Kirklees Health & Wellbeing Board meeting reveals unholy mess of Sustainability and Transformation Plan

At Kirklees Health and Wellbeing Board Meeting 24 November 2016, Councillors wrestled with a number of Sustainability and Transformation Plan questions  – which defeated them.

Leading the Chair, Cllr Viv Kendrick to announce,

“You can not blame the councils when they can’t comment on the plans of the other councils and when they are not involved with the decision making, you can’t be surprised if they don’t agree with it.”

Here are the main questions raised at the meeting – and what passed for answers.

(If you’re wondering what Sustainability and Transformations are, there’s info here.)

What are the missing bits of the published West Yorkshire & Harrogate STP and when will they be published?

Rob Webster, West Yorkshire & Harrogate Sustainability and Transformation Plan Leader,  said spreadsheets with detail had not been published. He is all for transparency and will ask NHS England if any detail in the spreadsheets can be published. He also said the STP leadership group of Clinical Commissioning Group Chairs and Chief Officers, are working on a public summary for workforce, finance and technology.

Cllr Viv Kendrick said she had not been aware of anything which had not been published. But she had had over 100 e-mails in one week from the public who were concerned about this.

David Kelly, Chair of North Kirklees Clinical Commissioning Group, denied there was any secrecy.

So where are these key financial documents and why didn’t anyone mention them?

  • The 16th September 2016 STP footprint financial returns,
  • The 21st October footprint financial plans which have to include a coherent story that includes provision and commissioning .
  • The detail of years one and two which are expected to be reflected in the CCG and NHS Provider Operational Plans required by December from organisations

Can the STP deliver the financial goal of cutting £1.07bn from the WY & Harrogate NHS & social care budget by 2020/21, compared to current spending levels?

Who knows?

But David Kelly is keen to see swift changes to  primary and community services – that will bring in NHS England funding via the GP Forward View and so help reduced the funding shortfall.

He  asked whether the “New Model of Care” contracts go far and fast enough in setting up Accountable Care Partnerships. These contracts are due to be signed on 23 December, along with others to deliver the STP in 2017-19.

Rob Webster was saying nowt.

Maybe because in Wakefield, this is going far too far and too fast for the GPs’ Local Medical Committee (LMC).

They have recently protested to Wakefield Clinical Commissioning Group about GPs being pushed into a New Model of Care contract called Multispecialty Community Providers (MCP) in 2017-19.

They fear this would force them into an Accountable Care Organisation, as stated in the Wakefield locality STP. This  amounts to a private-public partnership – like PFI, but for health care services as well as buildings.

The Mid Yorks Trust Board Meeting on 3.11.16 heard that Wakefield Clinical Commissioning Group intends to set up an Accountable Care Organisation with Mid Yorks Trust, a GP Federation, Virgin, Spectrum and perhaps others.

A Multispecialty Community Provider Accountable Care Organisation operates large scale primary and community services across an area as a “hub and spokes” and uses lower qualified staff, like physician associates and nursing associates, and people from voluntary organisations.

It has a fixed per capita budget for the population it serves, has to carry the risk of not being able to cope on that fixed sum – but can also keep any profits if it delivers care for less than the allocated budget.

What is that going to do to the patient- doctor relationship?

Wakefield Locality STP shows final business case approval for the MCP in October 2016, and a “market event” in December 2016.

Pushing GPs into large scale Multispeciality Community Provider organisations is part of NHS England’s GP forward View.  You can read about the damage this is causing to family doctors  here

A recent Nuffield Trust study found no evidence for this New Model of Care –  large scale GP federations run as Accountable Care Organisations – being either cheaper or more effective in patient care, or delivering higher quality.

It is being pushed by Optum – a subsidiary of United Health – the former employer of the NHS England Chief Exec, Simon Stevens.

NHS England’s 2017-19 Planning Guidance instructs Clinical Commissioning Groups to include the GP Forward View in their STP contracts for 2017-2019,  that are due to be signed by 23rd December 2016.

Can  N Kirklees & Greater Huddersfield CCGs and Kirklees Council hold the West Yorkshire & Harrogate Sustainability and Transformation Plan Joint Committee to account?

Judging from this meeting, the Sustainability and Transformation Plan governance structure is an unholy mess that seems designed to be unworkable.

Rob Webster said

“There are some things the HWBB can say and some things are outside their authority and the Right Care Right Time Right Place scheme is one of these.”

Richard Parry, North Kirklees Clinical Commissioning Group Chief Officer and Kirklees Director of Adult Social Care, said that at a West Yorkshire level, the Kirklees Health and Wellbeing Board recognises that, but we can not offer a commentary on the other 5 plans, it’s a pedantic point but…

Cllr Viv Kendrick said,

“You can not blame the councils when they can’t comment on the plans of the other councils and when they are not involved with the decision making, you can’t be surprised if they don’t agree with it.”

How does the Kirklees locality STP (aka Kirklees Plan) fit in with the West Yorkshire & Harrogate STP?

Who knows?  Rob Webster  said Councils and local Clinical Commissioning Groups are “still be in control” – but couldn’t explain how this is possible, when individual CCGs have delegated decision making to the West Yorkshire & Harrogate STP joint committee of CCGs.

There was whittering about whether the Healthy Child Programme – where the joint committee of West Yorkshire & Harrogate CCGs have set the strategy but delegated decision making to Kirklees Council – is an example of how Kirklees can still be “in control”.

What is the role of the Health & Wellbeing Board in overseeing the Kirklees Locality STP aka ‘Kirklees Plan’?

Answering the question: does the Health and Wellbeing Board have to sign off the West Yorkshire & Harrogate STP and how can it do that when it can only comment on the Kirklees aspects of it?  Rob Webster said that the Kirklees Health and Wellbeing Plan (ie the Kirklees Place Based Proposal in the West Yorkshire & Harrogate STP) can be signed off in January.

But the West Yorkshire & Harrogate STP Section 3, Place based Proposals, which summarises all the “locality” STPs, says:

“These plans have strong local buy- in and have been approved by the relevant Health and Wellbeing Board.”

If they have already been approved, why do they need signing off in January?

Please ask the Health & Wellbeing Board Chair and Cabinet Member for health Cllr Viv Kendrick , the Council Leader Cllr David Sheard,  and your ward Councillors. You can find all their names and email addresses here

Why does any of this matter?

To stop the STPs ,we have to know where their pinchpoints are. It seems that their organisational mayhem is a pinchpoints.

If you are confused about any or all of these arrangements , please tell:

Cllr Viv Kendrick
North Kirklees CCG Governing Body Chair David Kelly
West Yorkshire & Humberside STP leader Rob Webster.

And ask them how they are going to make sure that the West Yorkshire & Humberside STP AND the Kirklees STP (aka Kirklees Place Based Proposal) are not going to damage NHS and social care – given the cuts, privatisation and management chaos they entail.


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