Calderdale Councillors give go-ahead to NHS cuts plan without knowing much about it

Calderdale Councillors have decided to develop government-imposed Sustainability and Transformation Plans (STPs) that will savagely cut NHS spending – and paradoxically, at the same time, improve the quality of the NHS and social care as well as the health of the population.

The Calderdale Health and Wellbeing Board’s  decision at its public meeting on 25th August meant accepting the recommendations  from its  private meeting on August 11th , when Calderdale Clinical Commissioning Group presented a “transformative narrative” about the STPs.

The recommendations are to:

• give the HWB the role of  “owning” the Calderdale input into the West Yorkshire STP;
• come up with a Calderdale STP; and
• set up a Calderdale Transformation Board to work on the Calderdale Plan and report to the Health and Wellbeing Board.

The public HWB meeting also decided to tell the West Yorkshire STP Leader, Rob Webster, that they are not happy with the draft West Yorkshire STP Core Narrative document.

Particular points of contention are the Core Narrative’s statement dictating that Clinical Commissioning Groups will morph into to Accountable Care systems; its failure to mention HWBs; and its claim that ‘We will work closely with local communities’ – since West Yorkshire STP has no mandate to do this, except through Local Authorities.

Members of the public protest NHS STPs, outside Halifax Town Hall

Members of the public attended the meeting to protest about the STPs’ draconian cuts and move to American healthcare models, that open the NHS door wider to privatisation. A member of the public, Freda Davis, said:

“The meeting of the Health and Wellbeing committee was an eye opener. Where are community representatives and the voluntary sector? It was a circle of men in suits, with three women among them. When it was set up, there was a wide range of representatives.

Then I remembered that the Health bodies in the Voluntary Sector are still advised by Voluntary Action Calderdale (VAC),  who made the Calderdale HealthWatch such a weak watchdog. So nobody in the Voluntary Sector will be watching over this process as our NHS is dismembered.”

What the Councillors know they don’t know about STPs

Councillors  gave the go ahead to the STPs despite admitting that they knew little about these Plans; and they think elements of them – such as integrating primary care with social care and housing – require scrutiny by the Adults Health and Social Care Scrutiny Panel.

The Chair, Cllr Tim Swift, came up with a list of things that he doesn’t know about the STPs:

• if they are about existing proposals for cutting and changing NHS and social care services, or new “measures”
• the HWB’s role and powers in relation to the STPs
• how to set out and sell the HWB’s shared understanding of what they want to do through the STPs
• what the STPs will “morph into”
• what is in the STPs – “ We want transparency of documents”

Invisible STP documents are not meant to be published

At the moment, the STP documents are not visible to Councillors or the public – let alone transparent.

Cllr Tim Swift admitted that Calderdale Health and Wellbeing Board had not approved the “checkpoint” (draft) version of the West Yorkshire STP,  that the West Yorkshire STP leader Rob Webster had sent to NHS England on 30th June.

Has the Health and Wellbeing Board even seen it? It is not in any of the Board’s papers.

Why is it not publicly available? The North West London “checkpoint” STP  is publicly available – and two NW London Councils, Ealing and Hammersmith, have refused to accept it.

Perhaps this is the reason for keeping the “checkpoint” West Yorkshire STP under wraps.

Wendy Saviour, North Midlands Director of Commissioning Operations, Wendy Saviour, who told a recent meeting of Shropshire Clinical Commissioning Group:

“STPs are not meant to be published at all. They should not go to Board meetings. Some of them contain very radical things. These are highly political and highly contentious.”

The day after the Calderdale HWB meeting, the Guardian reported that:

“A leaked draft plan circulating amongst NHS Managers in West Yorkshire reveals proposals to close the equivalent of 5 wards in the Leeds Teaching Hospitals Trust. It also proposes a “major reconfiguration” of frontline NHS services in Wakefield and North Kirklees and Calderdale and Huddersfield.”

Why wasn’t this info brought to the Calderdale HWB meeting, if the West Yorkshire STP documents are intended to be so transparent?

Democratic deficit

Cllr Swift told the HWB meeting,

“We are trying to clarify the role of the Health and Wellbeing Board in the STP … We are at the start of the STP process, which makes no mention of the Health and Wellbeing Board. We are trying to get some discussion going about the process.

My personal observation is, the STP is simply a process. Formally nothing in it has a legal standing. Anything proposed in there has to be taken to existing government or local government structures.

The reality is, there is a lot of topdown drive for STP – NHS England see it as needed for the 5 Year Forward View. There will be a lot of pressure for service changes from STP.”

He added,

“There is a feeling that this is responding to someone else’s agenda, instead of being clear what we want to achieve. But Calderdale STP is not simply a response to West Yorkshire STP – but a shared understanding of where Calderdale needs to be going in terms of health & social care.”

Calderdale Clinical Commissioning Group’s Chief Officer, Matt Walsh, said that he wanted to reinforce the point that the West Yorkshire STP conversation in the last couple of months had raised awareness of the democratic deficit in all of this.

Health and Wellbeing Board is not happy with West Yorkshire STP “core narrative” document.

This did not reassure Cllr Geraldine Carter, who had problems with the West Yorkshire STP Draft Core Narrative. She said,

“I’m worried about CCGs moving to accountable care systems – what does it mean? How can West Yorkshire STP dictate that CCGs  are going to morph into something else? I’m worried that there’s no mention of HWBs.  The document seems to be very heavy handed. It says ‘We will work closely with local communities’  –  West Yorkshire STP has no mandate to do this except through Local Authorities. What is this document trying to tell us? I’m not sure I’m happy if this is how WYSTP is going to work.”

Dr Alan Brook, the Calderdale CCG Governing Body Chair, replied:

“The Health Communities West Yorkshire Forum said this needs to go to the Health & Wellbeing Board. The document is draft 0.2  – it has not been approved by any organisations, it has jumped to conclusions and made statements that have not been agreed.”

Cllr Carter said,

“So can we discuss this draft and say we’re not happy with it? It’s hard to do when we don’t have background information. How can we tell them we’re not happy? It seems to be an odd process. I’m pleased this document is not the final outcome.”

Cllr Tim Swift said:

“We can add these comments to our recommendations and feed them back.”

Morphing Calderdale NHS & social care into an American-style Accountable Care Organisation

Members of the public asked if  Calderdale Council would be part of the Accountable Care Organisation or system, that the WYSTP aims to transfer responsibility to, for planning and providing NHS and social care.

They inquired what the legal issues are, around changing the current NHS & social care commissioning and delivery system into what is effectively a new form of public – private partnership:  think PFI but for services as well as buildings.

They also queried whether the Accountable Care organisation or system would be the American Kaiser Permanente system or the Spanish Valencia model – the two systems advocated by the Secretary of State for Health, Jeremy Hunt.

Jeremy Hunt’s words to House of Commons Health Select Committee, 9 May 2016

Matt Walsh, Chief Officer of Calderdale Clinical Commissioning Group, disputed that Accountable Care Organisations or systems involve a  “requirement around privatisation”, and added,

“There are ideas to test out, particularly about how ACOs work well in the world.”

He revealed that his personal view was in favour of the South Central Alaska ACO
which is a social enterprise. He didn’t acknowledge that switching Calderdale’s NHS and social care commissioning and delivery organisations into this system would amount to privatisation.

SouthCentral Alaska ACO seems to be an STP flavour of the moment – it’s on the agenda at the upcoming  Kings Fund Summit on the development of Sustainability and Transformation Plans. The Summit, coming up in October,  is liberally sprinkled with speakers from American ACOs.

This is the destination where Simon Stevens, NHS England’s head honcho – formerly Chief Exec of one of America’s biggest private health insurance companies, United Health – wants to drive the NHS.

Sanctions for not providing what NHS England demands of STPs

Calderdale Clinical Commissioning Group Chief Officer Matt Walsh warned the Health & Wellbeing Board of the dire consequences of not following government and NHS England orders about the STPs.

He said that the West Yorkshire NHS system is looking to close the NHS funding gap to around £200m – assuming the financial position in those systems doesn’t deteriorate meanwhile. He added,

“But in 2016-17 the financial situation IS deteriorating. That is the scale of the ask.”

He referred the HWB to NHS England’s so-called STP financial reset document  –  “Strengthening financial performance and accountability 2016-17”, and said:

“It talks clearly about sanctions to CCGs and Trust providers who fail to provide what it demands. The final sanction for under-performing CCGs is that they will be replaced by Accountable Care Organisations.

We can say what we want here, but in the end we are subject to the regulatory regime.
The decision at the centre is if a CCG is deemed to be failing, it will be replaced by ACO.”

Cllr Tim Swift said that the HWB needs a brief summary of financial reset document and the link to the full doc.

West Yorkshire STP “reconfigurations” will be dominated by big Bradford and Leeds hospitals

Cllr Tim Swift said that decisions about reconfiguration will be largely dominated by big hospital trusts in Leeds and Bradford. This led Cllr Megan Swift to ask if Calderdale STP would just get lost in the West Yorkshire STP.

Dr Alan Brook replied:

“The centre is more interested in the West Yorkshire STP but even West Yorkshire isn’t autonomous, they’re part of a national plan to plug the £22bn funding shortfall. So there’s no guarantee that if West Yorkshire STP saves money locally, it won’t go somewhere else to plug the gap.”

Cllr Megan Swift asked how the crisis in Leeds, which she said has “ had money thrown at it”,  will affect the rest of West Yorkshire.

Matt Walsh said he wasn’t sure, but:

“I think we’re moving to a place where if one fails all fail, so we’re trying to get to a place where West Yorkshire is sustainable and can live within its means.”

As the Clinical Commissioning Group’s Finance Director and Calderdale Council’s Director of Adult Social Care have both upped sticks to Bradford, it seems that the Calderdale NHS and social care ship may be sinking, given the ferocity of the STP cuts.

The rest of us can’t just jump ship, so we have to make sure it doesn’t sink.