How managed decline of the NHS since 2010 has played out in Calderdale

2.5K words – about a 10 minute read.

Here is evidence to show how successive governments’ managed decline of the NHS since 2010 has played out in Calderdale.

And how “austerity” economic policies and lax regulation worsen public health, amounting to social murder and making a mockery of successive governments’ stated aim of NHS “reforms” to improve population health

A 2009 report by the global consultancy company, McKinsey originated the cost-cutting NHS policies that – according to a recent report commissioned by the Department of Health and Social Care – amounted to managed NHS decline and have led to the current crisis for both staff and patients.

The implementation of McKinsey’s recommendations has been clouded by government, NHS and Councils’ management-speak, gobbledygook and withheld information

It has taken massive efforts by members of the public and local NHS campaign groups to decode official documents and statements about the defunding and top-down redisorganisation of Calderdale’s NHS, social care and public health services over more than a decade.

Here’s a summary of what we’ve uncovered over the years.

The McKinsey NHS Productivity Report 2009/10- 2013/14

The McKinsey Report ,”Achieving World Class Productivity in the NHS 2009/10 – 2013/14: Detailing the Size of the Opportunity”, was commissioned by the New Labour government after the bankers had wrecked the global and UK economies in 2008. McKinsey’s NHS world class productivity report fed straight into the 2010 Coalition Government’s austerity agenda.

The McKinsey report identified a possible funding shortfall of £10-15bn in 2013/14 – around 10% of spend.

It prescribed increased “efficiencies” in the NHS in England that would cut costs by by between 15 and 22% of current spend, or £13–20bn/year, over the next 3-5 years.

This “austerity” prescription for the NHS, has contributed to the “vast damage on public services and the public sector workforce” that austerity economics has inflicted

As a recent study by the New Economics Forum has shown, suppressed public sector pay has caused a crisis in recruitment and retention, leaving public services critically understaffed. Cutting corners on investment has left a £10bn backlog of repairs in the NHS.

Cutting public spending in order to create space in the economy for the private sector to grow has been counterproductive.

It was a ridiculous policy, since it ignored the fact that investing in the public sector has a significant multiplier effect – in other words, every £1 spent generates more money circulating in the economy, which in turn generates more tax income for the government.

The fiscal multiplier for NHS spending is around 4.

Successive governments’ austerity economics have – predictably – tanked the economy. A 2023 report by the TUC’s senior economist, Geoff Tily, explains that compared with pre-1979 trends, GDP has fallen short by £2 trillion or nearly half.

Austerity economics has caused the British economy to lose around £400 billion of GDP compared with what the Office for Budgetary Responsibility forecasted in 2010.

Predictably then, as a direct result of these contractionary policies – introduced first by the Labour government’s Alastair Darling and then by Conservative Chancellor George Osborne – public debt rose from 56.6% of GDP in July, 2009 (i.e. after the financial crisis) to 90 per cent of GDP in 2013.

Britain’s rising public debt can therefore be attributed to the 2010 Conservative-Liberal Democrat coalition government’s determination to worsen the crisis by making the biggest cuts to state spending and investment since the Second World War.

Successive governments have then used this increase in public debt in an economically illiterate attempt to justify further public spending cuts.

Austerity is still embedded in Britain’s political discourse and is still a threat to Britain’s social infrastructure. More austerity is still to come as a result of the Chancellor’s 2022 autumn statement.

Between 2011 and 2018, 900,000 public sector jobs were cut. Over the same time period those with wealth have seen their wealth (household net worth, adjusted for inflation) treble by £7 trillion. As a result we now live within an economy designed to serve the interests of the wealthy – not workers – or indeed the climate.

As Ann Pettifor writes, austerity prevented – and now continues to dog – urgently needed investment in the public infrastructure needed to protect us all from coming climate shocks. There is a clear question of whether the goal of keeping the global temperature rise below 1.5C – is still ‘alive’. This is a clear public health issue.

Successive governments’ public spending cuts and privatisation of regulatory and enforcement bodies have led to social murder

NHS policies advocate “prevention” as a means of creating a healthier population, but inequality, poverty and climate change are all massive threats to public health. And successive governments’ austerity economic policies have increased these threats, not reduced them.

The privatisation of regulatory and enforcement bodies has also drastically reduced the state’s ability to deliver social protection and according to a 2016 report from the Centre for Crime and Justice Studies, has caused the “needless” deaths of thousands of British citizens each year because of the government’s failure to tackle food poisoning, health and safety breaches and pollution. Professor Steve Tombs, author of the report, said:

‘This is avoidable business-generated, state facilitated social murder. And quite remarkably, it proceeds daily, met largely by political silence.’

The Deputy Director of the Centre for Crime and Justice Studies pointed out this was the result of “radical” cuts to local authority inspections and enforcement.

Adding insult to injury, central government has slashed public health grants to local authorities

The Coalition government promptly put McKinsey’s cost-cutting “opportunity” into effect in 2010, as the ‘Nicholson Challenge’ to cut £20bn NHS spending each year by 2015

In Calderdale, the proposed defunding included:

£6.0 – 9.2bn found from provider costs. (This was the direct cause of cuts to Calderdale and Huddersfield hospitals staff, services and building maintenance.)

£4.7 – 6.6bn found from commissioner costs, partly through decommissioning “low value added healthcare interventions.” (This later developed into the national, so-called Evidence Based Interventions scheme to stop routine NHS funding of many elective care procedures and diagnostics). Commissioner costs were also cut through enforcing clinicians’ compliance with commissioners’ standards (which became the Rightcare scheme.) This cut 10% of West Yorkshire NHS hip, knee and eye operations when it was first introduced in the county in 2018/19, and aimed to cut £50m from the area’s NHS spending by 2020.

£2.7 – 4.1bn ‘savings’ from shifting hospital care towards cheaper out-of-hospital alternatives. These planned cuts were the origin of the Calderdale and Greater Huddersfield NHS ‘integrated care proposals’ to centralise our hospital services, close one of our two full, blue-light A&Es and shift many services out of hospital into “Care Closer to Home” – now renamed Calderdale Cares Collaborative, if I’m not mistaken. These proposals went under the name of the Right Care Right Time Right Place programme.

A company called PA Consulting gave local shape to the cost-cutting Nicholson Challenge, through the 2013 Calderdale and Huddersfield Health and Social Care Strategic Review

This was later was developed into the Right Care Right Time Right Place ‘integrated care proposals’ for Calderdale and Greater Huddersfield’s NHS and social care services.

Provision of the financial baseline data for the Strategic Review was contracted out to PA Consulting Group at a cost to the Clinical Commissioning Groups of nearly £1m.

One of the biggest recipients of government consultancy contracts – receiving £11 million over the first year of the Coalition – PA Consulting was led until December 2013 by former McKinsey alumnus Jon Moynihan – a massive Tory party donor since 2002.

Moynihan, who made a fortune over two decades leading PA Consulting, told the Financial Times the ultimate outcome of selling advice to the public sector would be to make government so small there would be “hardly anything to consult upon”.

PA Consulting came up with the proposal that the Calderdale and Huddersfield hospital cuts and centralisation “Vision” document should be presented as “an integrated care model”.

This was the origin of the Care Closer to Home scheme, which is central to the ongoing repurposing of Calderdale General Practice as a service that identifies, and prioritises the care of, groups of patients most at risk of A&E attendance and unplanned hospital admission, in order to keep them out of hospital.

From 2014-2019, Simon Stevens’ NHS England Five year Forward View and the related GP Forward View accelerated the implementation of McKinsey’s cost-cutting and privatising NHS plans

Altogether, the Calderdale Council Leader Cllr Tim Swift estimated around £80m NHS cuts in Calderdale would be required in the four years 2014/15-2018/19, as a result of NHS England’s Call To Action, published in summer 2013.

The quango told Clinical Commissioning Groups to come up with new 3-5 year commissioning plans that would find ‘local solutions’ to cutting their share of the projected annual £30bn NHS funding shortfall by 2020.

This led to the the 2013 Calderdale and Huddersfield Health and Social Care Strategic Review, mentioned above.

In Calderdale during 2014/15, the government’s funding of Calderdale and Huddersfield hospitals trust was due to be cut by £45m, while the Right Care Right Time Right Place plan aimed to save around £50 million.

This 2015 £45m funding cut plunged Calderdale and Huddersfield hospitals into a financial crisis that meant global management consultancy company Ernst & Young got to call the shots over the Right Care Right Place Right Time scheme.

This led 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.

In 2019 Calderdale Clinical Commissioning Group paid McKinsey £150K 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.

The accuracy of this report’s predictions is highly questionable. They had not been realised last time I received a Freedom of Information response on the issue from Calderdale and Greater Huddersfield Clinical Commissioning Groups.

The radical top down plans in the NHS England quango’s 2014-19 Five Year Forward View were quickly implemented, without any statutory basis, through the furtive establishment of West Yorkshire and Calderdale’s Sustainability and Transformation Partnerships in 2015, and their successors, West Yorkshire Integrated Care System and Calderdale Cares, a few years later.

The Integrated Care Systems were only put on a statutory footing in the 2022 Health and Care Act. The House of Commons Public Health Committee’s recent Report on Introducing Integrated Care Systems says,

“It is not clear what tangible benefits for patients will arise from the move to ICSs, nor is it clear by how much or by when things will improve.”

Many elements of the 2022 Health and Care Act – including the new Provider Selection Regime which is to replace existing NHS contract procurement regulations – are still to be finalised through secondary legislation.

It’s unlikely these regulations will be made in time for financial year 2023/24. Calderdale Adults Health and Social Care Board’s Detailed Review of Calderdale GP Practices omits to mention this.

But Calderdale’s Director of Public Health, Debs Hawkins, told the Adult Health and Social Care Scrutiny Committee on 19th January that she will want to discuss with providers what can be delivered with the Provider Selection Regime, when making new contracts for Health Visiting, school nursing, NHS health checks, sexual health services etc. Because she is concerned about the ability to get the same level of services in the upcoming new contracts, when Calderdale Council’s Public Health 2023/24 grant allocation is likely to be a real terms cut on the previous year.

Systematic attempts to pump doubt and confusion into public discourse

We contend that successive UK governments’ deployment of the austerity agenda to justify massive NHS defunding and redisorganisation in the wake of the financial sector meltdown represents a systematic attempt to “pump doubt and confusion into public discourse.”

These are the words of economics professor Philip Mirowski in his book “Never Let A Good Crisis Go to Waste – How Neoliberalism Survived The Financial Meltdown”, which examines how the financial sector survived its implosion in 2008. He attributes this as considerably due to:

“systematic attempts to pump doubt and confusion into public discourse…Think global warming denialism but now extended to the question of the causes and meaning of the economic crisis through the intentional manufacture of doubt and uncertainty in the populace.”

Attempting to scrutinise the state of NHS General Practice without taking the formative political context into account is likely to be pretty pointless

Denialism about the dismantling of the NHS under cover of the austerity agenda is not just the preserve of the UK government and its NHS England quango. It’s also being practiced by Calderdale Adults Health and Social Care Scrutiny Board in its Detailed Review of GP Practice.

Mirowski notes the emergence of a field of study called agnatology, which focusses on the deliberate propagation of ignorance through smoke-and-mirrors public discourse.

A member of the public reported that trying to take part in one of the public consultation drop ins about about “the future of Calderdale and Huddersfield hospitals and community healthcare” was “like wrestling with fog.”

Facing a tsunami of corporate-authored bullshit about NHS “reforms” in the wake of the financial sector collapse, NHS campaign groups have been forced to become agnatologists.

We were compelled to create “BS alerts” to expose official communications designed to generate ignorance about the managed decline of the NHS in the interests of government’s corporate cronies – a relationship which became more nakedly visible in the corrupt handling of the Covid-19 pandemic.

Now we’re not even allowed to attend or speak at Calderdale Health and Social Care Scrutiny Board.

Global American companies are calling the shots

Global, largely US-based companies have shaped the “systematic attempts to pump doubt and confusion into public discourse” following the financial sector collapse in 2008.

Probably the biggest, most significant NHS privatisation has been the privatisation of Department of Health and Social Care NHS policy making. Key roles have been handed to McKinsey alumni such as Penny Dash, rather than carried out by civil servants.

The privatisation of so-called “commissioning support” and “health system support” is also crucial to the operation of the new Integrated Care Systems. (There is more on this in Appendix 3.)

Public organisations responsible for planning and commissioning NHS services have been hollowed out, in order to give shelter to largely US companies to undertake their work.

There’s also a fast-moving revolving door between corporations and public sector agencies such as NHS England, NHS Digital etc, which blurs the distinction between corporations and the NHS.

None of this is referred to in the Detailed Review, although privatisation – and Americanisation – of NHS policy making has shaped the changing role of Calderdale’s General Practice since 2010.

This blogpost is Appendix 1 to my deputation to the 19th January 2023 Calderdale Adults Health and Social Care Scrutiny Panel – which the Chair, Cllr Howard Blagbrough, forbade me to make.

More info about how clinicians’ exodus from community health has been driven by cost-cutting “new care models” in Appendix 2 – here’s the link.

Info here about big changes to GPs in 2024 – yet another unevidenced and underfunded “rapid transformation for service delivery” – cue more cuts and privatisation. Info about the replacement of Primary Care Networks by Integrated Neighbourhood Teams that is omitted from Calderdale Council’s Detailed Review of General Practice.