A secret process to cut NHS spending and services is galloping ahead across England.

If you think this is all a VERY BAD IDEA, please tell your MP and Councillors. And get in touch with Calderdale & Kirklees 999 Call for the NHS (CK999) or one of the other organisations in the CK999 network and help us campaign to stop and reverse NHS Cuts and sell offs.

Sustainability and Transformation Plans (STPs) are the enforcement mechanism to make NHS commissioners, hospitals and GPs carry out, at speed, the NHS spending cuts and increased NHS privatisation that are required by NHS England’s Five Year Forward View, 2015- 2020.44 area “footprint” STPs are being drawn up in conditions of secrecy imposed by NHS England – as their North Midlands Director of Commissioning Operations, Wendy Saviour, told a recent meeting of Shropshire Clinical Commissioning Group:

“STPs are not meant to be published at all. They should not go to Board meetings. Some of them contain very radical things… These are highly political and highly contentious.”
“They  will all be published when Simon [Stevens] has seen them. There were meetings last week and over the next two weeks. Once they’re washed off and the national messages are gathered together, they will be published.”

Calderdale Health and Wellbeing Board in secret STP meeting

This may be why Calderdale Health and Wellbeing (HWB) Board delegated approval of the Calderdale Sustainability and Transformation Plan “checkpoint” submission and Local Digital Roadmap – due to go to NHS England in June – to a sub group of Calderdale CCG Governing Body consisting of the Chief Officer, Chair, Deputy Chair and the Lay Advisor. That way, the STP-in-progress didn’t have to go to the Governing Body.

The Health and Wellbeing Board has apparently also held a secret “development session” in July where – according to the  30 June 2016 Calderdale CCG Finance and Performance Committee Minutes – Calderdale Clinical Commissioning Group was to present a “transformative narrative” for how the Calderdale STP would deal with “gaps” in terms of NHS outcomes, quality and finance.

This Health and Well Being Board meeting does not seem to be on the Calderdale Council calendar – which made it next to impossible for the public to attend it – but the HWB Board Minutes of 23 June 2016 did list an upcoming “informal” HWB Board Meeting on 28th July.

I have emailed HWB Board Councillors to ask for the Minutes, why the meeting was informal and not listed in the Calderdale Council calendar, what this “transformative narrative” turned out to be and what the Health and Well Being Board response was. Cllr Tim Swift has forwarded this request to Calderdale Council media team for them “to check and confirm facts and assist in providing an accurate response.”

Update 17 August 2016

Calderdale’s Senior PR and Internal Communications Officer has now replied to my request for info:

In June the Clinical Commissioning Group governing body delegated authority to a subgroup of the governing body to review the Sustainability and Transformation Plan and Local Digital Roadmap (chair, deputy chair, lay advisor and chief officer). No authority was granted to approve, because the submission was a checkpoint submission, not a final plan.

Informal meetings are not normally listed in the Calderdale Council calendar. The meeting on 28 July was in fact postponed until 11 August.

The minutes of informal meetings are not normally published on the Council’s website.

The information discussed at the informal meeting of the Health and Wellbeing Board (HWB) on 11 August will be considered at the formal meeting of the HWB on 25 August.
Calderdale HWB sees itself as the place where there will be public discussion of the local Sustainability and Transformation Plan.

This reply clearly fails to answer any of Plain Speaker’s questions. I have emailed Cllr Tim Swift and the Calderdale Council PR & Internal Comms Officer about this. What possible justification can there be for Calderdale Council to withhold information about matters of legitimate public interest from the public?

Update 25 August 2016.

Today Cllr Tim Swift has emailed:

“The HWB has regularly held informal meetings since it was first formed. These have been used to make sure the different agencies and individuals involved fully understand the developing role of the Board, and to provide an opportunity to share as much understanding as we can about the different demands and issues facing them.

No decisions are taken in such sessions, and anything that requires a decision would always be reported formally to the HWB.

Making sure people are well briefed is, it seems to me, an important contribution to good decision making.”

Regarding the lack of any statutory rules governing decision making about the Sustainability and Transformation Plans, Cllr Swift has emailed:

“That’s a reasonable point which I think you need to take up with central government and with NHS England, as we in local government have been doing. Local councils across the country have been concerned that there was no formal role for local government, whether through HWBs or otherwise, and pressing for that to be changed. That is why we are reporting on the West Yorkshire STP process to the HWB, and it is why I have personally insisted that the five West Yorkshire leaders and chairs of HWBs should have an opportunity to comment on the West Yorkshire STP before it is submitted.

My understanding is that formally any proposal included within the STP would still need to be approved through existing governance structures, I.e. CCG governing bodies, Trust Boards, etc, which is why our focus in Calderdale now is to achieve a common understanding of what we have to do to deliver the best health and care possible within the resources available.”

End of updates

At the 9th June Calderdale CCG Governing Body meeting, I asked if the West Yorkshire & Harrogate STP footprint Board meetings are going to be held in public. Matt Walsh replied that:

“The West Yorkshire STP governance arrangements were currently being discussed and thinking would be shared with the CCG’s Governing Body in public as they were developed and finalised. At that point no formal agreements on governance had been agreed except for the Memorandum of Understanding which was being reviewed later in that meeting.”

So huge plans to cut and privatise the NHS are being drawn up by organisations operating without any formal governance process. Can this even be legal?

STPs have “ a markedly extra-legal character”

A report by the Centre for Health & the Public Interest (CHPI) says,

“the whole [STP] process has a markedly extra-legal character.”

Extra-legal sounds like a polite term for “outlaw”.

Through the the imposition of STPs, the government has effectively undone laws created by the Health and Social Care Act 2012, without bothering to go through Parliament.

The CHPI says

“…the resulting decision-making is governed by no statutory rules: it is not clear who will be accountable for the results in terms of service provision, or the accompanying redeployments of public funds, or the conflicts of interest or the opportunities for fraud which the process is liable to generate…Who is participating in each ‘local health system’, who they represent, how they are reporting back, where a record can be found of the meetings held and the decisions reached – this information at least should surely be systematised and made public if the process is to be considered in any way democratic. Independent published evaluations are also needed of what the various new models of care have acheived in practice, in terms both of patient care and productivity gains.”

Time to question the West Yorkshire and Harrogate STP Programme Management Office

The Calderdale STP is distinct from the West Yorkshire and Harrogate Footprint STP.

At the 9th June Calderdale CCG Governing Body meeting, I asked about the amount of money in the Sustainability and Transformation Fund for the West Yorkshire & Harrogate STP footprint.

Matt Walsh gave a typically uninformative answer – basically that the so-called Healthy Futures Programme Management Office (PMO), (which is based at Wakefield CCG) , was working on it and whole system allocations had been announced in the previous week but the CCG wasn’t saying what they are.

I reckon an email to the PMO is well overdue.