Sustainability and Transformation Plans are designed to buy off Councils – part 2

The reason nearly all Councils are rolling over and accepting Sustainability and Transformation Partnerships  – after token protests last autumn (2016) that collectively campaigners pretty much forced them to make – is because the Sustainability and Transformation Partnerships (many soon to become Accountable Care Systems, Partnerships or Organisations from next April) are designed to buy them off.

But the stream of cash that STPs redirect from supposedly ringfenced NHS funding into local authorities’ empty social care coffers is still not working anyway!

In Kirklees, stroke patients who should get rehabilitation in Dewsbury Hospital (since that is one of its primary roles now its A&E has been downgraded to an urgent care centre) cannot get out of Pinderfields to access the rehabilitation there, because there is no social care for those already in Dewsbury Hospital, to go home to – or indeed Care Home beds for those who need it, either! We are hearing of a 90 year old with a catheter, discharged to their home where their 60 year old son is supposed to be looking after them, with no visit from a medical professional for 4 days!

A North Kirklees Support the NHS campaigner said,

I think we have to rebrand the STPs’ new ‘managed care’ models as managed neglect!

Lip service is all Councillors ever gave to opposing STPs

St Helens is just one of a string of Sustainability and Transformation Partnerships that have recently said they are becoming an Accountable Care System .  And despite officials saying at a St Helens Care meeting last week that it was only designed to be local, it isn’t. The language has been taken straight from the ACO dictionary and the objectives are the same: limit the level of care, stick to a whole population (per person) budget and sell off assets. Perfect for absorption into the structure of the Cheshire and Merseyside Accountable Care Organisation.

Wirral Council Cabinet recently approved STP proposals for “integrated commissioning” of NHS and social care services, plus a Full Business Case – despite announcing last year that the Council opposed the STP. The Wirral Council report on key aspects of the “integration programme” said commercially sensitive information meant it was in the public interest to exclude the public and press from some bits of the meeting.

Members of the public said,

“It went through just on the nod, no questions, no abstentions. Phil Davies (the Council Leader) made a little speech about the erroneous comments about Council supporting privatisation of the health service; the Council was opposed to privatisation but had to make the best use of limited resources.  In the public gallery of course we could not make comments or ask questions.”


“‘Making the best of limited resources’ is becoming the mantra of those privatising the NHS, to cut short probing questions and justify the cuts to staffing, services, treatments etc. The CCG use it at every available opportunity and obviously the Council too.”

ck999 blogged about the great STP Council buy off last April , pointing out that,

If we want to stop Councils taking the STP 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 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.

To add to this, Tom Crewe has a very interesting (long) essay about how the government’s public spending cuts have hit local authorities hardest – and grossly disproportionately, as the poorest areas have been worst hit – in the 15th Dec 2016 London Review of Books.

Key points are:

“[Britain’s] political system is weighted overwhelmingly towards Westminster, with few institutional safeguards against the writ of Parliament, itself increasingly in thrall to the executive. Of every £1 raised in taxation, 91 pence is controlled and allocated by central government. The austerity programme pursued since 2010 has thrown into relief the vast power differential between central and local government: as chancellor of the exchequer, George Osborne spent plenty of time talking about devolving new powers from Westminster in order to create a Northern Powerhouse, but his most effective act of power-sharing was to transfer the burden of responsibility for deficit reduction onto councils, which account for around 25 per cent of total government spending. No other area of government has been subject to the same squeeze: since the start of the decade spending by local authorities has been reduced by 37 per cent, and is scheduled to fall much further over the next five years…

What we really mean when we say that austerity has slashed the state … is that it has wrecked the ability of elected local authorities to provide and administer many of the features and functions of the state as we understand them….

Between 2010 and 2015, £4.6 billion was cut from adult social care budgets in England. The services that remain are hopelessly overstretched: pay is generally abysmal and training limited (37 per cent of care staff have no recognised qualifications). By 2014, nearly 90 per cent of English councils were unable to offer any support for people with ‘low to moderate’ care needs (which includes those unable to undertake ‘personal care tasks’, ‘work or educational roles’ or ‘social and family roles’). Around two million older people now rely solely on support from family and friends. In September, the King’s Fund concluded that ‘access to care depends increasingly on what people can afford – and where they live – rather than on what they need. This favours the relatively well-off and well-informed at the expense of the poorest people, who are reliant on an increasingly threadbare … safety net.’ There is no let-up in sight: councils have a further billion pounds of cuts planned for the current year, with more to come until, in 2019, the gap between needs and resources will reach an estimated £2.8 billion, and spending on adult social care will fall below 1 per cent of GDP. One consequence is that the NHS can no longer safely discharge patients into the community, leading to a shortage of hospital beds.

Councils are also closing Sure Start children’s centres, one of New Labour’s most successful innovations. Designed to mitigate the effects of inequality as early in life as possible, the centres provide sessions with midwives and health visitors, ‘stay and play’ sessions, and other educational activities for families. A government-commissioned report, sneaked out last Christmas, found that ‘children’s centres can have positive effects on [social] outcomes, especially on family functioning that affects the quality of parenting, and that children’s centres are highly valued by parents’. ”

We have only really been shouting about the NHS but we have to shout about local government too.  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. The same Matthew Swindells who is now a key figure in NHS England,  driving the Sustainability and Transformation Plans

Central government’s punitive cuts to local government funding are bearing toxic fruit.

The recent Care Quality Commission report found that local authorities in West Yorkshire have a higher proportion of care beds that are rated as inadequate or in need of improvement. In Wakefield – site of the much vaunted Connecting Care care homes “Vanguard” pilot – 58% of care beds are rated as inadequate or needs improvement.In Kirklees the figure in 57% and in Leeds 34%.

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