Thatcher’s think tank nixes “integration and innovation” Health and Care Bill

  • West Yorkshire and Harrogate Integrated Care System Board is meeting though online video conference at 2-5pm on Weds 7th September 2021. The agenda and papers are here.
  • Preparation for the contentious Health and Care Bill is a significant topic at the meeting. This is the subject of our question to the Board.

Calderdale and Kirklees 999 Call for the NHS is asking the Board this question:

I would like to preface my question with a request that it is discussed by Board members in this meeting and not left to Integrated Care System managers to respond to.

The lack of Board discussion of questions from the public is a real weakness. We bring questions here for all the Board members to consider – but under the current process this doesn’t happen.  As a result, our questions are like pebbles that just skim across the surface of the meeting and have no effect on it.

At a Public Participation meeting with Integrated Care System managers on 17.3.21, referred to in the Minutes of 1st June 2021 Board Meeting as “positive”, Ck999 asked for the contact details of the 4 coopted members of the public on the ICS Board, so we could ask them to take up our questions in the meeting.  We also said we need to know what their remit, powers and duties are (if any). None of this has happened.

(You can download a record of the Public Participation meeting here)

So: Please will Board members discuss and comment on the fact that Rob Webster’s Chief Exec Report does not mention the recent Conservative think tank analysis of NHS integration, which uses West Yorkshire and Harrogate ICS as a case study, and recommends that:

“the Government should: Drop from the Health and Care Bill legislation to put ICSs on a statutory footing.
The evidence to date suggests that there is no clear link between integration and improved outcomes… Before charging on down this road, we need much better evidence that the ICS model is the right one to adopt.”

In particular, please will Board members discuss and comment on the following findings from the Centre for Policy Studies, that specifically refer to West Yorkshire and Harrogate ICS.

The Centre for Policy Studies report notes some positive evidence in terms of delayed transfers of care in the West Yorkshire and Harrogate ICS-

“but…there was a worrying and perhaps related rise in emergency readmissions…to hospital [which] had risen to 14.4% by 2019-20, overtaking the national average…Overall, there was no evidence of significant performance improvements. And again, there had been a significant increase in healthcare bureaucracy, with a 20% increase in managerial staff since 2016…

The establishment of the WYHHCP seems to have led to a degree of productivity decline, with greater inputs yielding no overall improvement in outcomes –even on an optimistic reading – in a region that has been cited as proving the effectiveness of the NHS England led approach.”

While

“The gap between West Yorkshire and England in terms of cancer mortality rates did not close in any significant way from when the S[ustainability and] T[ransformation] P[artnership] was set up.”

And

“On average, respiratory disease mortality was 0.4% lower in West Yorkshire in the three years from the establishment of the S[ustainability and] T[ransformation] P[artnership] in 2016 compared to the three years beforehand. However, the gap between West Yorkshire and England only closed marginally in West Yorkshire’s favor in 2017 and 2018, with the gap then opening up again in 2019.”

There is more analysis of other key health outcomes for West Yorkshire and Harrogate Integrated Care System that basically show no evidence of improvement since the STP was set up in 2016.

In terms of workforce,

“ The NHS workforce in West Yorkshire and Harrogate increased by 6.5% under the STP and ICS to reach 2,290/100,000 population in the region. This rise was 40% greater than seen nationally” – but  “the proportion of clinically qualified workers declined from 52% when the STP was set up to under 50% underthe WYHHCP.”

This is because:

• “There was a 10% increase in senior managers from March 2016 to March 2020, while the support and infrastructure workforces grew by 16% and 19% respectively.
• The clinically qualified workforce [only] grew up 6.5%”

If the 4 coopted members of the public on the Board would like to get in touch with Calderdale and Kirklees 999 Call for the NHS, you can email us on changingmorethanlightbulbs

Here is the Centre for Policy Studies report https://www.cps.org.uk/research/is-manchester-greater-a-new-analysis-of-nhs-integration/

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