North Kirklees NHS “engagement” event votes to restrict and withdraw NHS treatments

At the North Kirklees Clinical Commissioning Group’s ‘engagement’ event on Wednesday 5th October, participants thought about spending NHS money.

Kirklees and Greater Huddersfield NHS Commissioners are running a “consultation” from 12th October to 29 November on:

“things we could do to get better value from NHS spending.”

The secretive Sustainability and Transformation Plan being imposed on West Yorkshire by NHS England and NHS Improvement, requires vast cuts in NHS spending across the region, in order to deal with £hundreds of millions of government under-funding of the NHS  by 2020/21.

This comes on top of the last six years of under-funding, that has driven most hospitals into the red.

But of course the Clinical Commissioning Groups’ consultation isn’t talking about the fact that the biggest waste of money in the NHS is exactly the marketisation and privatisation that they were created to broker and advance.

54% of turkeys voted for Christmas

At the 5th October engagement event, one question that got 54% of the vote was that the NHS should only provide treatment that is cost effective. No one asked what ‘cost effective’ meant.

I contacted North Kirklees Clinical Commissioning Group to ask:

• What is meant by “cost effective” NHS treatment?
• What criteria does North Kirklees Clinical Commissioning Group use to decide on the cost effectiveness of treatment?
• Why didn’t they explain this at the engagement event?
• Doesn’t this lack of clarity, about what “cost effectiveness” means and how it’s decided, invalidate the whole engagement about the issue?

Their Head of Communications and Engagement replied,

The question you refer to was based on similar questions used by IPSOS MORI and NatCen Social Research to measure general attitudes towards NHS funding.

In relation to the use of this question at the recent North Kirklees event, it was asked in the context  of a wider conversation where participants were encouraged to discuss a number of specific scenarios, take the opportunity to express their  views, and ask questions.

The aim of the event was to a) highlight the CCG’s financial challenge b) generate insight into participants’ general attitudes with regard to the use of NHS budgets and c) understand what factors participants felt should be taken into account when making decisions about local health priorities.   We did not  define the term ‘cost effective’ as we wanted participants to discuss what they felt should be taken into account by the CCG when considering local health priorities.

So if they ask you what you feel should be taken into account when considering local health priorities, it’s worth saying that they should take into account the need to continue to provide a comprehensive, universal health service that is free at the point of use and based on patients’ clinical needs. In other words, they should continue to provide the full range of treatments and services, to everyone who has a clinical need for them. Full stop. End of story.

The Kirklees NHS commissioners bill their “consultation” on getting better value from NHS spending as:

“an open and honest discussion with local people…”

But the engagement event on 5th October was all about trying to get people to agree (without providing proper information) to restricting and withholding NHS treatments, so that the NHS is no longer a comprehensive health service that is free at the point of use and based on patients’ clinical need.

If you are affected by this – as a patient, family, friend or NHS staff -please get in touch. Calderdale & Kirklees 999 Call for the NHS are collecting information about the practical effects on people’s lives of these cost cutting proposals.

Don’t wait to restrict and withdraw NHS treatments – “have conversations now to secure the financial position this year”

At Calderdale Clinical Commissioning Group Governing Body meeting in August, the Chief Officer Matt Walsh reported on the the financial position of the NHS, which NHS England had spelled out in its July 2016 Sustainability and Transformation Plan “financial reset” document: Strengthening financial performance and accountability in 2016-17.

This is the context for Clinical Commissioning Groups’ plans to restrict and withdraw NHS services.

He explained that the financial reset document is about agreements between NHS England, NHS Improvement and the “principal provider sector” – ie mostly hospitals. He outlined the impact of this on CCGs. He added,

“The financial reset shows that the centre deeply anxious about the financial position this year and the legacy of this for NHS in rest of parliament to 2020.

It’s a binding system to commitments about financial control and deals done about how institutions deploy their financial resources.”

Matt Walsh told the Governing Body that that NHS England’s “financial reset” document sends the message to failing systems – that,

“If we don’t deliver what is called for, others will come in and do it for us.”

He said it is very clear statement about NHS Improvement and NHS England actions for what will happen to failing Clinical Commissioning Groups.

He went on to say that St Helens Clinical Commissioning Group was restricting services  – although by the time of the Calderdale Clinical Commissioning Group Governing Body meeting, St Helens Clinical Commissioning Group had backed down from their proposal to ban non-urgent operations – but he didn’t say anything about that.

He mentioned that his report describes things that other West Yorkshire Clinical Commissioning Groups are considering, in order to cut costs.

These include:

• limiting outpatient follow ups to elective operations, to a single appointment
• stopping prescriptions for self-limiting illnesses and of vitamins, food supplements and gluten-free products
• cherry picking patients for medical and surgical interventions that are “procedures of limited clinical value”

Matt Walsh continued,

“My advice is Calderdale CCG should not wait to do these things, but should start having conversations now to secure the financial position this year.”

Matt Walsh also said that the Clinical Commissioning Group would uphold NHS constitutional standards, so I asked him how that sits with his recommendation about cherry picking patients – although he objected when I called it cherry picking patients and said it was about limiting medical and surgical interventions to patients most likely to benefit and would only apply to “procedures of limited value”, where only certain patients will benefit – not across the board.

But the NHS Constitution says that patients,

“have the right to drugs and treatments that have been recommended by NICE for use in the NHS, if your doctor says they are clinically appropriate for you.”

And the Royal College of Surgeons says that

“ ‘ Procedures of Limited Clinical Value’ (PLCV) is a term NHS managers have applied to a range of elective surgical procedures that they no longer wish to fund…[B]ecause of the current financial restrictions,…many proven operations known to enhance health and improve quality of life have been included in this category, and hence are being denied to patients who need them.”

Harrogate and Rural District clinical commissioning group recently decided to withhold elective treatments for six months from patients who are obese or who smoke, as part of a plan to cut their costs by £8.4m this financial year.

Ian Eardley, vice president of the Royal College of Surgeons, said:

“The policies for smokers and overweight patients that Harrogate and Rural District CCG intend to impose ignore the public outcry that surrounded similar plans.”

St Helens CCG was recently forced to abandon plans to save money by stopping all non-urgent referrals for four months and NHS England stopped nearby NHS Vale of York CCG doing a similar policy.

Harrogate and Rural District clinical commissioning group is part of the West Yorkshire and Harrogate “Footprint” Sustainability and Transformation Plan. This plan is being prepared in secret, and is not intended for publication until 23rd October – after  the 21st October deadline for submission to NHS England. But we can be sure that it  will stop the NHS in West Yorkshire and Harrogate from being a comprehensive health service, by restricting and withdrawing NHS treatments.

And we can also be sure that, when challenged about this, the STP guys will justify it by saying they “engaged” with “stakeholders” about it, who voted for restricting NHS treatments to those that are “cost effective”.

Participant at “engagement” event warns “cost effective” NHS services mean huge cuts

One of the participants at the North Kirklees Clinical Commissioning Group 5th October engagement event wrote to the local press that, according to Sustainability and Transformation Plans, “cost effective” NHS treatment means that,

“…lack of NHS dentistry in Dewsbury and Bradford will spread to other places. Everyone in West Yorkshire, even Denby Dale, travels to Leeds for A&E – other than stroke victims who maybe go to Pinderfields. In addition we’ll travel anywhere in our Clinical Commissioning Group area for a GP appointment, eg. Cleckheaton to Mirfield. People with rare conditions are not ‘cost effective’ to treat so are likely to be refused. Why?

In excess of 10 profit making companies work in North Kirklees and Huddersfield NHS. Why are their healthy shareholders more entitled to NHS revenue, than patients for treatment? Why should profit-driven management consultancies make decisions for the NHS? Be careful what you vote for.”

Updated 19 Oct 2016 with reply from North Kirklees Clinical Commissioning Group Head of Communications and Engagement.