Lincolnshire County Council Leader says Sustainability and Transformation Plan is “not their document” so they can’t publish it

The Leader of Lincolnshire County Council has rebuffed Lincolnshire citizens who asked him to publish the Lincolnshire Sustainability and Transformation Plan on the Council website, so that the public has time to understand it before contracts for the STP’s first two years are signed on December 23rd, on the instruction of NHS England.

Cllr Martin Hill, Leader of Lincolnshire County Council,  said the Council has not “received the STP for consideration” and that as it is not “their” document they can’t publish it on their website:

Dear [name redacted],
The County Council is aware that NHS England has required a Sustainability and Transformation Plan to be drafted for Lincolnshire, and for this draft to be submitted to NHS England before it is taken any further. Officers of this Council who are responsible for services that might have an effect on – or be effected by – developments in the NHS, such as Adult Social Care and Public Health, have been required to make contributions to the planning process in respect of these services and have done so.
The County Council has not received the STP for consideration, but we look forward to doing so. We have expressed many concerns regarding aspects of NHS operation within the county over recent years and we are keen to have a say in any plans that we understand are intended to address fundamental elements of future operation.
I fully understand your concerns about the lack of transparency of the emerging STP. But as I have explained it is not our document, so I cannot comply with your wish for us to publish on our website. Therefore I suggest you contact the NHS with your request.
Regards,
Martin Hill

Following this up on behalf of the public, on 25th October the Lincolnshire County Councillor for Grantham Barrow commented on the Fighting 4 Grantham Hospital facebook group,

“I did ask about the STP today. The response I got was that while a number of Lincolnshire County Council officers did have a partial input into the STP where there was a health/council crossover of services such as with public health and adult social care no officer at LCC has seen a copy of the final document. The NHS are keeping it under wraps which is causing the council a number of issues because we want to see the impact that it is likely to have on us.”

So, if Cllr Hill can’t or won’t publish the Lincolnshire Sustainability and Transformation Plan (STP), what do we know about it from other sources?

Making Lincolnshire’s NHS function with £300m funding shortfall by 2020/21

STPs are being imposed by NHS England in order to redesign NHS services in a way which caps spending within a limit which is consistent with government spending plans, and which increases NHS privatisation in line with conditions that the government placed on the “extra” NHS funding it awarded in the Autumn 2015 Comprehensive Spending Review.

There is a growing consensus amongst senior NHS staff and think tanks that NHS services and standards can only be maintained if the government substantially increases spending on the NHS. In his recent letter to Sarah Wollaston, Chair of the Health Select Committee, the Chief Executive of NHS Providers, Chris Hopson, says,

‘But the trust leaders we represent are now clear that ……. it is no longer possible for their trusts to provide the right quality of service and meet the required performance targets on the funding available. They believe something now has to give. Either the service receives more funding than is currently planned or we need immediate choices, however undesirable they may be, on whether to reduce the priorities the NHS is trying to deliver, ration access to care, relax performance targets, close or reconfigure services, extend charges or co-payments, or reduce the size of the workforce.’

If the government sticks to its current expenditure commitment, there will have to be substantial cuts in NHS services across the country, including hospital closures.

The scale of the damage will become apparent as the 44 STPs are published. In this situation, those who have been waiting for an opportunity to further degrade the NHS will call for additional patient charges, and personally-funded health insurance plans for a range of treatments no longer provided by the NHS.

Lincolnshire’s hospitals are currently underfunded by £60m /year. By 2020/21 that means a funding shortfall of £300m.

Lincolnshire’s STP is about cutting and changing the NHS in the county so that it can make do with the £300 million funding shortfall  by 2021.

The case for change, produced in June 2016,  outlines the how the Lincolnshire Sustainability and Transformation Plan proposes to make do with the £300m/year funding shortfall by 2020/21.

It is based on standard NHS England instructions for carrying out the cuts and privatisation plans in the 5 Year Forward View 2015/16 -2020/1.

All 44 Sustainability and Transformation Plans across England are basically the same, since they follow the same NHS ENgland planning guidance; the differences are just which hospitals and hospital departments they’re going to cut and where they’re going to transfer the hospital services they’ve cut, into primary and community services.

Moving hospital services to “centres of excellence”

The Lincolnshire STP case for change says that they are considering which hospital services to move to what they call “centres of excellence”, and where this would be.

Some specialist services they are thinking of centralising in centres of excellence are:

  • mental health
  • cancer
  • stroke
  • vascular

They say there will be at least one hospital for specialist emergencies like heart attacks and strokes.

The Lincolnshire STP case for change says the main hospital sites in Grantham, Boston and Lincoln will not all provide the current range of services that they do now.  They say:

“This may mean some patients having to travel further when they do have to visit hospital.”

They are talking about centralising maternity services in one hospital, instead of the current two maternity units in Lincoln and Boston.

Network of urgent care centres

They propose a network of urgent care centres which will deal with most urgent care, with A&E limited to emergencies.

Piecing this together with what’s already happening – the Meeting of Health Scrutiny Committee for Lincolnshire, Wednesday, 21st September, 2016 10.00 am (Item 23.) noted that:

“the Grantham A&E had a range of conditions which could not be dealt with and patients with those conditions were always taken to another hospital.  This had been the case for a number of years.  This had been a source of frustration since the temporary partial closure of the unit, as the residents of Grantham were not aware that the services at this A&E department were extremely limited;
Clear criteria had been set out in a paper produced by Professor Sir Bruce Keogh, National Medical Director of NHS England, which suggested that any unit not meeting that criteria would be classed as an Urgent Care Centre rather than an A&E.”

This suggests strongly that Grantham A&E will be downgraded to an urgent care centre in the Sustainability and Transformation Plan.

Shifting hospital services into GP and community care

They are proposing to shift many hospital services into primary and community care – a proposal common to all the STPs.

Speaking of the same proposals in the Birmingham STP -which Birmingam Council has published despite NHS England’s instruction that STPs should not be published until they have had their comms team go over them –  Birmingham LMC chief Dr Robert Morley said:

‘The STP, and in particular the plans to massively increase the delivery of out-of-hospital care, to transform general practice and to give it far greater responsibilities across a range of areas are simply undeliverable bearing in mind the meagre additional investment, the unambitious plans to increase primary care workforce and the woefully inadequate intention to support general practice sustainability and viability.’

The meeting of the Health Scrutiny Committee for Lincolnshire on 21st Sept 2016 notes the shortage of GPs in the Grantham area.

Withdrawal and restriction of NHS treatments and services

In addition to cuts to hospital services and their transfer into the “community”, the harsh sanctions and tight financial controls that NHS England and NHS Improvement have imposed on Sustainability and Transformation funding mean that across England, Clinical Commissioning Groups are planning to withdraw and restrict a range of NHS treatments.

The current treatments that Lincolnshire CCGs are proposing to restrict or withdraw are:

  • so-called Procedures of limited clinical value
  • so-called over the counter medicines,  like anti-histamines, gluten free items, enteral feeding and baby milk

At the 28th September 2016 South West Lincolnshire CCG Governing Body meeting, the Deputy Chief Officer Jo Wright said that the CCG had been working with the other Lincolnshire CCGs on “updating the Prior Approval Policy including Procedures of Limited Clinical Value”.

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.”

The 2015 NHS Lincolnshire Prior Approval document lists the  procedures that require prior approval before a doctor can carry them out. They include:

  • cosmetic procedures like surgical treatment of varicose veins,
  • autologous cartilege transplantation for cartilege defects of knee joint
  • carpal tunnel syndrome
  • hip arthroscopy
  • obesity/bariatric surgery
  • vasectomy
  • cataract surgery
  • fertility services
  • grommet insertion
  • hip, knee and other joint revisions
  • hip replacement
  • community surgical scheme operations

The private session of the 28th September meeting of South West Lincolnshire CCG Governing Body considered and debated a full paper about stopping a range of GP prescriptions of so-called over the counter medicines,  like anti-histamines, gluten free items, enteral feeding and baby milk – unless in exceptional circumstances. The Governing Body members agreed to delegate authority to the Chief Officer and Chief Finance Officer to approve the final policy document for public consultation.

The consultation is running from 4 October to 18 November 2016. Any changes as a result of the consultation will come into effect from 1 December 2016.

Allan Kitt, Chief Officer, South West Lincolnshire CCG and Lincolnshire STP leader, said:

“Like everyone we have to balance the books and not live beyond our means  whilst at the same time getting the best possible care and treatment for patients. In reviewing the medicines we prescribe, it has become clear that we could make substantial reductions in our prescribing costs if we ask those people in a position to buy their own over the counter type medicines, like paracetamol and antihistamines, to do precisely this.”

This restriction of GP prescribing comes under the “promoting self care “ rubric that is big in the Lincolnshire STP – as in all the others, since this is a requirement of NHS England’s cuts and stealth-privatising 5 Year Forward View plan 2015-2020.

The public consultation blurb says,

“Proposed service changes will ensure the health budget for Lincolnshire is spent as effectively as possible, whilst minimizing waste and promoting self-care.”

Of course Allan Kitt’s statement “we must balance the books and not live beyond our means” is entirely spurious. We are the 6th richest country in the world, the government awards massive subsidies of around £93bn/year of public money in corporate welfare and we could perfectly well afford to fund the NHS adequately if we chose to. It is a political decision not to.

Privatisation

It is a condition of the extra NHS funding approved in the government’s Autumn 2015 Comprehensive Spending Review that this is used to increase opportunities for private health companies within the NHS.

The South West Lincolnshire Clinical Commissioning Group’s report to the Lincolnshire Health Scrutiny Committee meeting on 18th Nov 2015 included information about privatisation of NHS services. It said that the CCG was developing “New provider relationships” and increasing access to the independent sector. It added that:

“The CCG was well placed to access alternative providers due to a lack of capacity in Grantham, Lincoln and Boston.”

Why is there a lack of NHS capacity? Because of NHS underfunding.

The South West Lincolnshire Clinical Commissioning Group told the 18th Nv 2015 scrutiny committee that it had launched a  pilot scheme for a new hearing loss service within Specsavers in Grantham to provide an alternative to current hospital services which were unable to meet demand.  The service was expected to enable hospital services to focus on serious cases and give faster local access.  An evaluation of the pilot would take place after twelve months and, if successful, would be fully procured.

Optum’s £3m/year  commissioning support contract

As of February 1st 2016 South Lincolnshire and South West Lincolnshire CCGs have been working with Optum Commissioning Support Services (Optum CSS) for all procurement and contracts, as well as marketing, communications and engagement and ‘back office functions’ ranging from payroll to IT support. The three year contract is worth £3m/year.

Optum is part of United Health, the global American private health insurance company that NHS England Chief Executive Simon Stevens was previously a Vice President of.

Optum promotes the United Health “care models” that Simon Stevens’ NHS England 5 Year Forward plan 2015/16-20/21 aims to import into the NHS, via the Sustainability and Transformation Plans.

This Commissioning Support privatisation has taken place across England

It is typical of the corrupt revolving door between private health companies and the NHS that the current Senior Vice President, Optum Growth Strategy since April 2015  was previously the NHS England (Leicestershire and Lincolnshire) Director, where he worked from September 2012 – April 2015. This is someone called David Sharp.

So NHS England sets up the privatisation of commissioning support in 2015, in a process that makes Optum the lead provider in its list of approved suppliers. David Sharp quits his job as Director of NHS England (Leicester and Lincolnshire) in April 2015 and by February 2016 two Lincolnshire CCGs give Optum a £3m/year contract for their commissioning support.

Given Optum’s decidedly dodgy operations in the USA, NHS England’s acceptance of Optum on the list of approved private companies to provide commissioning support was criticised by the then-shadow health minister, Jamie Reed:

“Ministers need to explain how it can be right that companies that are being pursued for poor care standards abroad could possibly enter the NHS.”

This was because US federal government took out a lawsuit against Optum for packing their hospices across 13 US states with patients who were not coming to the end of their lives –  this allowed Optum to cut the most expensive costs that come with admitting people and dealing with their deaths, and to maximise its profits from Medicare, the source of approximately 90% of its revenue.

The lawsuit said that  Optum “consistently and deliberately” sought to increase the number of patients for whom it could bill for end-of-life hospice care, despite repeated warnings that a substantial portion of its patients were not terminally ill.

Lincolnshire County Council is one of 13 Sustainability and Transformation Plan partners

Lincolnshire Health and Care, the partnership of 13 health and care organisations across the county, has worked together to produce the Sustainability and Transformation Plan.

Lincolnshire County Council is one of the 13 STP partners. The others are:

  • Lincolnshire West Clinical Commissioning Group,
  • South Lincolnshire Clinical Commissioning Group,
  • South West Lincolnshire Clinical Commissioning Group,
  • Lincolnshire East Clinical Commissioning Group
  • United Lincolnshire Hospitals NHS Trust,
  • Lincolnshire Partnership NHS Foundation Trust,
  • Lincolnshire Community Health Services NHS Trust,
  • Lincolnshire County Council,
  • Lincolnshire Local Medical Committee
  • Healthwatch Lincolnshire (observer seat on behalf of Lincolnshire residents)
  • Lincolnshire Care Association,
  • East Midlands Ambulance Services NHS Trust
  • NHS England.

If Lincolnshire County Council is one of the partners, how has it not “received the STP for consideration”?

Lincolnshire Health and Care says  it is committed to publishing the STP to the public in full, ‘likely in the next six weeks’.

It says no final decisions over services will be made until the public have had a chance to express their views.

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