West Yorks and Harrogate STP’s coded answers about transition to Accountable Care

We are tired of the secrecy and furtiveness of the West Yorkshire and Harrogate Sustainability and Transformation Partnership, which is due to cut £1bn from the area’s NHS and social care spending by 2020/1, compared to the projected amount if services continued as they were in 2015.

So as a start we asked for some information about who they are, what they’re doing and why this isn’t public information.

How were the West Yorks & Harrogate STP System Leadership Executive Group appointed and who appointed them?

The leadership is made up of existing health care leaders already working across West Yorkshire and Harrogate organisations. The only appointment made was for Ian Holmes, Director of West Yorkshire and Harrogate, Health and Care Partnership [ie STP]. Ian was appointed in August 2016 by a partnership panel.

Who are the members of the WYH STP leadership team?

The System Leadership Executive Group lists the current members as at 8 December 2017. However, the reply to our question said,

“We are revising the membership as part of the development of the Memorandum of Understanding (MoU) and our work towards increasing local autonomy.”

That evasive bit of code  – ‘increasing local autonomy’  seems to mean ‘becoming an Accountable Care System’. Or Integrated Care System. Or Place-Based system. Or Scattered To The 4 Winds system.

When did they decide to turn the WYH  ST Partnership into an Accountable Care System, from April 2018?

“No decision has been made. Our leadership team have discussed the benefits of greater autonomy and control over resources, including money, from national bodies that this would bring to WY&H. We believe that this is a route we should consider taking.
Our ambition is to move towards this in shadow form from April 2018.  This is subject to all parties, including NHS England, being content that the freedoms, flexibilities and resources match the requirements for delivery in our partnership plan.”

Apart from the “No decision has been made” sentence, that is a selective quote from Rob Webster’s blog,  posted some time around the end of 2017, before we received the answers to our questions.

The blog doesn’t  sound too much like “no decisions have been taken”. Rob Webster, the STP Leader, wrote:

“…Moving to an ACS is the natural progression for our partnership. … Becoming an ACS will build on our strong partnership relationships and the foundations we are putting in place for better health care now and in the future.”

We found the answer to be disingenuous and seemingly designed to mislead – especially knowing what we now know from the Wilmington Healthcare report on the Memorandum of Understanding.

This report says the Memorandum of Understanding will commit the individual NHS organisations to abandoning control of their finances in favour of system-wide financial control that allows the Accountable/ Integration Care System leader to intervene in their organisations, and seemingly ties them into  commissioning and contracting methods specified in the new Accountable Care Model contract, that is currently subject to two Judicial Review that are to be heard in the Spring. We are asking West Yorkshire and Harrogate STP further questions about this.

When and where was the WYH ST Programme Directors’ “priority meeting” held, that discussed the Accountable Care System Memorandum of Understanding and any other matters relating to the proposed Accountable Care System?

The WYH ST Programme Leaders meet as a group on a monthly basis. An important part of the way we work will be an agreement (or Memorandum of Understanding (MOU) between partners and with national bodies. This will underpin the next phase of our development, setting out shared governance and accountability arrangements, and highlighting shared commitment to working together.  This is part of ongoing conversations across the WY&H leadership meetings.

Who has been discussing the proposed ACS with NHS England and NHS Improvement, when and where?

“Preliminary, exploratory discussions have taken place between the leadership team and NHS England.  These discussions are ongoing.”

What papers/emails/minutes of meetings have been produced for those discussions and please will you send them to me?

The discussions held to date have been exploratory and have been held in private. Minutes and other papers are not publically [sic] available.

Please also send agendas, papers and minutes for a) the Meeting of the WYH STP leadership team that decided to set up a WYH ACS from April 2018 b) the priority meeting of the WYH STP Programme Directors that hat discussed the ACS Memorandum of Understanding and any other matters relating to the proposed ACS.

As above.

Why have these meetings been held in secret, without notifying or inviting the public to attend?

The discussions to date have been exploratory and for this reason have been held in private.  We are committed to openness and transparency and when firmer proposals have been developed these will be presented to the appropriate forums in public.

A progress update was given to the West Yorkshire JHOSC on the 28 November and is also in our November blog which is publically [sic] available. You can read this here.

Cloaked in jargon

We had to use our handy STP Code Book to decipher various weird jargon.

‘Place’ seems to be code for a locality Sustainability and Transformation Partnership (soon to be an Integrated Care System).

The list  of the current West Yorks & Harrogate STP leadership team identifies Commissioning Group Chief Execs by their “place”:

Jo Webster, representing CCGs (and Wakefield place)
Matt Walsh representing Calderdale place
Amanda Bloor, representing Harrogate place
Helen Hirst, representing Bradford place
Carol McKenna, representing Kirklees place
Phil Corrigan, representing Leeds place

If the February 2018 meeting of Calderdale Council Cabinet is anything to go by, “place” in this context is a euphemism for a local Sustainability and Transformation Partnership/Accountable Care System (now rebranded a Integrated Care System).

Calderdale Councillors coyly insisted on calling it “place-based care”, in order to avoid using the words “integrated” or “accountable”, or which they described respectively as “toxic”and having “American connotations”.

We think Accountable Care Duck apparatchiks may have dragooned the poor word ‘place’ to cover up the mismatch between local authority areas and Clinical Commissioning Group areas.

This is a confusing and irrational feature of Sustainability and Transformation Partnerships and Accountable/Integrated Care Systems.

Combined with the Department of Health and NHS England’s encouragement of competition between GPs, that is destabilising the boundaries of GP practices, this will make rational planning and allocation of resources well- nigh impossible.

As Professor Allyson Pollock told the Health Select Committee last week, who put their fingers in their ears because this was not the evidence they wanted.

Accordingly, we have de-coded ‘place-based’ care as meaning ‘scattered to the 4 winds care’.


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