Say NO to West Yorks and Harrogate NHS slash and trash plan 2019-24

Call to Action: If you live in West Yorkshire or Harrogate, please comment on this blog post by midnight on 20th September and we will collate and send the comments to the 6 Councils represented on the West Yorkshire and Harrogate Integrated Care System Board and to the Board’s Chair, Director and Chief Executive. (The comments box is at the end of this blog post.)

West Yorkshire & Harrogate Integrated Care System Board meeting 3.9.19, Wakefield Council

On 3rd September, West Yorkshire NHS defenders told the second meeting of the West Yorkshire and Harrogate Integrated Care System Board that we REJECT their draft 5 year operational plan 2019-24, that they have to send to the NHS England quango by 27th September.

This thoroughly Thatcherite 5 year plan (dictated by the government’s national Long Term Plan) :

• Shrinks the NHS by restricting patients’ access to services (it calls this ‘managing demand’, ‘reducing unwarranted variation’ and ensuring ‘sustainability’).
• Makes the NHS ‘digital by default’, with the intention of limiting patients’ face-to-face consultation with GPs and other clinicians, and driving them to NHS111, online/video consultations and the use of apps.
• Cuts costs in order to pay off NHS Organisations’ deficits and debts – caused by years of underfunding and ruinous Private Finance Initiative interest repayments.
• Runs the NHS like a business where money matters more than patients’ needs.
• Turns the NHS into a cash cow for global life science, digitech and health service support companies.
• Shifts hospital services into 50+ Primary Care Networks each serving 30k-50k patients and replaces statutory community health and social care services with a plethora of underfunded voluntary sector organisations, patients’ self-care and reliance on unpaid care from family and friends.
• Cuts and centralises hospital services, effectively undermining District General Hospitals to the detriment of safe services and causing patients to travel further for hospital care.
• Bullshits about ‘culture’ and ‘relationships’ as if they will solve the NHS’s problems – when what is needed is enough government funding to restore the #NHS4All, passing the NHS Reinstatement Bill as a matter of urgency, and proper investment in NHS staff training and workforce planning.
• And has to return a surplus of £21m next financial year!! Why?!

About the only sense talked by the Board came from co-opted lay member Jackie Dolman, a Calderdale parent carer and autism/disability adviser to the NHS England quango. She said very politely – and Calderdale and Kirklees 999 Call for the NHS couldn’t agree more:

“NHS values are not coming through in this document.”

Calderdale and Kirklees 999 Call for the NHS public statement to the Board

This is what Jenny Shepherd told the Board:

NHS Organisations often seem to start their meetings with a patient story.

So here’s one for this Board meeting, in relation to your draft 5 year plan.

It concerns a mental health patient, but it’s not about mental health.

It relates to the whole drive of the NHS Long Term Plan and your local “response” to it – which is to increasingly rely on digital technology while reducing the role of clinicians to its adjuncts.

Whether this means having to follow digital clinical assessment algorithms when diagnosing patients, or reducing face-to-face consultations with patients.

Relatedly, this drive is also to “shift care left” out of hospitals, into primary care networks and onto the shoulders of voluntary organisations, family, friends and patients themselves who are being admonished to self-care with the help of digital technology.

And this in turn is related to the decision in the Board’s 5 Year Plan and the Terms of Reference, to put population health management at the heart of the Integrated Care Systems and their key building blocks, the Primary Care Networks. Several of my questions to the Board are about this.

Calderdale and Kirklees 999 Call for the NHS thinks this direction of travel is a big mistake. It will circumscribe the professional role of clinicians. And contrary to all the blurb about patient-centred personal care, it will often effectively abandon patients to their own devices. Under the rubric of “increasing patients’ resilience and empowering them to self care.”

At a Greater Huddersfield Clinical Commissioning Group Annual General Meetings a few years ago, this was referred to as “realigning people’s mindsets”. The language has changed but what it refers to hasn’t.

This tragic patient story illustrates the consequences.

It was told to me in response my comment during a conversation, that there’s something deeply weird and disturbing about this case study from the West Yorkshire and Harrogate Integrated Care System’s 5 yr draft plan:

“South West Yorkshire Partnership NHS Foundation Trust is working with the University of Huddersfield to pioneer the use of computer artificial intelligence (AI) to predict which mental health patients are most likely to take their lives. Now that the potential to predict suicides using AI has been established, work will continue so that the technology can be used by healthcare professionals in their day to day work. The prototype of the automated suicide predictor is locally adapted to the Trust; but the AI could be adapted for other mental health services.”

This is the patient story, told to me by a West Yorkshire and Harrogate clinician:

“We’ve just talked about a patient who took his life as a review. He’d been assessed entirely appropriately and to a better than average level. The notes were thorough and so was the gp’s plans. The gp had tasked himself to make contact in a week ( which is quicker than usual ) but by the second planned contact he’d committed suicide. The Crisis team had been referred to. He’d been assessed as at risk but hadn’t given the impression of immediate intent. One of the older gp’s pointed out not that long ago he would have been on a section with one to one constant supervision. I’m not sure any app is going to be able to replicate that.

I just don’t believe there is an app to predict suicide risk. And unless whatever that computer algorithm predicts is backed up with capacity to help that individual and get them intensive services a suicide predictor is entirely redundant; what’s the point of foresight without preventative capacity?”

This is so sad.

The whole direction of travel of the Long Term Plan and the West Yorkshire and Harrogate Integrated Care System 5 year strategy is to water down skilled clinical care and replace it by volunteers, already overloaded unpaid carers, apps and half-trained allied health professionals. With no doubt dire consequences.

And before anyone challenges my reference to half trained allied health professionals, this is based on another patient story which I won’t go into now, about a mental health patient’s unfortunate experience with an Emotional Health and Wellbeing Coach.

This is a new role in another Integrated Care System and the person recently employed to perform it – after completing a part time, one year distance learning course – both violated professional boundaries and was unable to impart any useful skills or knowledge to the patient and their family.

This is all really horrible.

The Board’s response

Rob Webster, Chief Exec of both West Yorkshire and Harrogate Integrated Care System and the South West Yorkshire Partnership NHS mental health foundation trust, dismissively said that the app was meant to support clinicians not undermine them. The evidence is that many suicides and homicides are committed by apparently low risk patients. And they are hearing from patient groups, as reported from Healthwatch, that the new plans meet their needs.

Is this an adequate response to the issues and concerns we raised? We don’t think so.