- This is a long read (4.5K+ words) that explains with detailed reference to Calderdale why we have to kill the Health and Care Bill 2021. (Petition here: Protect the NHS: Scrap the Health and Care Bill)
- It analyses how the Health and Care Bill 2021 would terminally damage Calderdale’s NHS and social care services. They have been shrunken and under threat for years from a cost-cutting “transformation” programme, driven by local and regional non-statutory integrated care systems.
- Similar cost cutting programmes have been imposed across England. Public campaign groups have sprung up everywhere to defend the local NHS from such attacks. It is pure spin that breaking up the NHS into 42 Integrated Care Systems means local NHS and social care services can be designed to meet local needs. Priorities everywhere are dictated by NHS England’s Long Term Plan and by the government’s Life Sciences Industrial Strategy.
- The Health and Care Bill would lock this in place. It is the endgame for scores of hotly-contested hospital cuts, centralisations and downgrades, and the related shift of hospital services into large scale, avowedly cost-cutting GP and community health services networks and hubs.
- The Don’t Blow It! campaign urgently calls on MPs to kill the Health and Care Bill before it kills us.
The 2021 Health and Care Bill, which passed its second reading in the House of Commons on 14th July, creates a legal basis for dismantling the NHS into 42 cost-cutting, regional health and social care bodies. These statutory bodies, called Integrated Care Boards, will each oversee a number of local “partnership arrangements” in their region.
On instructions from the Department of Health and Social Care’s quango NHS England, this dismantling of the NHS has been carried out since 2014 – without any legal basis.
SInce 2014, NHS England has been headed up by Simon Stevens, former CEO of the Medicare business of the world’s largest health insurance company United Health (2020 revenue, $251.08 bn) and President of its Global Health division. Under his direction, NHS England has imposed the Medicare model on the NHS through a 5 year plan, 2014-2019, followed up by the 2019-24 Long Term Plan
Formerly called Sustainability and Transformation Partnerships and since renamed Integrated Care Systems, these non-statutory 42 health and social care bodies are already shrinking the NHS into a set of copies of the USA’s limited publicly funded/ privately provided health insurance system, Medicare/Medicaid. Medicare/Medicaid provides minimal health care for people who are too poor or old to buy private health insurance.
In West Yorkshire, this has led to the formation of the non-statutory West Yorkshire and Harrogate Integrated Care System (aka West Yorkshire and Harrogate Health and Care Partnership).
The Health and Care Bill 2021 aims to conclude this process by putting it onto a statutory basis.
The Bill is bad for patients and bad for NHS staff. It reduces the government’s obligations to secure NHS care for us all (in clause 15, 16 and 18). And through a number of measures, the Bill would worsen the current NHS front line staff shortage – currently amounting to 40,000 full-time equivalent nurses and 49,000 full-time equivalent doctors and doctors in training in England across primary and secondary care. It would put clinical staff under more pressure.
It would be next to impossible to undo this legislation, given the number of NHS contracts awarded to global companies that would use international trade dispute courts to oppose any future legislation to return the NHS to a public service.
Out-of-hospital ‘care models’ are key to this limited public/private health insurance system
These cost-cutting “new care models”, based on closing, centralising and downgrading costly hospital services and shifting healthcare out of hospitals into the “community”, come straight out of the playbook of the global management consultancy company, McKinsey.
Specifically, out of McKinsey’s 2009 report on how to cut NHS spending. The Report was commissoned by the New Labour government in 2008, following the government’s bailout of the bankers after they crashed the global and national economy.
Among other proposed cuts, McKinsey’s “Achieving World Class Productivity in the NHS 2009/10 – 2013/14” report called for the NHS to make:
“savings of £2.7 – 4.1bn from a shift in the management of care away from hospitals towards more cost effective out- of-hospital alternatives”.
In Calderdale and Kirklees, the contentious Calderdale and Huddersfield Right Care Right Time Right Place plan for cost-cutting hospital and community services “transformation” follows this nationally-mandated template.
The Plan was conceived in 2012 and 2013 by the Calderdale and Huddersfield Health and Social Care Strategic Review Executive Committee, with baseline financial data for this cuts-driven plan produced by PA Consulting.
And it was the PA Consulting rep Martin Horncastle who suggested, at the February 2013 Strategic Review Executive Steering Group Meeting, that the hospital cuts and centralisation “Vision” document should be presented as “an integrated care model”.
For their decisive input, PA Consulting was paid nearly £1m by the Clinical Commissioning Groups.
Crucially, during 2014/15 the government’s funding of CHFT was due to be cut by £45m, while the Right Care Right Time Right Place plan aimed to save around £50 million, by:
- Replacing the two District General Hospitals in Halifax and Huddersfield with one acute and emergency hospital in Halifax for both areas, and one small planned care and rehab hospital in Huddersfield for both areas, plus a downgraded walk-in only A&E/urgent care centre.
- Shifting a lot of services out of hospital and limit the need for unplanned hospital attendance and admissions, by providing care closer to home for the frail elderly and patients with chronic health problems. Between them they are the most costly group of patients, because of repeated hospital stays.
The Care Closer to Home scheme started in 2014 without any public consultation.
And the financial crisis that the 2015 £45m funding cut plunged Calderdale and Huddersfield hospitals into meant Ernst & Young got to call the shots over the Right Care Right Place Right Time scheme. This lead to public protests in Halifax, culminating in a letter from the Calderdale public to Monitor, the hospitals regulator.
By this time, Calderdale was short of £155m NHS funding. Both Calderdale and Greater Huddersfield NHS commissioners agreed to postpone the public consultation on proposed hospital cuts and changes, because they didn’t know if the hospitals Trust would be financially viable in five years time.
The public consultation finally took place in 2016, omitting the Care Closer to Home scheme and focussing only on the hospital cuts and centralisation. The public rejected the plan but the Commissioners ignored this, claiming the public were too irrational and emotional to understand it.
In 2018, the Secretary of State also rejected the Right Care Right Time Right Place plan, and required local NHS organisations to show how increased investment in out-of-hospital services would reduce the need for A&E attendance and unplanned admissions. Calderdale Clinical Commissioning Group paid McKinsey £150K in 2019 to produce a “detailed capacity modelling report” intended to show how the integrated out-of-hospital care model (first proposed by PA Consulting) would reduce the need for A&E attendance and acute hospital beds.
Impossible to see if planned hospital capacity is safe
Two years on, in 2021 there is still no evidence that McKinsey’s proposals are having the desired effect – unsurprising since their advice was misleading.
In response to a CK 999 Freedom Of Information request for evidence, Calderdale and Kirklees NHS Commissioners gave us a huge list of Care Closer to Home/ out-of-hospital services delivered by an array of NHS, local authority, private and voluntary sector organisations, using new methods and relying heavily on patients’ self management of their conditions and on unpaid care from family, friends and volunteers.
The out-of-hospital services aim to reduce A&E attendances, emergency admissions to hospital and length of hospital stay by the frail elderly and other people with chronic physical or mental health problems. Key Perfomance Indicators for the various services have been identified that measure the level of achievement of these outcomes. But no data has been provided about whether these intended outcomes are being achieved.
The Calderdale and Kirklees Care Closer to Home programmes also aim to cut £millions of costs each year by keeping these patients out of hospital, but no data has been provided about cost savings to date.
Calderdale and Kirklees Councillors’ Joint Health Scrutiny Committee is still pushing local NHS commissioners for information about the impact on A&E attendance and emergency hospital admissions of additional investment in increasing community and primary care capacity in Calderdale and Greater Huddersfield.
The Joint Health Scrutiny Committee met on 4th August 2021 to examine an update from Calderdale and Greater Huddersfield Clinical Commissioning Groups, that claimed no data existed on this “Care Closer to Home” issue because Covid19 ate their homework.
CK999 were not impressed. (Here are our deputations to the Committee.)
In the absence of evidence about the impact on Calderdale and Huddersfield hospitals of these “out-of-hospital alternatives”, it is impossible for the Scrutiny Committee to assure the Secretary of State that planned hospital capacity is safe.
It seems most unlikely.
One of the most glaring lessons from the pandemic is that the UK is horrendously under-equipped with hospital beds and Intensive Care Unit capacity. And that Primary Care is also seriously under-resourced and in crisis.
GP Online reported recently that
“P[rimary] C[are] N[etwork] clinical directors are facing burnout and struggling to develop their networks – with nine in 10 reporting higher- than-expected workload and concerns that ‘additional roles’ staff brought in to support practices have yet to reduce workload.”
Calderdale is in the lowest quartile nationally for GPs per head of population. GPs phone systems are dysfunctional, as Calderdale AHSC Scrutiny Panel recently heard. And the May 2021 Calderdale Commissioning Primary Medical Services Committee identified a high (level 12) risk that the “additional roles” being introduced in GP practices will compromise the safe delivery of care and intervention for patients.
This is the context for the then-Calderdale Clinical Commissioning Group Accountable Officer’s statement that people are too dependent on the NHS for their health care.
Ending the “dependency model” of health care
West Yorkshire Integrated Care System policy is that this “dependency model” needs to be replaced by “social prescribing” that steers patients into voluntary and community sector-run activities deemed to be good for their health, and by “empowering” patients to become “more resilient” – self-caring at home with the support of unpaid care from family and friends.
In 2015, Kirklees Clinical Commissioning Group said this would entail “realigning people’s mindsets“
Today both Kirklees and Calderdale Clinical Commissioning Groups and their Council counterparts speak warmly and often about “community asset-based” and “strengths-based” care.
This is fundamentally a neo-liberal response to neo-liberal epidemics such as loneliness, diabetes, obesity, stress, respiratory and cardiovascular diseases which are the results of specific political and policy decisions
The Health and Care Bill 2021 offers nothing to solve any of these problems
How could it? The Bill imposes a Duty on integrated care boards to promote innovation (S19 (2) 14Z39) and a Duty to promote integration (S19 (2) 14Z42), and requires integrated care partnerships to “prepare an integrated care strategy (S20 (4) 116ZB (1) ). But ‘integration and innovation’ measures have been called into question by a recent systematic analysis of evidence, which concluded:
“In theory, collaboration between local health care and non-health care organizations might contribute to better population health. But we know little about which kinds of collaborations work, for whom, and in what contexts. The benefits of collaboration may be hard to deliver, hard to measure, and overestimated by policymakers.”
What the Health and Care Bill would do is nail in place the imposition of the limited public/private Medicare health insurance model on the NHS in England that has taken place since McKinsey told the government how to cut NHS spending. The Bill is the endgame for scores of hotly-contested hospital cuts, centralisations and downgrades, and the related shift of hospital services into large scale, avowedly cost-cutting GP and community health services networks and hubs.
As in the USA, in England the imposition of this “managed” healthcare system, which operates on the basis of commissioners’ and providers’ financial considerations not patients’ clinical needs, is creating a two tier health service.
One tier is a limited, cost-cutting NHS – which isn’t even a National health service any longer, but a set of 42 cost-cutting regional health care bodies set up without any legal basis.
Already Clinical Commissioning Groups – which the Health and Care Bill will abolish and absorb their functions into statutory Integrated Care Boards – aim to restrict patients’ access to health care to people whose treatment represents best value for money for providers.
Among the most worst examples of this so-called referral management is the cash-for-cuts GP referral scheme. In 2018 about a quarter of all Clinical Commissioning Groups were found to be offering cash payments to GPs as an incentive to not refer patients to hospitals. And NHS Coastal West Sussex, Enfield, West Leicestershire and Rotherham CCGs made profit sharing arrangements with their GP practices, allowing them to keep some of the money the Clinical Commissioning Group saved by not having to pay hospitals to treat their patients.
The Bill risks further restrictions to patients’ access to care on the basis of actuarial considerations, as a consequence of the tight financial controls it hands to Integrated Care Boards (HC Bill Part 1, section 23,3), combined with risk/reward share contracting that makes providers carry the burden of any “overspending”.
The second tier is a private health care system where those who can pay, get what they want.
Increasingly this private health care system is nested within NHS hospitals, such as the private cancer ward run under the brand Nova Healthcare in the Bexley Wing of the St. James’s Institute of Oncology, Leeds and the Warrington and Halton Hospitals NHS Foundation Trust’s so-called MyChoice scheme.
Health and Care Bill’s Integrated Care Board financial control measures will speed up NHS dismantlement
As already mentioned, the Health and Care Bill hands tight financial control powers to the statutory Integrated Care Board (HC Bill Part 1, section 23,3). This will allow the Board to enforce collective financial control over each member organisation .
One way in which this power will be exercised is through new statutory Integrated Care Partnerships in each local authority area.
The Health and Care Bill (Section 20 (1) requires the statutory Integrated Care Board and each responsible local authority in its area to set up some form of partnership arrangement to run the NHS, social care and other health-related services in the local authority area.
The relationship between these local partnership arrangements and the overall Integrated Care Partnership seems unclear but whatever it is, both will be subject to financial control by the statutory Integrated Care Board. A member appointed by the Integrated Care Board must be part of the Integrated Care Partnerships (Health and Care Bill Section 20.4.2), and the Integrated Care Board itself is subject to an entirely crazy cost-cutting financial regime imposed by central government – described below.
Case study: how the Health and Care Bill 2021 will put a stranglehold on Calderdale and Kirklees’ NHS and social care services
In its 5 Year Plan 2019-24 (p170), West Yorkshire and Harrogate Integrated Care System puts a ‘subsidiarity’ spin on the operations of Integrated Care Partnerships:
“The Integrated care partnership (ICPs) brings together the main commissioner and provider health and social care organisations in a given area to work as one.
“Each organisation has its own budget but will agree, with other organisations in its ICP, how it is spent for the benefit of the local community.”
This spin conceals the reality of statutory Integrated Care Board control of Integrated Care Partnerships’ money:
- Already each organisation in the non-statutory West Yorkshire and Harrogate Integrated Care System is subject to collective financial control – even though this is currently by consent, theoretically.
- A government carrot/stick means that if the Integrated Care System had not accepted NHS England/Improvement’s control total, it would not have received “incentive funding” for organisations that would otherwise be in debt (ie seriously underfunded).
- In 2019/20 West Yorkshire and Harrogate Integrated Care System’s incentive funding was £72m and it also received £32m non-recurrent support funding to organisations that would otherwise be in deficit; without this funding, the Integrated Care System would have had a planned deficit of £80m.
- Having accepted the control total, and the incentive funding that comes with it, a further carrot/stick is that 15% of the “incentive” funding available to the Integrated Care System is dependent on staying within the control total. For 2019/20 this was worth £8m to West Yorkshire and Harrogate Integrated Care System.
- Theoretically until now the Integrated Care System has had a choice about whether to accept the shared control total – but this will not be the case under the Health and Care Bill 2021.
- The Health and Care Bill 2021 requires the Integrated Care Partnership joint committee to include a member of the statutory Integrated Care Board that runs the regional Integrated Care System that the Integrated Care Partnership is subject to.
- When the Health and Care Bill 2021 absorbs Clinical Commissioning Groups and their functions into the statutory Integrated Care Board, it will seemingly also create the statutory power for the Board to enforce collective financial control over each member organisation (HC Bill Part 1, section 23,3):
“Financial duties of integrated care boards: expenditure limits
“(1) An integrated care board must exercise its functions with a view to ensuring that expenditure incurred by the board in a financial year does not exceed the sums received by it in that year.”
New forms of risk/reward share contracting shift the risk of breaching financial controls from commissioner to provider
The statutory Integrated Care Board member on the Integrated Care Partnership Joint Committee will surely use their power as NHS commissioner to drive local providers to restrict patients’ access to treatments, and to reduce the range of treatments provided.
With the commissioning function embedded in the statutory Integrated Care Board, local provider organisations in place-based Integrated Care Partnerships won’t stand a chance if – as is the case – their funding is not enough to provide all patients with the range of treatments they need.
The Health and Care Bill (Section 21) also gives NHS England controls over the capital and revenue “resource use” of Integrated Care Boards and NHS hospitals.
S 23 gives NHS England the power to “impose financial requirements on integrated care boards” that includes “directions about their management or use of financial or other resources.”
Section 26 abolishes Monitor and Schedule 5 transfers its functions to NHS England. We have seen how Monitor put the Calderdale NHS in a stranglehold in 2015 when NHS funding cuts made it impossible for Calderdale and Huddersfield NHS hospitals to operate safely. We cannot expect anything different from a transfer of NHS Improvement’s powers to NHS England.
Commissioner “incentives” to providers to restrict patients’ access to care that is unaffordable, given inadequate government funding, will surely be even more forthcoming than they have already been, for example through the “cash for cuts” scheme to reward GPs for not referring their patients to hospital.
The Health and Care Bill 2021 locks in place the imposition of the USA Medicare system on our NHS – here’s how
The pressure on cash-strapped providers to restrict patients’ access to care has been growing since cost-cutting Sustainability and Transformation Partnerships were set up in 2015.
The cost-cutting agenda of the New Labour government-commissioned McKinsey report that has driven the government’s imposition of the USA Medicare system on the NHS since 2010, will be locked in place by the Health and Care Bill. The financial section of West Yorkshire and Harrogate Integrated Care System’s 5 year Plan 2019-24 p160- 167 spells out the mechanics:
First off, the shared control total is set at a level that requires the Integrated Care System as a whole to make spending cuts (“efficiencies”). In 2019-20, £240m spending cuts were needed – but at the same time, the 5 year plan predicted a £24m surplus.
These “efficiencies” are basically the difference between what the Integrated Care System needs to provide the services required by the public, and what the government funding is.
While making these cuts (set at a rate that has been historically unattainable in the NHS), the Integrated Care System also has to make a surplus, in order for providers to access an additional funding scheme worth 0.5% of income.
From 2020/21 onwards all incentive payments – that basically provide money to keep providers in the black – will be rolled up into one combined Financial Recovery Fund for organisations in deficit (ie underfunded).
“With these payments, West Yorkshire and Harrogate Integrated Care System plans to improve its financial position every year for the next five years. It will increase surpluses from 2020/21 onwards.”(West Yorkshire and Harrogate Integrated Care System 5 Year Plan 2019-20, p 161)
All the while making cuts (“efficiencies”), based on the Long Term Plan funding settlement that requires the NHS to reduce costs recurrently by 1.1% each year, through “cost improvement plans” such as seeing more patients with the same number of staff, in order that this would free up resources to invest in out-of-hospital care.
Cutting costs to divert public investment into health technology, data analytics and out of hospital services companies
A lot of that investment in out-of-hospital services seems likely to go straight into the pockets of health technology and data analytics companies and companies like Totally Ltd – who set out when Sustainability and Transformation Plans were introduced, to corner “a massive market opportunity” in out-of-hospital services, with a plan
“to build and develop a high quality diversified out-of-hospital UK healthcare services group… from diagnosis through to discharge.”
The “financial challenge” of meeting its control total in 2019-20 meant that West Yorkshire and Harrogate Integrated Care System organisations had to make an average of 2.81% cost reduction – more than double the 1.1% set by the government. And even that 1.1% was more than the average 0.9% efficiency improvements by NHS trusts in the decade to 2016/17, according to a recent Nuffield Trust blog post “Reality check: The Long Term Plan settlement: 2019-20 to 2023-24.”
In a report to its Governing Body back in January 2020, Calderdale Clinical Commissioning Group acknowledged the financial risks of being part of the West Yorkshire & Harrogate Integrated Care System.
The CCG complained it was “increasingly being tied into the performance of ICS partners” while West Yorkshire and Harrogate Integrated Care System risked not achieving its financial targets, because various provider trusts had not met, or were forecasting they won’t meet, their own financial targets.
NHS values are not coming through – Integrated Care Systems are a means of siphoning public money into private companies
This entirely crazy method of funding Integrated Care Systems may explain the reaction to the West Yorkshire and Harrogate Integrated Care System’s Five Year Plan by co-opted Board lay member Jackie Dolman, a Calderdale parent carer and autism/disability adviser to the NHS England quango.
She told the Board very politely – and Calderdale and Kirklees 999 Call for the NHS couldn’t agree more:
“NHS values are not coming through in this document.”
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 – and to divert investment into private companies, charities and other voluntary and community groups as providers of Care Closer to Home/out-of-hospital services
- 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 had to return a surplus of £24m in 2020/21!!
The surplus is to be generated from “efficiences” (cuts), set at a level which has been historically unachievable, in order to invest in out of hospital services. Which as stated above, often means investment in private companies, because the contracts for these new out-of-hospital services are being given to them. The Integrated Care Systems are a means of siphoning public money into profiteering private companies.
Regardless, Calderdale Council Cabinet agreed on 7 June 2021 to
“support… the development of an Integrated Care Partnership model for Calderdale.”
Torturous Calderdale Integrated Care Partnership bureaucratic jiggery pokery (aka governance structure)
Prepare to be completely confused by all the different boards and partnerships!
Councillors? Are you up to speed on this issue? Particularly Councillors on the various health scrutiny committees, that have the power and duty to make sure significant changes to the local NHS are in the interest of the public and the NHS itself.
An update to Calderdale Cabinet on 7 June 2021 set 21st September 2021 as the date for
“confirmation of detailed place and ICS arrangements”.
But neither Calderdale Adults Health and Social Care Scrutiny Board nor Calderdale and Kirklees 999 Call for the NHS have examined these detailed arrangements. Perhaps they should call an urgent unscheduled meeting to do so.
According to Calderdale Clinical Commissioning Group,
“Place-based arrangements between local authorities, the NHS, the voluntary sector, related partners, and providers of health and care will be defined through I[integrated] C[are] P[artnership] arrangements developed in place,”April 2021 Calderdale Cares Update 3.3, p 46.
Here’s where it gets really confusing.
According to a Freedom of Information response from Calderdale Clinical Commissioning Group, an informal alliance of the Provider and Commissioner organisations in Calderdale Collaborative Community Partnership Board, (previously known as Care Closer to Home), already oversee the Care Closer to Home/out-of-hospital services elements of the cost-cutting Right Care Right Time Right Place plan.
This informal alliance has signed a Memorandum of Understanding setting out how partners will work together. Athough not a formal or legally binding contract, the Calderdale Collaborative Community Partners Partnership Agreement has been added to the CCG’s contracts register.
Calderdale Clinical Commissioning Group has sought to develop Care Closer to Home services through a collaborative rather than a competitive approach. The CCG sees the continuation of this approach entirely in line with the aims of the proposed ‘Provider Selection Regime’ referred to in the [Health and Care] Bill.”
These organisations are signed up to the Alliance Agreement:
- Calderdale Clinical Commissioning Group,
- Calderdale Metropolitan Borough Council,
- Voluntary Action Calderdale (VAC),
- Calderdale and Huddersfield NHS Foundation Trust,
- South West Yorkshire Partnership NHS Foundation Trust (SWYFT),
- Locala Community Partnerships CIC,
- Calderdale Primary Care Networks (x5),
- Community Pharmacy West Yorkshire.
There is also a Calderdale and Greater Huddersfield Partnership Transformation Board (PTB), which is to:
“have oversight of transformation across the acute trust footprint, including Right Care Right Time Right Place and recovery activities.“
Calderdale Clinical Commissioning Group’s April 2021 update on Calderdale Cares (formerly Calderdale Sustainability and Transformation Plan, then Calderdale “place-based integrated health and social care system” ) shows that the informal Care Closer to Home Alliance aka Calderdale Collaborative Community Partnership Board (to be repurposed as the Partnership Transition Board) will be subordinate to the new Calderdale Integrated Care Partnership. How much sense does this bureaucratic jiggery pokery make?
And how publicly accessible and “transparent” will these new Integrated Care Partnership and Partnership Transition/Collaborative Communities Programme Boards be?
The ‘Transforming Community Services’ update to Calderdale Adults Health and Social Care Scrutiny on the work of Calderdale Collaborative Community Partnership Board made no mention of this – or the 21st September deadline for confirmation of detailed arrangements.