Please tell your Councillors and MP to scrap West Yorkshire and Harrogate Sustainability and Transformation Partnership

Here are downloadable template emails/letters that you can change as you see fit and send to your ward Councillors and MP, telling them why they need to scrap the West Yorkshire and Harrogate Sustainability and Transformation Partnership

Here is where you can find your MP and Councillors’ contact details.

Here is why Councillors and MPs must scrap Sustainability and Transformation Partnerships

West Yorkshire and Harrogate STP is steaming ahead – since 1st April 2017 it has turned from a Sustainability and Transformation Plan into a Sustainability and Transformation Partnership.

Its cuts and privatisation agenda aside, the Sustainability and Transformation Partnership is undemocratic, secretive and possibly unlawful due to the fact that it has no statutory basis – ie basis in law.  It is operating through non-statutory committees that have binding decision-making powers over their statutory members. How can that be right?

Area – wide commissioning decisions about cuts, centralisation and networking of hospital clinical and non-clinical services are being taken by the West Yorkshire and Harrogate Joint Clinical Commissioning Committee that can force binding decisions on individual Clinical Commissioning Groups.

At its first meeting in July 2017, the Joint Clinical Commissioning Group was bashing on regardless with plans to centralise the area’s stroke services – even though the NHS England Clinical Network Clinical Lead had to admit the “case for change’s” claims of supporting evidence are phony.

The West Yorkshire and Harrogate Joint Clinical Commissioning Committee has repeatedly failed to explain their claim that the member Clinical Commissioning Groups retain their statutory powers and accountability, when this seems to be overridden by the Joint Clinical Commissioning Committee’s assumed powers.

These include the power to bind Clinical Committee Groups to a majority decision that they do not agree with and did not delegate their Joint Clinical Commissioning Committee representatives to make; plus, the Joint Clinical Commissioning Committee Memorandum Of Understanding (Schedule 4, 2.8) says that “Joint Committee Decisions may be made by the Joint Committee without reference back to each Party.” [ie Clinical Commissioning Group]

The West Yorkshire and Harrogate Joint Health Scrutiny Committee is not doing its job. It last met in March 2017 and when contacted in the summer, the Scrutiny Officer said there are no plans or dates for future meetings.

An NHS England directive has ordered all Sustainability and Transformation Partnerships to move towards setting up Accountable Care Systems/Accountable Care Organisations

This is a new business model for the NHS and social care in England that is explicitly designed to impose cuts, restrict services to patients who offer “the best return on investment” and dismantle the NHS into local health and social care systems.

Private health care companies and their lobbying organisation the NHS Partners Network explicitly see Accountable Care Organisations as a route to increased NHS privatisation, and the government is committed to Accountable Care Organisations as means of long term partnerships with the private sector. (although NHS England keeps quiet about this) The government’s 2015 Spending Review settlement for the NHS committed the government to encouraging long-term partnerships with the private sector in a number of key areas including:

Restrictions and denials of care

Setting up Accountable Care Systems/Accountable Care Organisations will increase restrictions and denials of care which are already becoming commonplace. The NHS is meant to be comprehensive – offering the full range of approved, evidence-based treatments – and universal – meaning it treats everyone with a clinical need. Accountable Care Systems/Accountable Care Organisations abandon that basic principle of the NHS. Clinical Commissioning Groups are already focusing on “Demand management” in order to cut costs.

One way they are “managing demand” is to prevent GPs from referring patients to consultants, and require them to go through private referral management companies that weed out patients whose treatments do not represent good value for money. Another is to require them to send patients to “hubs” like the Musculo Skeletal (MSK) Hub in Greater Huddersfield that is run by Locala.

This Locala Hub refers patients to a private company, InHealth Pain Management Solutions. One patient has already had their initial Pain Management Solutions appointment cancelled three times in a row without explanation, meaning that they are still living with pain and with no clear prospect of receiving treatment for it.

Even when they do finally get seen, with some limited exceptions they will find this company’s treatments are limited to medication recommendations to the patient’s GP (who has had to send their patient there in the first place, without being allowed to treat the patient themself) and 6 months attendance at a pain management programme in groups or alone, which require patients to engage in a comprehensive self management programme.

So much for care closer to home. Care round the houses, endlessly postponed and then DIY is more like it.

Workforce plans are un-evidenced, unbearable for nurses and damage patient safety

The care models and deskilled and cheaper “modern workforce” that Sustainability and Transformation Partnerships are to set up are un-evidenced and not in the public interest or the interest of the NHS – as the referral of the Calderdale and Kirklees Right Care Right Time Right Place proposals to the Secretary of State shows. These proposals are a key part of the West Yorkshire and Harrogate Sustainability and Transformation Partnership.

Calderdale and Huddersfield NHS Foundation Trust is desperately short of nurses.  Data analysed by the Royal College of Nursing shows that Trusts with nursing shortages are increasingly replacing registered nurses with cheaper, unqualified healthcare assistants.

Reliable evidence shows that replacing registered nurses with unregistered support staff leads to higher patient mortality rates. Not only is this bad for patients, but it is not fair on Healthcare Assistants to put them in situations they are not qualified to cope with. But this is the “skill mix” that Sustainability and Transformation Partnerships aim to create.

Increasingly, targets, box ticking, overwork are destroying nursing as a caring compassionate art in today’s NHS as the government and its quangos fragment, cut and privatise it.

District nurses need to account for every minute of their time – every activity is allotted time, from accessing notes to patient care and travel. It is demoralising and timeconsuming. Their laptops are poor and as they are out and about, the notes they are supposed to write end up as home work, with nurses reporting that they often are writing notes at 9.30pm.

Recently-retired Community Matron Anne Marie Hutchinson said,

“Working with vulnerable clients with inadequate resources is hell on earth. You cope initially by doing unpaid overtime then you burnout. I was lucky, my retirement date came and I took the opportunity to get out. Still feel guilty about those left behind!”

The Sustainability and Transformation Partnerships’ “modern workforce” plans seem to be attacking the very essence of nursing, although most people don’t know this yet. A recent Welsh court case about who should fund the qualified nurses in Care homes and the “continuing care budget” centred on whether nursing includes personal care. The NHS disingenuously argued that they don’t need to fund the entire nurse pay for continuing care, if that nurse is doing “personal care” that a lower qualified assistant could do.

This has called into question the entire definition of nursing; it is incredibly important for nursing and could fuel the current establishment’s agenda of downgrading the profession.

The continuing care budget is already very difficult – one of our grandmas was all but dead by the time they decided her needs were “nursing”. If the cuts and privatisation quangos can further crack the need to define what is a nursing need so it doesn’t include personal care, they not only avoid the expense of many nursing home beds but take away the entire art side of nursing, leaving it as a clinical task-orientated activity.

A Palliative care nurse spoke recently at a practice meeting about their job threat. The authorities are discouraging anything that could be undertaken by a less qualified member of the team being included in the activities of senior staff. Who needs a hand to hold when dying? Anyone can do that.

In Shropshire, all health visitors have been told they have to reapply for their jobs and if unsuccessful will be downgraded to Band 5. Unite reps are fighting this. This is down to the Council cutting £600k from its public health spending – at a time when the Clinical Commissioning Groups are planning to cut hospital services and people are supposed to have care closer to home instead. Who is going to provide care closer to home if there are hardly any health visitors? So much for integrated care and integrated Council/Clinical Commissioning Group commissioning.

There are downgrades everywhere – specialist nurses are often on band 5 or 6 now and the NHS Agenda for Change job profiles have in some cases helped the downgrades.

No agreement between local authorities and the NHS about Sustainability and Transformation Partnerships

Despite the fact that Clinical Commissioning Groups and Local Authorities are meant to run integrated commissioning for continuing care/social care (“Care Closer to Home”), the Joint Clinical Commissioning Committee excludes local authorities.

A recent local government association survey showed that there is no agreement between local authorities and the NHS about Sustainability and Transformation Partnerships. So how can they set up Accountable Care Systems/Organisations that are to include both Local Authorities and Clinical Commissioning Groups that will have responsibility for delivering all the community/social care/public/primary health services for their area – if not the hospital services too? Which could be included under Primary and Acute Care type Accountable Care Organisations.

The shortcomings of local authorities when charged with delivering public private partnerships are evident in massive social housing failures. This bodes ill for how they will deliver public private partnerships for health and social care.

These are just some of the reasons to Scrap the STPs, fund the NHS and social care adequately and reinstate the NHS and social care as publicly owned, provided and managed services that are free from commercialisation and privatisation.

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