Scepticism about NHS Sustainability and Transformation Plans at Dewsbury and Mirfield District Committee meeting

A Kirklees Councillor and members of the public gave a sceptical response to a presentation on Kirklees and West Yorkshire Sustainability and Transformation Plans at the Dewsbury and Mirfield District Committee meeting on 6th October.

Richard Parry – Kirklees Council director of commissioning, public health and adult social care – acknowledged a “democratic deficit” in the preparation of the Plans.

Sustainability and Transformation Plans are about the rapid imposition of cuts and privatisation on the NHS.

NHS England is offering bail out (sustainability) funding to replace Department of Health bail out money for Trusts’ deficits – and at the same time imposing huge sanctions on clinical commissioning groups and Trusts that fail to meet the harsh conditions attached to this funding “carrot”.

Each of the 44 “footprints” must produce a plan that will eliminate NHS deficits across their areas by next financial year and significantly increase the role of the private and voluntary and community sectors in the NHS.

Sustainability and Transformation Plans (STPs) are a departure from the current laws that govern the NHS – but no regulatory or legislative changes have been made to enable or accommodate them. This must mean they are of dubious legality.

They are being prepared in conditions of considerable secrecy, on the orders of NHS England.

Here are Richard Parry’s Kirklees STP slides, with more than their fair share of impenetrable jargon.

Richard Parry said that the Kirklees draft Sustainability and Transformation Plan has been to the  Clinical Commissioning Group Governing  Body. He said there is more flexibility than with the West Yorkshire STP about how the Kirklees STP is developed, and it’s about bringing health things together in Kirklees.

He claimed that the following engagement activities have shaped the development of the Kirklees STP: Meeting the Challenge, Right Care Right Time Right Place, Care Closer to Home, Primary Care Strategies and New Council (how the Council adapts to less money but growing needs).

Since the public and the Kirklees and Wakefield Joint Health Scrutiny Committee rejected the Meeting the Challenge proposals, and the public has overwhelmingly rejected the Right Care Right Time Right Place Proposals, it’s a bit odd that they have gone into Kirklees STP.

He said any new changes to come forward will be subject to a consultation process and that  Kirklees STP has to narrow:

• the health inequalities gap in Kirklees,
• the financial gap and
• care & quality gaps.

The use of “gap” is an interesting metaphor – it suggests that it is something that can be “filled”. Whereas in fact what is proposed is more cuts and privatisation, which would both erode the NHS still further, in order to shrink it in line with continued government underfunding.

He said that the care and quality gaps were the result of “NHS workforce challenges” and “social care workforce challenges” in relation to home carers and nursing home staff.  These “challenges” – ie shortages – drive poor quality and increase costs from the use of agency staff. He said tackling these will cut “costs and finance gaps”.

Richard Parry also said that Sustainability and Transformation Plans would end the current practice of commissioners paying for services delivered, because he says this encourages providers to provide more care because they get paid for this. This is a really weird example of what happens when you start to think about the provision of public services in terms of the operation of market forces.

The solution to the problem of any such perverse incentives – if they do in fact exist, because I really doubt that our hospitals Trust is busily trying to get more people to attend A&E so that they can get paid for extra patients –  is to remove the NHS from the market and the market from the NHS. Not to introduce flat rate per capita payments based on the population size (called capitated payments), which is what Sustainability and Transformation Plans aim to do.

This would replicate the American private health insurance model used by Health Maintenance Organisations and Accountable Care Organisations. These are healthcare companies that provide managed care (ie prescribed treatments), for cherry-picked patients who are going to be the cheapest to treat.

Richard Parry did not explain this aspect of STPs.

High level interventions to tackle local challenges.

Instead he stuck to the blurb on this slide:

Asked to explain the meaning of “Business models to encourage providers to maximise independence”, Richard Parry said,

It’s about doing away with the need for home care by making people independent so they don’t need it. People would be so healthy they don’t need healthcare. I recognise this would be absolute utopia.

He added that the way the money flows round the system doesn’t encourage independent care and the STPs need to find different ways of payments (see above about capitated payments and the reshaping the NHS and social care into an American private health insurance system.)

As an example of self care, Richard Parry said this  was something Locala was already enforcing, through requiring some people to change their own wound dressings, rather than the district nurse doing it.

An example of “building on digital roadmaps to maximise digital opportunities” was diagnosis overnight in Australia.

He said that working with the Kirklees economic strategy to maximise the impact of the health sector on local economy,  was about how to end poverty that is a cause of illness.

He said that the West Yorkshire STP will be sent to NHS England on 21st October.

But he didn’t say that the public and the Councillors and MPs who represent us have next to no idea about what’s in it!

Members of Calderdale and Kirklees 999 Call for the NHS attended the meeting, hoping to find out what Richard Parry had told the 3 Kirklees Councillors who turned up to his STP Briefing on 14th Sept.

Unfortunately he had to rush off, so there was only time for him to present his slides and answer 3 questions, one from a Kirklees Councillor on the Dewsbury and Mirfield District Committee, and two others  – including the one about the meaning of “Business models to encourage providers to maximise independence”, already mentioned, above.

One of the Kirklees Councillors on the District Committee said:

“This is just another strategy – in past they’ve done consultation, but they don’t listen to the result or take on board what people are saying.”

Richard Parry replied,

“The NHS has quite a short planning horizon, I absolutely recognise the democratic deficit to NHS. And some things take so long to implement that things have moved on by the time they are implemented.”

He added that all elected representatives need to be informed and involved in the West Yorkshire STP. Since it is to be sent off in two weeks and elected representatives don’t know what’s in it, that is an empty statement.

Terry Hallworth picked up on this point and said:

“ There’s talk about the public being engaged and consulted on STPs but the STP has to be presented very shortly and they’ve been done in secret and we have no idea what’s in them.”

Richard Parry replied:

“With my local government hat on, I would say there has been a democratic deficit. The NHS has planned without informing the public properly. I’m very aware this is a criticism that’s been levelled at the West Yorkshire STP and Karen Coleman has been seconded from Kirklees to the West Yorkshire STP to engage the public. The Kirklees plan is only pulling together existing schemes and trying to make them work together more effectively.”