At the Doncaster Health and Wellbeing Board meeting on Thursday 12th January, members of the public will call on it to reject the South Yorkshire & Bassetlaw Sustainability and Transformation Plan (SY&B STP).
This is because:
- It is driven by an estimated £571m funding shortfall by 2020/1 – almost certainly an underestimate, as it is based on the promised government NHS funding increase of £8bn, whereas Conservative MP and Chair of the Health Select Committee Sarah Woollaston points out that the real terms increase in Department of Health spending to 2020/21 is just £4.5bn – and will result in reduced spending per person. She also points out that a serious shortfall in capital, as a result of ongoing raids to plug deficits, is undermining the prospects for the transformational changes necessary to produce future savings.
- It ignores the costs of the higher than national average deprivation in all five areas, that is associated with above average levels of poor health and shortened life expectancy.
- The SY&B STP leader, Sir Andrew Cash has said that the NHS needs a 4%/year funding increase – not the paltry increase available through the STPs.
- GPs in London say that STPs can’t save money without cutting services and that STPs are a financially driven exercise. They demand that the STPs are stopped and the percentage of GDP spent on the NHS be restored to a value to adequately resource it and provide patients with the care they deserve.
- It acknowledges (p41) that there is a very high level of risk attached to delivery of some of the changes – but it does not say what these risks are or what likelihood there is of avoiding them.
- It does not tackle the social & economic determinants of ill health but it imposes behaviour change on chronically ill people, on the false assumption that lifestyle choices cause their illness.
Doncaster Health and Wellbeing Board also needs to answer other STP questions
The S Yorks and Bassetlaw STP financial info is sketchy in the extreme – as is all the other info. Where are all the financial documents that the STP had to send to NHS England, along with all the STP appendices? Has the Council seen them? If not, why not? On p 41 the STP admits that they don’t know if the financial modelling is realistic and capable of being implemented.
What has been the involvement of Doncaster Council in the preparation of the STP? It is listed as one of the 25 partners that have been consulted on the STP. How and where was Doncaster Council consulted, and what did it say?
Where is the evidence that community-based care will make the planned cost savings or the planned reduction in hospital admissions?
Given the centrality of digital technology to the STP, is the Health and Wellbeing Board aware that a recent report identifies new unintended adverse consequences of electronic health records?
Is the S Y & B STP going to put the Healthy Lives programme out to competitive tender?
What is the STP’s “new supported employment pathway”, funded by a £15m investment from the DWP, and designed to “deliver increased number of employment outcomes for residents unemployed where they have a health condition or disability”?
Can the Health and Wellbeing Board provide assurances that this is not going to involve “employment is a health solution” measures (due to come into effect in April 2017), that Disabled People Against Cuts say tie the STPs into the DWP’s health and work programme? This involves the imposition of “work cures”, including setting employment as a clinical outcome and allowing medically unqualified job coaches to directly update a patient’s medical record.
Is the Health and Wellbeing Board aware that reshaping primary and community care by setting up accountable care organisations and multispeciality community provider new care models risks destroying GP family doctors and replacing them with corporate providers?
Is the Health and Wellbeing Board aware that there is little good quality evidence to inform the commissioning of a social prescribing programme; that most available evidence tends to describe evaluations of pilot projects but fails to provide sufficient detail to judge either success or value for money; and that NHS England is promoting access to non-clinical interventions by voluntary and community groups as a way of making general practice more sustainable (ie cutting costs)?
The STP summary paper for the HWB meeting is tendentious
It baldly says that its intention is to provide the HWB with an opportunity to support the plan.
It misleadingly claims that the aim of the STP mirrors the aim of Doncaster HWB (which is to improve health and wellbeing of Doncaster residents and to reduce inequalities in health outcomes.)
But p45 of the STP shows that its aims also include closing the finance and efficiency gap and P 40 says that the scale of the financial “challenge” is why radical change is needed to services and the way people use them.
The financial “challenge” is based on government lies about the scale of government borrowing
Tax justice campaigner and economist Richard Murphy points out that the social care financial crisis is entirely manufactured, as a result of government decisions to use quantitative easing to benefit irresponsible and dishonest banks, rather than local and devolved governments; and that the government is lying about the scale of government borrowing – its justification for constraining NHS funding and cutting other public spending – which in turn has been shown to increase to ill health.
There is no reliable evidence that the new care models can save money and improve patient care and outcomes.
The S Yorks and Bassetlaw STP assumes a significant reduction in demand for hospital services, which implies a reduction in hospital beds – although the STP does not refer to this.
The NHS is now so far above the 85% occupancy rate once considered ideal that 12,000 extra beds would be needed to return to it. This is from a Nuffield Trust Report.
In other STPs like W Yorks and Harrogate, bed cuts are supposed to be ok because Care Closer to Home is meant to reduce hospital admissions.
But Southwark and Lambeth Integrated Care research has found NO evidence that community-based care made the planned cost savings or the planned reduction in hospital admissions in the short term.
Nowhere does the STP or the summary paper for Doncaster HWB refer to any of these shortcomings.
The South Yorkshire & Bassetlaw Sustainability and Transformation Plan’s proposals for wider public service reform in order to improve health and wellbeing are incomprehensible. They have something to do with the DWP’s health and work programme, mentioned above, and seem to derive from the Minister for the Cabinet Office’s ideas on the future of public services that “involve reforming the relationship between the citizen and the state” through “commercialisation, experimentation and digital”. Ideas that disabled activist Kitty S Jones has roundly criticised.