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.

13 comments

  1. I worked at AGH as a nurse, Thatcher decided that hospitals needed internal audit to decide why some hospitals cost more to run than others. Before internal audit, I had a patient who had developed ‘foot drop’. I asked the physio to check and she agreed and said she needed a splint, I rang Mary in the plaster room, the splint was arainged for that afternoon and aplied, the consultant was informed on his next ward round. After infernal audit, another patient developed foot drop, I informed the physio who told me that the consultant (surgical) has to write at letter of referal to the ortho paedic consultant (Mr. Norton), who will refer the patient to the surgical apliance people, (Vizards of Leeds) . End result, a delay of 1 week, Vizards sublet the splint to Mary in the plaster room. Total, deliberate waste of time and money. The NHS used to be the cheapest and most eficient health system around, it is and has been for 30 yrs slowly being privatised.

    Liked by 2 people

  2. Digital technology can not replace qualified clinicians. The long term plan is not fit for purpose. The NHS should be fully in public hands, patients are not for profit.

    Liked by 2 people

  3. In 2013 when I found a cancerous tumour in my mouth I was fast tracked and had surgery within a couple of weeks. It came back in 2017. Different story. Although the specialist told me to contact his secretary direct if I found another tumour, she had been told to refer me to appointments who told me I would have to wait two months. I went to my GP who again fast-tracked me. Now I’m being told by the specialist that the appointment system is a shambles and if I have any concerns to get in contact at once. My brother and sister-in-law work for the NHS so I know there is more going on. We are not robots who need to be diagnosed by software, we are human beings. My brother-in-law committed suicide. He had been having treatment on and off for a few years so mental illness is not trackable and straightforward and can’t be solve by a machine.

    Liked by 2 people

  4. I agree with some of this but i think telephone appointments are great and would welcome skype or something. I used to have to go off for an appointment check that my medication that i have been on for 8 years wasn’t having any bad affects. Now i just get a call check everything still fine as i was before but now im not taking up a 15 appointment and having to go off work instead im just getting a 5ish minute call when the doc has a gap or someone doesn’t show up. So i just have to go in for my LFTs which is fantastic!

    Liked by 2 people

  5. Where health and lives are at stake people should always be put first not profits. These plans put people way down the list. We pay for our NHS it belongs to us. These proposals are not going to improve anything for patients or service users, they will in fact only result in an inferior service which then places already sick and vulnerable people at further risk.

    Liked by 2 people

  6. As usual, this NHS reorganization uses acronyms and unevidenced advertising language to persuade the public that we will have better health-care by reducing access to clinicians, replacing this with digital diagnosis, voluntary workers and self-care whilst effecting huge financial savings. A moment’s thought tells me that this – together with increased centralisation of high quality services – will mean loss of essential face-to-face consultation and the added burden to patients of further travel for specialist care. All this, together with increased possibilities for privatisation of mhd resources, means LOSS for us patients of our cherished NHS care in an attempt to balance the books. We need government to prioritise this essential service with adequate funding instead of all this trickery with deceptive accounts of future benefits when it is quite clear that the loss for patients far outweighs any theoretical /doubtful/unspecified gains. I say ” NO” to this proposal.

    Liked by 2 people

  7. I say No to this proposal.
    We are in 2019, at the stage the US was in 1971 as the Nixon administration introduced the Keiser Permenente protocol. He advertised on TV that this new ‘arrangement’ was because he wanted the best healthcare for every American. Look at the expensive, dysfunctional, corrupt operation Nixon’s intervention has spawned today! (Nixon was the most corrupt politician at that time, I had seen in my life. In those days there were investigative journalists with a bigger platform for their work, than today.)

    When will people recognise that the National Health Service has been compromised?
    The Secretary of State’s Duty to provide- Gone and with it everyone’s ‘right’ to services and local political accountability.
    Universal Health Services-Gone, leaving once cash strapped pregnant women if the baby does not live, who are not ‘eligible’ for free services having to walk about in England with a dead baby inside them until emergency treatment is needed in A&E.
    Comprehensive Health Services- Gone, with all areas in England rationing or denying treatment altogether.

    Even today, people’s future health is being compromised because they are not getting their low level infections treated and are having to rely on over the counter preparations which can, in some instances cause liver damage and goodness knows what else.

    Any talk by ‘managers’ with no clinical experience of Right Care Right Time Right Place is nonsensical because any one disease can present as numerous different symptoms in different people, just because physiologies are unique.

    All the politicians colluding with NHS England in this travesty should know exactly what they are doing!

    Liked by 2 people

  8. Excellent summary of the flaws in the so called “strategic plan”. Huge NHS underfunding makes a mockery of stated intentions to reduce health inequalities, restructure and improve services, and save money. The small amount of funds promised by government (should it ever materialise) will at best lead to temporary financial restabilising while in no way allowing implementation of all the un-costed service developments in the NHS Long Term Plan. Demands on secondary care are increasing while the “left shift” means less money for hospitals, as well as restricted access to treatments and clinics (e.g. what north London CCG are now calling for from their GPs) and the greater centralisation of services. The IPPR think tank report last week showed the devastating impact of the Private Finance Initiative on NHS finances, with Trusts paying £80bn for only £13bn of private sector funded investments in new hospitals. The admin costs of the NHS have gone up from around 5% to 15% as a proportion of total spend since competition and marketisation were introduced (with no evidence that the latter have lead to improvements in patient care), yet where is this mentioned in the plan? 66% of Trusts are in the red and many have borrowed money from the DH&SC to keep afloat at an interest rate of 6%. This means Trusts are collectively paying around £4m a week just on the interest! In line with solutions for ‘balancing the books’ (i.e. transferring costs to the patient and their carers) elaborated by Simon Stevens, McKinsey and the World Economic Forum, the plan anticipates patients will look after themselves, face rationing of services, use digital apps rather than face to face contact, and see almost anyone but a doctor when they are ill. Time for a radical rethink.

    Liked by 2 people

  9. Having read all of this, I started to think about the specific comments which I might make: 1 ‘Digital by default’ not only isolates the patient & undermines their experience, but ultimately de-skills our doctors & healthcare workers too. Therefore, de-skilling the NHS as a whole. 2 Human beings vary and a National Health Service should be geared up to deal with that variety of an individual’s experience of illness – not restrict it and pare it down to some number or algorithm. 3 It is deeply ironic (and naïve), to suggest that self-care via digital technology can be applied to mental healthcare when several studies and experts cite those very platforms as being detrimental to (especially children’s) mental health. But at the end of the day – this document lacks integrity & humanity, because the ‘Five Year Operational Plan’ eschews those qualities and is intended to favour markets over people. So, in summary – the best ‘forward view’ for our nation’s health & well-beiing, would be the Reinstatement Bill.

    Liked by 2 people

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