and in ensuring the plans are effectively delivered…

“The 2015 Spending Review settlement for the NHS committed the government to encouraging long-term partnerships with the private sector in
a number of key areas including:

  • development of new models of care including Accountable Care Organisations
  • the upgrade of diagnostic capabilities
  • hospital groups and acute care collaborations…

Sustainability and Transformation Plans (STPs) will be place-based, multi-year blueprints that ensure the additional funding secured in the Spending Review is
effectively channelled into transforming the way care is delivered.”

That guide is co-written by Rob Webster, the new Sustainability and Transformation leader for the West Yorkshire & Harrogate Footprint. So we know what to expect from him.

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 STP footprints fail to eliminate the overall NHS deficit across the area, NHSE and the hospitals competition enforcer/regulator NHS Improvement will step in and direct changes to be made in a particular area. (Designed by global management company KPMG for a fee of £1m, from 1 April 2016 NHS Improvement replaced Monitor and the Trust Development Authority.)

Any real-terms increase in Clinical Commissioning Group funding will also depend on “successful development of STPs”, according to the private health companies guide.

Democratic deficit

The STP therefore represents a massive reassertion of central control. In addition, GPs on Clinical Commissioning Group Governing Bodies will lose their vote about commissioning decisions to be taken on a regional basis in the “footprints”. Until now they have had voting rights in the precursor regional collaborative assembly of Clinical Commissioning Groups – West Yorkshire and Harrogate’s “10 Commissioning Collaborative” (10CC).  In the STP Footprints, only Clinical Commissioning Group Chief Officers will be able to vote on STP Footprint decisions.

GPs on Calderdale Clinical Commissioning Group Governing Body were clearly disgruntled about this when Chief Office Matt Walsh announced it at the April meeting. The Chair Dr Alan Brook said,

“In the 10CC, decisions did remain with CCGs in the past. Now in the proposed [Healthy Futures footprint] structure, CCGs will only be represented by Accountable Officers. Clinical leaders will attend but aren’t part of decision making. It’s a significant alteration in the powers of clinical needs. I’m drawing the attention of GPs present to the altered relationship with 10CC. It’s a significant step.”

Penny Woodhead, the engagement officer, said,

“We need to make sure we don’t lose Calderdale CCG values in this shift, for example, robust engagement.”

Matt Walsh said,

“This was articulated at the Health and Wellbeing Board this morning. There is a democratic deficit within the West Yorkshire picture. It’s very difficult to see how politics at the West Yorkshire level will work out.

Calderdale is very dependent on the rest of West Yorkshire services, eg Leeds – unlike other CCGs.”

Julie Lawreniuk, the Finance Officer, said,

“For things to be delivered at the West Yorkshire level, it would need to show better outcomes by delivering at scale.”

But she didn’t say what outcomes – patient outcomes, financial outcomes or what.

Dr Caroline Taylor asked what the lead commissioner role/organisation means.

Matt Walsh said that Wakefield Clinical Commissioning Group is hosting the Healthy Futures programmes office to run Healthy Futures.

Dr Nigel Taylor said that specialist commissioning is new for Healthy Futures and asked if NHS England has delegated specialist commissioning.

Julie Lawreniuk said that NHS England has delegated bariatric surgery to CCGs and added,

“It’s about future proofing future delegated specialist commissioning.”

What does that mean?

Whatever it means, she went on,

“We need to be careful which services we delegate to Healthy Futures. Matt Walsh has been a leader in this.”

Someone asked what about Local Authority relationships with Leeds City Region Combined Authority. That question went unanswered.

The upshot is that decisions about what happens to our hospitals and other NHS and social care services in Huddersfield and Halifax will not be made in Kirklees and Calderdale, which 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.

This explains why both Owen WIlliams, the hospitals Trust Chief Exec, and Dr Brook, the Calderdale Clinical Commissioning Group Governing Body Chair, have both said during the CONsultation process that if they don’t make the Right Care Right Time Right Place hopsital cuts, NHS Improvement will come in and make far worse cuts.

It also means that Save our A&Es campaigners’ attempts to stop the proposed hospital cuts from being carried out have to be part of a broad national campaign to restore the NHS and free it from the depredations of the stealth privatising government, NHSE, NHS Improvement and the West Yorkshire STP footprint.

In the Greater Manchester STP “footprint”, the nominated leader is the unelected Chief Exec of Manchester City Council. 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 England funding frontloaded in the government’s spending review.

(Update 12/5/2016: Health economists have pointed out that the rest of the £3.8bn NHS England funding comes from taking money from other areas of the NHS budget, such as training of staff, investment in public health, regulation of quality, and national planning and support for providers.)

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

“…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.”

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 emailed 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).”

In a typically bland press release that obscures all these issues, Calderdale Council  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 ( who has since lost her place on Calderdale Council in the 5th May elections).

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. (ie eliminating any deficits)

The Calderdale Council press release did not mention that  “there was concern at local government level about the coverage and pace of the STP and the ability of local councils to express their views.” But this is what Matt Walsh (the Calderdale Clinical Commissioning Group Chief Officer) told the Calderdale Clinical Commissioning Group Governing Body meeting in March 2016, as the Minutes of that meeting record.

Nor does the press release mention the democratic deficit with the STP that Matt Walsh told the  April 2016 Calderdale Clinical Commissioning Group Governing Body meeting about.

Nor does it say anything about the fact that at the March 2016 Calderdale Clinical Commissioning Group Governing Body Meeting Bev Maybury, the Calderdale Council Adults Health and Social Care Director, “echoed some of the concerns raised and spoke of the importance of considering the STP together with devolution. The discussion at the health and well being board should consider what this meant for Calderdale residents first and then wider. Paul Butcher [the Public Health guy at Calderdale Council] also advised there was concern about the pace and where and how decisions were being made…” and there’s more along these lines.

I’ll dig out the HWB Board minutes which is where all this council stuff will have been
discussed and update this post with more information.

At the April 2016 Calderdale CCG Governing Body meeting, members of the public asked:

  1. Q: How is the CCG developing a shared vision of the STP with the local community? Which they’re supposed to do according to NHS England guidance. A: The CCG said they “believe the approach is consistent with the approach of the last 3 years”. And that they are working with Calderdale Health & Well Being Board which is to have “strengthened ownership of health” – whatever that means. And they had a workshopping session with them that morning. In other words, they’re doing nothing to ask local people what we think.
  2. Q: NHS England’s STP guidance says it depends on an open iterative engagement process – how is Calderdale CCG complying with this? A: They are working with the Health And Well Being Board, as above and have “fantastic engagement evidence” from the last two years” – engagement which the then-Chair of Calderdale Adults Health and Social Care Scrutiny Panel described at the end of the 2 year engagement as having been carried out in a “goldfish bowl” and told the Clinical Commissioning Group they should broaden the range of people they “engaged” with.
  3. Q: The biggest “stakeholder” is the public – when will Calderdale Clinical Commissioning Group robustly engage with us? A: Through the current Right Care Right Time Right Place consultation. ( As if – to the best of my quite extensive knowledge, the CCGs and Trust have said nowt about STPs in the course of the consultation so far. Time to ask them.)
  4. Q: What processes for “bringing local leaders together as a team and developing a shared vision with the local community, which also includes local government as appropriate” did Calderdale CCG set up and work through to produce the Calderdale Sustainability and Transformation Plan ‘footprint’ document that was submitted to NHS England on 29/01/16? A: They said see the info about the Health & Well Being Board in their answer to question 1. (But when did their work start with the Health & Well Being Board, mentioned in Question 1? Before or after they sent off the 29 Jan doc?)
  5. Why didn’t Calderdale CCG inform the communications officer about this? With the result that when I asked for information about the STP, the comms officer confused the STP with Calderdale CCG’s  Five Year Strategic Plan 2014/15 – 2018/19 and erroneously referred me to that document. A: A lot of Calderdale CCG’s 5 Year Strategic Plan has gone into the STP. The comms officer’s confusion “reflects the complexity of the NHS planning process”
  6. Q: Is the Calderdale STP footprint document in the public domain?  If it isn’t, why isn’t it? A: Minutes from the Calderdale CCG Governing Body meeting in March 2016 show the assumptions in the planning. Calderdale will have its own STP and will be part of the wider STP footprint.
  7. What processes for “bringing local leaders together as a team and developing a shared vision with the local community, which also includes local government as appropriate” has  Calderdale CCG set up and is working through to produce  the final STP document which is to be submitted to NHSE in June 2016 – and, according to the CCG Comms Officer, will be published until July 2016?  A: Calderdale Health & Well Being Board.
  8. What processes for “bringing local leaders together as a team and developing a shared vision with the local community, which also includes local government as appropriate” has Calderdale CCG set up and worked through to produce the Memorandum of Understanding for Healthy Futures, which is to “to develop and implement a Sustainability and Transformation Plan for the people of West Yorkshire and Harrogate and improve effective governance structures for place based commissioning through those arrangements to effect such Plan.”? A: The Memorandum of Understanding has gone to the Healthy Futures Board which has been established and is working with NHS England etc.
  9. The geographic scope of the Sustainability and Transformation Plan had to be submitted by Friday 29 January 2016, for national agreement. Local authorities had to be engaged with these proposals.
    a)What was the original geographic scope of the STP that was submitted? A: the STP Footprint
    b) What criteria were used to determine that scope?
    c) Was Calderdale MBC  engaged in these proposals?
    d) Which services were included in the original geographic scope? A:  The Jan 29 the submission didn’t go into detail about services
    e) What criteria were used to determine the services to be included? A:  The Jan 29 the submission didn’t go into detail about services
    f) How much overlap will there be with the other transformation footprints?
    g) What impact will the new geographic footprint have on health and social care in Calderdale?
  10. In other areas there are Transformation Boards to oversee the process  of producing Sustainability and Transformation Plans. Is there a Transformation Board in Calderdale? If so, what is its remit and who are its members and where does it sit in the ‘system architecture’? A: Calderdale CCG  “expects Calderdale Health & Well Being Board will be the site for the conversation about Transformation”
  11. Delivering the Forward View: NHS Planning Guidance 2016/17 – 2020/21 tells “local systems, early in the New Year, to go faster on transformation in a few priority areas, as a way of building momentum.” This momentum is to make “ local NHS systems …become sustainable” by “accelerat[ing] their work on prevention and care redesign”. So what priority areas of transformation is Calderdale CCG going faster on, since the New Year? A: Info about priority areas of transformation are in the draft 2016-17 1 year plan. They include the initial proposals for demand moderation, allocative efficiency, provider productivity, and income generation required for the NHS locally to balance its books.The majority are in QIPP (so-called Quality Innovation Productivity and Performance, ie “efficiency savings”). The report at the last CCG Governing Body meeting gave an overview of this and wider “productivity changes”.

This post updates an earlier post about Sustainability and Transformation Plans.

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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