Unions to discuss response to West Yorks & Harrogate NHS Integrated Care System at Thursday 26th September meeting

West Yorkshire County Association of Trades Union Councils has called a meeting in Leeds on Thursday 26th Sept. The aim is:

  • to enable trades unionists to find out more about what the NHS West Yorkshire and Harrogate Integrated Care System is,
  • understand why trades unionists should be concerned about it
  • consider how they can work across unions and Trades Union Councils to protect jobs and NHS services across the West Yorkshire and Harrogate ICS area when these are under threat.

The meeting is from 7-9pm, Thursday 26th September at St George’s Conference Centre, (meeting room 1), 60 Great George St, Leeds LS1 3DL.

Facebook event here: How should Unions respond to West Yorks & Harrogate Integrated Care System?

West Yorkshire County Association of Trades Union Councils Secretary Pete Keal said,

“West Yorkshire County Association of Trades Union Councils is concerned about the Integrated Care System that has been set up in the West Yorkshire and Harrogate Area.

“NHS campaign groups such as Keep Our NHS Public, 999 Call for the NHS and Health Campaigns Together fear that the Integrated Care System is implementing cuts, reconfiguration and significant service changes.

“The County Association believes that trades unions need to organise across the West Yorkshire and Harrogate area to protect jobs and NHS services in the context of the Integrated Care System. As a West Yorkshire-wide Trades Union body, West Yorkshire County Association of Trades Union Councils is organising this meeting as a start to working with trades union branches and officials to further this.”

2018 Trades Council Conference unanimous motion opposing Integrated Care Systems

Last year, the 150th Annual Trades Council Conference unanimously passed a composite NHS motion from Cheshire, Calderdale and Derby Trades Councils, that called on the TUC to take action to oppose Accountable Care Systems (rebranded by NHS England as “Integrated Care Systems”) and Sustainability and Transformation Plans/Partnerships; and to support the campaigning activity of Keep Our NHS Public, Defend our NHS, 999 Call for the NHS and Health Campaigns Together.

2018 Annual Trades Council Conference

Some quick facts on West Yorkshire and Harrogate Integrated Care System

Here’s a brief run down about what the Integrated Care System is and does.

It is a non-statutory ‘partnership’ – meaning it has no legal existence or decision making powers

The ‘partnership’ consists of 7 acute hospital trusts, 2 mental health trusts, 9 Councils, 9 Clinical Commissioning Groups (soon to be 7 as a result of mergers), 50+ Primary Care Networks, 1 community interest company, 1 community healthcare trust, 1 ambulance trust, Yorks and Harrogate Healthwatch organisations, Yorkshire and Humber Academic Health Science Network, NHS England and NHS Improvement – North East and Yorkshire, Public Health England (Yorkshire and the Humber), Health Education England (Yorkshire and the Humber).

It was set up in shadow form in May 2018, as the next stage of the cuts-driven West Yorkshire and Harrogate Sustainability and Transformation Partnership

The Sustainability and Transformation Partnership was secretively set up in 2016, charged with cutting £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.

This was to be achieved through ‘transformation’ of NHS, social care and public health services. This ‘transformation’ is based on the imposition of USA-style managed or accountable care, as practiced by USA healthcare companies such as Kaiser Permanente, United Health and its subsidiary Optum.

The West Yorkshire and Harrogate Integrated Care System went live in April 2019

The main difference between the Sustainability and Transformation Partnership and the Integrated Care System is that the Integrated Care System will assume some of the NHS quangos’ powers, and it operates a new ‘financial architecture’ for the area’s NHS.

This ‘financial architecture’ is dictated by the quangos NHS England and NHS Improvement. It requires the Integrated Care System to deliver a £21m surplus next financial year, while simultaneously paying off the “deficits” that the area’s NHS organisations have accumulated as a result of years of underfunding.

Which is all pretty mind boggling for a non-statutory partnership with no legal existence or decision making powers. And it means the extra NHS funding announced by the government will pretty much be swallowed up this year by paying off the so-called deficits.

By November 15th, the Integrated Care System has to complete its fully costed 5 year operational plan 2019-24

The 5 year plan spells out how the Integrated Care System is going to carry out the government’s NHS Long Term Plan

The draft has to go to NHS England by 27th Sept.

It was presented to the Integrated Care System Board on 3rd September, along with the WY&H Integrated Care System Workforce Strategy. It was also presented to the West Yorkshire and Harrogate Joint Health Scrutiny Committee on 4th September, where it met with severe criticisms from Councillors.

Workforce issues

This is obviously the direct concern of Trades Unions that represent NHS, social care and public health issues. Here are some of the main workforce issues in the Integrated Care System’s draft 5 year plan 2019-24

Developing primary care networks and primary care network teams is central to the Integrated Care System’s draft 5 year plan.

As of July this year, there are now 50+ primary care networks in West Yorkshire and Harrogate. Eash serving populations of between 30k-50k, and bringing together primary and community care as well as social care and public health, they are responsible for enabling the so-called ‘left shift’ of services out of hospitals into primary care and from there into patients’ self-care. This is central to the cost-cutting ‘transformation’ of services.

However there is no indication in the Integrated Care System’s draft 5 Year plan 2019-24, or in the Integrated Care System Workforce plan, about how they are going to deal with the shortage of staff to deliver these out-of- hospital services.

For example, there is a shortage of district health nurses. The Integrated Care System’s draft 5 Year plan says primary care and community care should come together and then ignores community care.

Not only are community health services completely ignored in the Integrated Care System’s draft 5 yr plan – this is the same at national level. In early 2018, NHS England dropped its intention of working out a national plan for how community health services could successfully carry out this so-called “left shift’ of care out of hospitals. NHS England has also denied that it ever said that this would be necessary.

Other workforce aspects of primary care networks that need Unions’ input

These issues are ignored in the Integrated Care System draft 5 year strategy and its workforce plan.

The left shift of hospital care into primary care networks relies on the employment of hundreds of allied health professionals in new grades of staff, and on changes to the nature of the work of existing clinical staff.

It also greatly increases the role of voluntary sector organisations, replacing 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. With the very real risk that this will undermine the role and scope of professional, paid, skilled clinicians and provide lower quality care for patients.

Community health services, public health services and industrial scale behaviour change schemes for so-called ‘improving population health’ are all wide open to privatisation in the Integrated Care System 5 year plan. This has major implications for the workforce – both existing and newly recruited.

Clinical directors of Primary Care Networks are reportedly already overwhelmed by the demands of their role and need support to avoid burnout.

Social care

The Integrated Care System draft 5 year strategy refers to rejigging the collapsing “care market”. But it ignores the needs of care workers for training, career progression, parity of pay with comparable NHS staff etc

Children and young people

The children and young people’s section of the Integrated Care System’s draft 5 year plan says nowt about health visitors. At the West Yorkshire and Harrogate Joint Health Scrutiny meeting on 4th September, Calderdale Councillor Colin Hutchinson asked,

“Is it going to take another Baby P to get health visitors back on the agenda?”

Health visitors are vitally important. As are school nursing sevices. They could take up a lot of the Children and Young People’s preventive health needs.

Other workforce-related issues in the Integrated Care System draft 5 year plan

These include:

  • Ongoing staff shortages at all levels and areas of the NHS, the lack of any additional money for the NHS staff training quango, Health Education England and the apparent lack of any rational training programme.
  • The related proposal for networked hospital services with flexible staffing arrangements that mean staff will float between hospitals, as hospital management requires.
  • Staff shortages and the need to cut costs are driving hospital cuts and centralisation in Calderdale and Greater Huddersfield. Calderdale and Huddersfield Hospital Trusts 2017 workforce plan showed a 479 reduction in Whole Time Equivalent staff over next 10 years. One of the ways CHFT planned to make do with 479 less staff is “new professional roles” – like Physician Associates and new less-qualified nursing assistants.
  • This raises patient safety issues. The Royal College of Nursing pointed out in 2017 that it was unreasonable and unsafe to expect unregistered staff to fill staffing gaps. They are still calling for more nurses and safe staffing legislation.
  • As part of ‘operational efficiency measures‘, under the Sustainability and Transformation Partnership the area’s hospitals replaced fixed staff ratios with Care Hours Per Patient Day. This is an import from the privatised American health care system. It says nothing about the skills, knowledge and experience of whoever’s doing the caring.  But  a recent study  showed that wards with a higher ratio of registered nurses to healthcare assistants had fewer slips, trips and falls. Those with more Health Care Assistants had a higher than average amount of falls.
  • The use of care at home is very difficult to monitor and measure outcomes of. This needs to be addressed – without putting unbearable amounts of reporting and monitoring onto the nurses and others who deliver it.
  • The Integrated Care System draft 5 year plan makes much of the move to “personalise” the NHS, through increased use of personal health budgets by patients with long term illnesses and health care needs. This means patients buy in their own care. How is this covert privatisation going to affect NHS staff?
  • The Integrated Care System draft 5 year plan is to make the NHS ‘digital by default’ within the next few years. This has huge implications for NHS staff. Increasingly, clinicians are required to follow algorithms in clinical decision making tools when making diagnoses. Increasingly, they will be required to hold patient consultations online rather than face to face. Increasingly, they are being supplanted by apps. These are huge changes to clinical practice and it’s not at all clear that trades unions have any position on this or are taking any steps to mediate or moderate this process.

Here are 999 Call for the NHS current #NHS4All demands, please support them!

Here is Calderdale And Kirklees 999 Call for the NHS report on our deputation statement to the West Yorkshire and Harrogate Integrated Care System Board meeting on 3rd Sept, that discussed their draft 2019-24 five year operational plan

We shall shortly send the Integrated Care System our formal response to their draft 5 year plan, and will upload it to this blog.

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