After more than two years of secretive developments, on Weds 5th March Lincolnshire Sustainability and Transformation Partnership announced its “engagement” process for huge Lincolnshire-wide cuts and changes to the county’s NHS services.
This blog post gives an overview of Lincs Sustainability and Transformation Partnership’s claims for the “engagement” and the flaws and failings in NHS England’s directions for Sustainability and Transformation Partnerships.
There is info about Lincs Sustainability and Transformation Partnership’s proposals for cuts and centralisation of hospital services here. Details of proposals for moving Grantham hospital medical services into the “local enhanced neighbourhood team” – aka Care Closer To Home – are here. Information about how Lincolnshire Health Scrutiny Committee is failing in its vital role is here. [link coming soon]
The proposals are the original 2016 Sustainability and Transformation Plan reheated
Nothing’s changed – except in the meantime significant cuts and changes have been made by stealth.
According to John Turner, Senior Responsible Officer for Lincs Sustainability and Transformation Partnership and Accountable Officer for South and South West Lincolnshire Clinical Commissioning Groups, the engagement is about discussing “emerging options” . He says Lincs Sustainability and Transformation Partnership:
“anticipate that formal consultation will follow as a separate exercise…once our discussions with NHS England are complete and the source of capital funding has been identified.”
“Nothing has been decided. The NHS can only make substantial changes permanent once it has been through a full public consultation process in line with our statutory obligations and national guidance.”
No-one who’s been following what United Lincolnshire Health Trust and the Clinical Commissioning Groups have been up to over the past two or three years will believe for a minute that “Nothing has been decided.”
If you have doubts about this, just read Paul Lewis’s 07.08.18 Open letter to the editor of The Grantham Journal. (downloadable .doc file.)
Dancing to the government’s NHS cuts and privatisation tune
Contrary to the claim by Nick Boles MP, that Lincs STP “has been drawn up by senior doctors and nurses – and not just imposed on us by the bureaucratic machine” – the Lincolnshire STP proposals comply with NHS England’s template, first laid out in 2014 in the Five Year Forward View and now updated in the NHS Long Term Plan.
They are basically the same across all 44 Sustainability and Transformation Partnerships and all involve what John Turner calls:
“a new NHS service model for the 21st century”.
The NHS Long Term Plan requires all Sustainability and Transformation Partnerships to become Integrated Care Systems by April 2021.
The proposals involve:
- Cutting and centralising hospital services – more info here ( Lincolnshire hospital cuts and centralisation proposals would worsen health inequalities and increase patient deaths)
- Moving hospital services into new primary care networks serving 30K-50K patients that each shares a “locality hub” serving up to around 180k patients.
- Restricting patients’ access to GPs – who will mostly only see high cost patients with complex conditions while new grades of less qualified staff will see everyone else.
- Pushing much of the work of health and social care onto patients themselves, their families, friends and voluntary sector organisations (the so-called “left shift”).
- Large scale behaviour changes schemes targeted at patients suffering from or deemed to be at risk of modern epidemics eg obesity, diabetes, anxiety, depression, heart and respiratory problems – regardless that these are largely determined by social, economic and environmental injustices and deregulated corporations.
- A lot of remote digital monitoring of people’s participation in these behaviour change schemes through wearable technology – with pretty horrendous privacy and civil liberties implications (briefly discussed by Shoshana Zuboff in her Surveillance Capitalism book), and the slippery slope towards conditionality of NHS care.
Where’s the evidence that this “new model of care” will improve patient care, cut costs and deal with workforce and capacity shortages?
These are the stated aims – but recent reports by the National Audit Office and the Nuffield Trust say there is no evidence that the new “integrated care” model would meet the intended aims of reducing costs and improving quality of patient care.
However, the Lincs Sustainability and Transformation Partnership claims otherwise.
“Home First or Integrated Community Care (ICC)… is a high priority for us and in Lincolnshire. …We know people do better mentally and physically if they can be cared for in or close to home by health and care staff based in the community and the evidence supports this.”
Where is this evidence?
This new model is based on the USA’s Accountable Care Organisations that deliver the limited publicly funded Medicare/Medicaid system for people who are too poor or ill to afford private health insurance. It would radically change patients’ (and GPs’) experience of the NHS, with the explicit aim “managing demand” for NHS services .
This involves the introduction of financial considerations as well as clinical considerations when deciding which patients get which treatments – threatening the core NHS principle of a comprehensive service for all.
Inadequate funding will make it hard to maintain NHS standards so performance standards may be “revised”
Lincolnshire NHS is suffering from an annual £100m funding shortfall, and has been badly underfunded since the coalition government decided in 2010 to cut spending on public services.
But as a result of the government’s NHS 70th Birthday funding increase, Lincolnshire’s NHS money is expected to rise from £1.1bn in 2018/19 to almost £1.4bn in 2023/24.
This extra money has to be used to eliminate the “deficit” – ie the extent to which NHS organisations have had to spend more than the funding the government has given them, in order to continue to provide an adequate service.
The increase is estimated at 3.3% a year. It is below the historic average and just about enough to keep pace with growing demand. This means maintaining NHS standards will be difficult.
According to the Health Foundation, the NHS Long Term Plan
“hints that revised performance standards may soon arrive.”
“Revised” means “lower”.