The reason nearly all Councils are rolling over and accepting Sustainability and Transformation Plans – after token protests that collectively the public and Reclaim the NHS campaigners pretty much forced them to make last autumn – is because the Sustainability and Transformation Plans are designed to buy them off.
The mechanism is for Sustainability and Transformation Plans to function like a bigger Better Care Fund that siphons NHS dosh into their empty social care coffers. So this is a way for them to continue to provide statutory services that otherwise they wouldn’t be able to, and would then have whatever the local government equivalent of NHS Improvement is, taking them into special measures or its equivalent.
The evidence is in the financial bits of the Sustainability and Transformation Plans.
For instance, the West Yorkshire & Harrogate Sustainability and Transformation Plan can’t eliminate the projected £1.074bn 2020/21 shortfall that will result from government underfunding of the NHS and social care – even with Sustainability & Transformation Funding – which in WY& H S is an anticipated £0.2bn.
The (reduced) projected shortfall in 2020/21, as a result of the cost cutting STP measures, is £91m.
This shortfall is made up of a £43m NHS surplus and a £135m social care shortfall. This shows that a lot of the reason for the STPs is to bail out local authorities due to MASSIVE central government cuts to local authority grants. This means that the government promise to ring fence NHS spending has been definitively broken. (It already had been, through the Better Care Fund and reallocation of public health spending to other directorates in local authorities, and personal health budgets etc.) But this is a full scale bail out of local government by the NHS.
Meanwhile the BMA has just put out a press release reporting on the Public Accounts Committee report published today (Thursday 27th April) which says that the Better Care Fund was
“little more than a ruse to paper over funding pressures.”
The Better Care Fund is a way of propping up the Council’s social care services after brutal funding cuts have left adult social care services in England facing a £4.3bn “black hole” in funding by the end of the decade.
The lack of social care, as funding has been cut, has led to more frail elderly and chronically ill patients going to hospital and then staying there longer than they need, because there are no social care services to take care of them on leaving hospital.
BCF spending is high risk because there’s no real evidence it will work to reduce acute hospital admissions
Elaine James from Calderdale Council’s Adult Health and Social Care directorate said that BCF spending is high risk because there is no real evidence that it will work.
She explained that there are no real grounds for believing that taking NHS money from the hospital and giving it to Calderdale Council, in order for the Council and the CCG to spend it on adult social care, is going to reduce acute hospital admissions.
“We have said for some time now that using the Better Care Fund to prop up depleted social care budgets will only place further pressure on an NHS already at breaking point.
“This [Public Accounts Committee] report also highlights the huge holes in planning for adequate social provision in STPs, with areas piloting new care models seeing slower growth in admissions and delayed transfers of care. To roll out these plans without evaluating them first smacks of short term-ism. Given the scale of the savings required in each area, there is a real risk that these transformation plans will be used as a cover for delivering cuts, starving services of resource and patients of vital care.”
No shit, Sherlock.
If we want to stop Councils taking the Sustainabilty and Transformation Plan bribe, we have to get them to challenge “austerity” economics in general and public spending cuts in particular. And we also have shout at the government – whichever one it may be after the June General Election – to stop starving local government to death, which is what they’re doing. This is galling because you’d think Councils would have been doing this themselves, but no.
We have only really been shouting about the NHS but we have to shout about local government too, I think. And about the whole public service reform stuff that was started under the Blair government, with one Matthew Swindells in the Cabinet Office working on it. ( He is now an NHS England Director with a big role in pushing digital technology as key to the Sustainability and Transformation Plans. This will make his previous employer Cerner happy since they will sell a lot of this digital technology to the NHS.) His obnoxious paper “The jigsaw of public service reform” is here.