People power brings West Yorks and Harrogate Accountable Care System proposal to Scrutiny Committee

The West Yorkshire and Harrogate Joint Health Scrutiny Committee, made up of Councillors from across the region, finally met on 28 November after a gap of 8 months and discussed:

• The need to scrutinise the West Yorkshire and Harrogate Sustainability and Transformation Plan (STP) as a whole.
• The proposal that it should become an Accountable Care System (a new type of local public/private NHS and social care organisation, based on the business model used by the USA’s Medicare/Medicaid programme that provides a limited range of healthcare for people who can’t afford private health insurance).
• The STP centralisation of stroke services.

This is thanks to everyone who signed the initial ck 999 open letter  to the Councillors’ STP Scrutiny Committee; and to the Calderdale Health and Wellbeing Board Chair Cllr Tim Swift who – when asked – endorsed the request for the Scrutiny Committee to do its job of scrutinising the West Yorkshire and Harrogate Sustainability and Transformation Plan/Partnership.

However only 4 Councillors turned up, apart from the Chair. Only three said anything, two left early and the meeting became inquorate before the end.

The Scrutiny Committee meeting started with deputation statements by ck999 and North Kirklees Support the NHS.

Sustainability and Transformation Plan Chief ignored NHS protectors’ key concerns

The West Yorkshire and Harrogate STP chief exec Rob Webster said that he would address the concerns raised in the ck999  correspondence.

In fact he ignored our key concerns about:

• STP harsh financial controls
• an end to the NHS providing the full range of treatments to all who have a clinical need for them
• speeding up the development of a two tier health and social care system
• increasing NHS and social care privatisation and potentially handing control of an area’s NHS and social care to a private company.

He said it’s unfortunate that American terms are being applied to the NHS, but Accountable Care means moving away from competition to collaboration and getting more autonomy from central government. (However a King’s Fund report points out that Sustainability and Transformation Plan financial controls mean central government is taking back power and there is now far less local autonomy than the 2012 Health and Social Care Act legislated for)

Rob Webster said Accountable Care would make the NHS in England more like Scotland and Wales. (A claim Cllr Smaje demolished.)

He denied that Accountable Care Systems are about privatising the NHS, and added,

“STPs in principle are a good thing. Problems can’t be solved by one organisation workng alone or on annual cycles.

It brings people together to plan for communities in the medium term so the NHS is more sustainable.”

He added that the West Yorkshire & Harrogate Sustainability and Transformation Partnership (STP) was making progress and more capital was to be fed through STPs. In West Yorks and Harrogate STP, there is more capital for:

• inpatient CAMHS [Child and Adolescent Menta Health Services] – £13m
• zero suicide strategy
• Significant cancer diagnostic money.

Rob Webster concluded that they need to move from a Partnership into having more autonomy (code for becoming an Accountable Care System). In practice partners would take on not just commissioning & provision, but work with regulators in a different way. If they move to an Accountable Care System, it would take on some regulatory function, in exchange for funding for workforce, estates etc. All that has to be approved by Councils and other statutory bodies.

Councillors didn’t ask what regulatory function the Accountable Care System would take on, although this seems rather vital information.

The Councillors also omitted to challenge Rob Webster on all his omissions – they didn’t ask him about our key concerns, nor about his failure to provide key financial and other background information for Scrutiny last winter.

STP and Accountable Care Systems governance

Cllr Smaje did get her teeth into the Sustainability and Transformation Partnership’s furtive decision-making. She pointed out,

“I’m still not clear how anything discussed at the Sustainability and Transformation Partnership goes to the JCCC [Joint Clinical Commissioning Committee] because the Partnership meets in private. Surely we should see their decisions when taken, before they go to the JCCC, so Scrutiny can scrutinise them.

WYAAT [WestYorkshire Association of Acute Trusts] is not a public meeting & how do we find out about their decisions?

Local Authorities have an informal group. Providers have an informal group.

How can Scrutiny get hold of all these decisions?”

There are no decisions to be taken in the Sustainability and Transformation Plan – but where there are, there’s a lot of engagement

Rob Webster replied,

“How do we engage on decisions? There are no decisions to be taken in the Plan – it’s a series of high level intentions.

Where there are decisions, for example about stroke services, there’s a lot of engagement. The timeline is crucial for scrutiny to consider.

We want really effective scrutiny at every level – including here.

If an ACS (Accountable Care System) is to to take control of resources that are currently held nationally, better scrutiny is needed.”

Smooth talk about welcoming better scrutiny needs to be taken with big pinch of salt

In November 2016, Rob Webster told the Kirklees Health & Wellbeing Board meeting  that he was all in favour of transparency and would check with NHS England about releasing additional key STP financial documents that had not been made available to Councillors or the public.

These and other key STP background documents failed to materialise, so ck999 put in a Freedom of Information Request for them, which was refused – as we told the January 23rd 2017 meeting of the West Yorkshire and Harrogate Joint Health Scrutiny Committee.

On hearing this, the then-Chair, Cllr Peter Gruen, said it was disgraceful that the Scrutiny Committee hadn’t had any proper information about the Sustainability and Transformation Plan, thanked ck999 for the deputation statement which was new information and added grimly,

“Jim Mackey from NHS Improvement has said that ‘Local politicians should be managed’.”

Why is Cllr Gruen no longer on this Scrutiny Committee?

West Yorkshire and Harrogate Accountable Care System would not be like NHS Scotland

Cllr Smaje punctured Rob Webster’s claim that Accountable Care Systems would be more like the NHS in Scotland and Wales:

“What would governance be across West Yorkshire & Harrogate that’s like the Scottish NHS? For example, Scottish health boards. When that was set up, their previous organisations were dissolved. We need a fuller understanding of what that means.”

Rob Webster said,

“It’s up to us to make decisions about governance structure and processes. Councils won’t be dissolved, CCGs won’t be dissolved.

In discrete neighbourhoods we need better primary, community and voluntary sector cooperation. Each would have about 50K population. We need to have governance for those local neighbourhood organisations.

Then we will decide at West Yorkshire level what governance arrangements will serve West Yorkshire- wide needs.

That would involve Councillors, NHS organisations, communities, Healthwatch and the third sector.”

None of the West Yorks and Harrogate STP decision making bodies are elected and accountable to public

The Chair, Cllr Hayden, said that none of the West Yorkshire and Harrogate Sustainability and Transformation Partnership decision-making bodies are elected and accountable to public.

Rob Webster replied,

“All decisions are taken with reference to the statutory processes of the bodies in the room.

The political engagement of the STP has been through Health and Wellbeing Boards and Health and Wellbeing Board Chairs. This is necessary but not sufficient. We’re talking to Council leaders about how to make it more democratic.

If we have to make tough choices in future, we have to have democratic involvement in decision making and scrutiny.

We have to make sure governance is fit for purpose if we want to create an ACS.”

Since the Accountable Care System, governance issues and contract are now on the West Yorkshire and Harrogate Joint Health Scrutiny Committee workplan, let’s see how that goes.

We are keeping a close watch – particularly since before they decided on their STP scrutiny workplan, the Joint Health Scrutiny Committee expressed doubts about whether they have the capacity and mechanism to scrutinise the West Yorkshire and Harrogate Sustainability and Transformation Plan as a whole.