New West Yorkshire NHS ‘Integrated Care Board’ 17th May meeting- looks like it will all fall apart sooner or later

The new statutory NHS West Yorkshire Integrated Care Board (ICB) will meet as a ‘shadow’ board in public on Tuesday 17 May 2022, at 11am.

The meeting will discuss the 2022/23 NHS Operational Plan and will be held virtually via Microsoft Teams.

The agenda and meeting papers can be accessed at https://bit.ly/37jvm1f  The meeting can also be watched live via the same link.

The Integrated Care System says,

“The board won’t be established formally, and all its members confirmed until 1 July 2022. It is meeting in ‘shadow’ to support the preparations for the ICB ready for when it becomes a statutory body from the 1 July.”

West Yorkshire Councillors recently called for safeguards for patients and NHS staff, after they scrutinised the complex and confusing draft Constitution and governance arrangements for the statutory Integrated Care Board and its associated committees,  as well as unwieldy collaborative arrangements with other bodies. 

These new arrangements are required by the contentious Health and Care Act 2022, which received Royal Assent on 28th April.

The West Yorkshire NHS Operational Plan for 2022/23 was submitted to NHS England and NHS Improvement (NHSE/I) on 28 April.

Weirdly, the Integrated Care System Operational Plan 2022/23 Report – prepared for the Integrated Care Board meeting by Anthony Kealy, Locality Director, NHS England / NHS Improvement and Jonathan Webb, West Yorkshire Integrated Care Board Director of Finance designate – says that,

“[T]he shadow ICB has no formal role in agreeing or approving the plan [but] it will be responsible for oversight of its delivery throughout 2022/23…This plan has been developed in partnership by the existing statutory organisations in West Yorkshire.”

Unfortunately we have been knackered over the past week and have not managed to send in questions in time for the meeting.

However we are sending in questions about the West Yorkshire NHS Operational Plan for 2022/23 for a written answer.

We are also asking if the lack of the shadow Integrated Care Board’s formal role in agreeing or approving the plan is because it is still in shadow mode.

Planned West Yorkshire NHS £73m deficit for 2022/3 plus 4-5% efficiency requirements – ie cuts

The funding shortfall of £73m in West Yorkshire’s NHS Operational Plan for the current financial year is terrible news but no surprise.

CK999 has long been warning that Calderdale’s NHS and social care services have been shrunken and under threat for years from a cost-cutting “transformation” programme, driven by non-statutory integrated care systems. This has now been put on a legal footing with the passage of the 2022 Health and Care Act.

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 Act 2022, which has created the 42 new statutory Integrated Care Boards, has locked these cost-cutting “transformations” 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. Leading to the creation of a two tier health system where those who can afford to – or can crowdfund successfully – go private and the rest make do with limited NHS services.

Two-tier public/private health system

For decades now successive UK governments and the NHS quangos have been gradually imposing a version of the USA’s ‘managed care’ system on the NHS. This restricts patients’ access to publicly funded healthcare and creates a 2 tier health system where those who can afford to, pay to go private and the rest are left with a stripped down public health service where many will simply not be treated. Now the Financial Times reporter John Burns Murdoch has put hard figures on this disgusting trend.

Pointing out that increasingly, poor people are turning to crowdfunding websites to pay for private healthcare, his data show that,

“30 years ago, US out-of-pocket spending on healthcare — costs that cannot be reimbursed through insurance, but are borne by the individual — was more than double that of the UK.

“Today, the two are virtually indistinguishable.

“Critically, it’s the Britons least able to afford private healthcare who are bearing the brunt.

“The share of UK household spending going on hospital costs has risen 60% since 2010, but more than doubled among the poorest, who now spend as much as the richest in relative terms.

https://t.co/4onf90Tvkn

The Integrated Care System Operational Plan 2022/23 Report says,

“5.2.8 The ICS has submitted a £73m system deficit plan on its £4.8bn NHS revenue allocation to NHSE/I which should still be considered as work in progress. This plan comprises a consolidation of the financial plans of the five CCGs and the ten NHS providers in West Yorkshire, as well as the Yorkshire Ambulance Service (YAS). We have represented the whole of the financial risk for YAS in our numbers, and would expect a contribution from two other ICSs should the risks remain following further scrutiny.

“5.29. All plans have been approved through the governance of individual organisations as well as being subject to system oversight and review. Efficiency requirements across our organisations and the system equate to around 4 – 5%. Feedback on the submitted financial plan is awaited from NHSE/I.”

Efficiency requirements of 4-5% are huge and many Integrated Care Systems are pushing back against NHS England’s financial targets

The average efficiency improvements by NHS trusts in the decade to 2016/17 was 0.9% according to a recent Nuffield Trust blog post “Reality check: The Long Term Plan settlement: 2019-20 to 2023-24.” How is West Yorkshire’s NHS going to make 4-5% “efficiency” cuts?

The Health Service Journal recently reported that “multiple” ICSs were ‘pushing back’ against NHS England’s financial targets for 2022/3 because of huge funding shortfalls – including West Yorks ICS which had submitted initial plans to NHSE that included a £121m financial shortfall.” Apparently the initial plan said work was continuing to “firm up our activity, workforce and finance plans to close this gap”.

According to the Health Service Journal,

“Several senior leaders in struggling areas told HSJ they will be unable to break-even, and they are pushing back on the ask from NHSE. One source said this was likely to be the reason that final guidance was still to be published, despite the new financial year already having started. Another source, who is chief executive of an acute trust, said: ‘Almost every trust board in the country is going to settle on a deficit budget, and then see how that plays out in negotiations with NHS England. Some of it is a negotiation, but some of it is also us being able to say, with ambulance handovers what they are, [and] with the need for elective recovery… we just can’t do it.’ Another chief executive from a large acute trust said the breakeven requirement was ‘just not realistic’.

Our questions

We are sending in questions for written answers to clarify:

  • How have the Integrated Care System got the original £121m funding shortfall down to a £73m planned deficit?
  • Is it through planned 4-5% “efficiency requirements” ie cuts?
  • That is a huge scale of cuts. How do they anticipate it will be possible to carry them out, while meeting their goals for improving all the many NHS services identified in the operational plan, and their commitment to providing access to comprehensive NHS care for all?
  • In terms of the Operational Plan, what is the relationship between the new statutory Integrated Care Board and its place subcommittees, eg the Calderdale Cares Partnership? Given that the Calderdale Cares Partnership Agreement states that despite its delegated powers from the Integrated Care Board,

“This Agreement is not legally binding and does not impose any legal obligations on any Partners, nor does it add to or override any existing contractual obligations held by any Partners. In endorsing the Agreement Partners fully retain their organisational sovereignty and continue to be accountable for their respective statutory responsibilities.”(Para 2.3, Calderdale Cares Partnership Agreement.)

This is what the operational plan report says about what they’ve done to “improve the deficit position”:

“5.34. A range of actions have been taken to improve the deficit position including peer review through the weekly West Yorkshire Integrated Care System Finance Forum meetings, and deep-dive reviews for organisations with deficit plans. Chief Executive-level escalation meetings were held with a number of organisations and places.

“5.35. Further ongoing work will include:

• Continued focus on efficiency and productivity in all organisations and places with financial gaps – including the establishment of Recovery Forum(s);

• Work via WY ICS Finance Forum on options/measures to support efficiency (with potential consistent approaches across West Yorkshire)

• Continued dialogue across the other two ICSs in Yorkshire & Humber and NHSE/I about the operational, workforce and financial challenges in the Yorkshire Ambulance Service

• Providing clarity on the underlying financial position/medium-term financial recovery (e.g. by undertaking HFMA financial sustainability self-assessment)

“5.36. The capital plan includes an £8m (or 5%) allowable over-commitment on £158m system capital allocation.”

“6.3. The financial position very tight [sic],primarily as a result of “unfunded” excess inflationary pressures as well as reductions in COVID financial support. Most of our risk is clustered in a small number of organisations. We will continue to work together to understand financial risk and use mutual support and accountability to seeks ways to manage this risk. This however is in the context of awaiting feedback on our plans from NHSE/I.”

“a number of further actions will be progressed, including:

• Further work to triangulate the finance, activity and workforce plans to understand key risks;

• Continuing work to address the health inequalities impact of elective care plans;

• Work to assess the quality impact of efficiency plans;

• Elective recovery – progress capital plans to develop dedicated ‘green’ elective care facilities at Bradford, Dewsbury, Pontefract, Chapel Allerton and Wharfedale;

• UEC – progressing plans on ambulance handovers and balancing risk and on discharge

• Discussions with partners and YAS on ambulance pressures, which includes a national conversation given issues across the sector.

7.2. Further feedback or challenge from NHSE/I may require some adjustment to specific elements of the overall plan.”

We hope to get further information about what all this actually means from written answers to our questions.

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