Calderdale Plan to cut £63m NHS and social care costs by 2020/1 will improve people’s lives

At its 12 January meeting, Calderdale Health and Wellbeing Board is considering several items about the Calderdale “locality” Sustainability and Transformation Plan.

This aims to cut NHS and social care spending in Calderdale so that the projected 2020/1 £79m funding shortfall, due to government underfunding of the NHS and social care, is reduced to £16m.

According to a paper that the Health and Wellbeing Board will consider, these cost cutting plans will prevent ill health and reduce health inequalities.

All is for the best in the best of all possible worlds in Thunder-ten-Tronckh Town Hall.

Those of us on the receiving end don’t see it that way

Calderdale 38 Degrees NHS Campaign Secretary Rosemary Hedges will ask Calderdale Health and Wellbeing Chair Cllr Tim Swift how he and Cllr Bob Metcalf, the Cabinet member for Health and Social Care,  have responded to the letter signed by over 200 Calderdale citizens,  calling on them to write to Calderdale Clinical Commissioning Group telling them to suspend the STP operational plans and contracts that they had to sign by 23rd December,  and to disclose the full detail of their plans.

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Whether or not Cllrs Tim Swift and Bob Metcalfe did what so many members of the public asked them to, Calderdale Clinical Commissioning Group sent NHS England its 2017-19 STP Operational Plan, and the 2017-19 contracts with providers that will make this Plan happen.

Calderdale Clinical Commissioning Group Governing Body hasn’t seen or approved these contracts and plans

But it turns out their own Governing Body hasn’t seen or approved the 2017-19 STP operational plan or the contracts, despite the fact that Calderdale CCG’s Constitution says the Governing Body has responsibility for “making decisions on the commissioning of services, care and support for patients where the CCG has a duty to commission healthcare services within the available resources.”

According to an email from Calderdale CCG, the Governing Body is due to formally agree the operational plan at a meeting early in the new year.

I have asked the Health and Wellbeing Board:

“How is the CCG Officers’ assumption that the Governing Body will agree to the operational plan and contracts that they have come up with, compatible with the Governing Body’s responsibility for making decisions on commissioning?”

Contracts have riders to STPs when it becomes clear what they are!

On top of this, the Calderdale CCG Chief Officer Matt Walsh told the October 27th Calderdale Health and Wellbeing Board that the CCG were only able to agree these contracts with riders to STPs when they were made clearer.

I have asked the Health and Wellbeing Board:

a) What contracts were signed and what were the riders?

b) Does this mean that Calderdale CCG 2017-19 contracts and STP operational plans (which have not even been agreed by the CCCG Governing Body) are subject to change, depending on decisions made by the WY&H STP footprint?

c)More specifically, how are Calderdale CCG’s commissioning decisions  (and in the course of time, integrated Calderdale CCG/Calderdale Council commissioning decisions), going to be affected by the many footprint-wide “collaborative proposals” in the WY& H STP and by the seven WY&H STP “big decisions” that were  identified in the 11 August Calderdale HWB development workshop with Calderdale CCG?

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West Yorkshire & Harrogate STP Collaborative proposals

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d) What does this mean for the Sustainability and Transformation Plan “democratic deficit” that was clearly identified at the 25th August HWB meeting?

e) Finally, does the Calderdale STP mean anything, when there are so many big decisions that are to be taken at footprint level, in a process that is completely unclear and has no legal/statutory basis?

This was a big bone of contention at the August 25th 2016 Calderdale Health and Wellbeing Board.

At that meeting, Cllr M Swift asked,

“Will Calderdale STP just get lost in the West YorkshireSTP? They have a crisis in Leeds, money’s been thrown at it there, how will that affect rest of West  Yorkshire?”

Matt Walsh replied:

“I’m not sure – but I think we’re moving to a place where if one fails all fail, so we’re trying to get to a place where West Yorkshire is sustainable and can live within its means.”

He warned about the NHSE financial reset doc “Strengthening financial performance and accountability 2016-17”, which forces the STP footprints to limit their spending to take account of £30bn government underfunding of the NHS by 2020, compared with what would need to be spent to maintain current levels of provision.

He  said

“It talks clearly about sanctions to CCGs and trust providers who fail to provide what it demands. The final sanction for underperforming ccgs is that they will be replaced by ACOs. We can say what we want here, but in the end we are subject to the regulatory regime.”

Disgruntled Councillors decided to tell Rob Webster, the STP leader, that they didn’t like a lot of his draft “core STP narrative”.

That was in August.

Now the Health and Wellbeing Board just wants to make cuts and pass them off as improving people’s lives

The Calderdale Sustainability and Transformation Plan shows Calderdale Council intends to cut social care costs in line with the government’s £29m underfunding of social care by 2020/1, through integrated commissioning arrangements.

A paper for the January 12th HWB meeting, which proposes shoving all Council services into an Integrated Commissioning Executive, says nowt about this.  It just says the aim is:

“to improve the lives of the people of Calderdale by bringing together planning for broader determinants of health and well being.”

The paper admits that this does not tackle social & economic determinants of ill health, and goes on to say that, nonetheless, it should be done because:

“…health care accounts for the largest portion of additional public spending associated with poverty, around £29 billion per year. There is a growing weight of evidence that health care utilisation and costs are strongly related to poverty, both as presently experienced and as a legacy from past experiences of poverty…around a quarter of all spending both in acute hospital care and in primary care can be attributed to greater use of these services by people in poverty… this creates a huge additional cost.”

The trouble is, Calderdale Sustainability and Transformation Plan’s proposed action on healthcare inequality is so-called preventative measures that amount to imposing behaviour change on chronically ill people, on the false assumption that lifestyle choices cause their illness; and integrated commissioning of the whole range of council services.

It is impossible to get any sense from either the Calderdale Sustainability and Transformation Plan or the Health and Wellbeing Board paper on Integrated Commissioning, about how this is going to improve the lives of Calderdale people.

Maybe the new Integrated Commissioning Executive is more to do with the Minister for the Cabinet Office’s ideas about the future of public services, which “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

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