Integrated Care System papers show West Yorkshire and Harrogate are hurtling towards an unaccountable Local Health Service

On 30 July (2pm, Leeds Civic Centre) a meeting in public of the West Yorkshire and Harrogate Sustainability and Transformation Plan Joint Health Scrutiny Committee will question  West Yorkshire and Harrogate Integrated Care System leaders about what they’re up to.

Papers for the Committee clearly show that the Integrated Care System plans mean an overall substantial change to NHS, social care and public health services across the region.

But they avoid drawing attention to the scale of the cuts the ICS intends to make.

They say nothing about how the Integrated Care System will impose a system-wide financial control on all the constituent organisations.

They make un-evidenced claims about the enhanced role of Councillors.

They make it clear that hospitals, primary care, mental health care, maternity care, social care and public health services are to be radically transformed – and with them, the patient/clinician relationship and the core NHS principle of universal access to comprehensive health services, free at the point of need.

The West Yorkshire and Harrogate Sustainability and Transformation Partnership (now Integrated Care System) must consult the public on the whole Integrated Care System

The Next Steps document predicts a £1.2bn funding shortfall by 2020  – so that is the size of cuts they have to make in their “transformation”. Inevitably this will amount to a significant change to NHS and social care services.

This huge sum is 1/5 of the total projected NHS and social care budget of £5.8bn by 2020/21.

They propose:

  • £0.5bn efficiency cuts through delivering services in different ways
    £0.4m [presumably this is a typo for £0.4bn?] “right care”
    £0.1bn projects delivering savings across region
    £0.2bn sustainability and transformation funding

The Integrated Care System has new ways of making these cuts

We need  to know what they are.

The Next Steps doc mentions developing “a single financial strategy” for the Sustainability and Transformation Plan, in preparation for the 2018/19 planning and contracting process.

Where is it?

It may involve:

“risk-share arrangements, outcomes based contracting and designing incentives for system working”

The legal (and practical) complexities of system-wide working are indicated in the Memorandum of Understanding of the 4 mental health trusts:

“The Parties recognise that it is currently the duty of the commissioners, rather than the Parties as providers, to decide what services to procure and how best to secure them in the interests of patients. In addition, the Parties are aware of their competition compliance obligations, both under competition law and, in particular under the NHS Improvement/Monitor Provider Licence for providers, and shall take all necessary steps to ensure that they do not breach any of their current or future obligations in this regard.”

As for outcomes-based contracting  – last November a campaigner asked the Joint Health Scrutiny Committee whether the Integrated Care System would commission for outcomes that matter to patients – or to bean counters who are looking for reductions in things like hospital bed days for different illnesses and the effect on spending on elective admissions.

The Next Steps doc says that Right Care is intended to cut £0.4bn and already the Joint Clinical Commissioning Committee has approved a Right Care plan for 2018/19 that cuts spending by £50m, through restricting patients’ access to orthopoedic and opthalmic elective surgery, plus so-called Procedures of Limited Clinical Value.

That is de facto privatisation

De-funding a service so patients (who can afford to), have to seek treatment elsewhere amounts to de facto privatisation, according to a Reader in Respiratory Medicine at Imperial College London.

Campaigners have already warned about an emerging two tier NHS/private health care system. Last November  an NHS cancer patient was marooned on a cold noisy corridor in Leeds hospital as the ward was full, although there was a private cancer ward in the same hospital.

Where is the Integrated Care System  Memorandum of Understanding?

It is vital that the Joint Health Scrutiny Committee sees this. According to a Wilmington Healthcare report, the Memorandum of Understanding is to:

“commit the area’s NHS organisations to work to a Sustainability and Transformation Partnership-wide financial control total.

This means a limit to NHS spending for the whole area, rather than for individual NHS organisations. This is something new. The inference is that Individual NHS organisations  no longer control their own finances. How will this work?  What does it mean for patients?

Presumably referring to the system financial control total, the Integrated Care System summary coyly mentions  a:

“mutual accountability framework for new financial arrangements…”

Does this give the Integrated Care System Leader – and/or the leadership team – “intervention powers” in individual NHS organisations?

Here are five questions for Rob Webster and the Integrated Care System leadership:

  • What power have you got?
  • Where did you get it from?
  • In whose interests do you use it?
  • To whom are you accountable?
  • How do we get rid of you?

An Unaccountable Local Health Service

The Integrated Care System Summary mentions “flexibilities and freedoms”  –  what are they?

It says the Integrated Care System will assume some NHS England and NHS Improvement regulatory functions  – which?

The Integrated Care System is taking on the quangos’ regulatory powers – without even their limited accountability to the Secretary of State. This doubles the NHS’s distance from democratic accountability to the elected government.

We’re zooming towards 44 unaccountable local health services. Underfunded, cuts-driven & privatising. The effects on the West Yorkshire and Harrogate NHS, social care and public health services will be huge.

The Integrated Care System summary claims there will be clearer routes for Councillors to be involved in developing integrated care – what are they?

Last Autumn we asked about the Sustainability and Transformation Plan Programme Directors’ priority meeting on the Integrated Care System Memorandum of Understanding.

They told us that there are no local authority reps on the Programme Directors Board.

But apparently the West Yorkshire and Harrogate local authorities have to sign the Memorandum of Understanding. So what input have Local Authorities and Councillors had, as potential signatories?

The Sustainability and Transformation Plan also said that the leadership team and NHS England were having private preliminary discussions – minutes and other papers were not publicly available. Nonetheless, they were

“committed to openness and transparency and when firmer proposals have been developed these will be presented to the appropriate forums in public.”

So where is this openness and transparency?

Significant changes to the NHS, social care and public health made or planned by the Integrated Care System

They include:

Cuts to hospital services and replacement by out of hospital care delivered through 50 large scale primary care home practices. Private companies have welcomed this as a “massive market opportunity”.  (But in the case of Huddersfield and Calderdale – the Secretary of State has found these plans to be not in the interests of the public or the NHS – they fail to show how or if they meet NHS England’s 5th consultation test that effective community services must be in place before hospital beds are cut, in order not to risk patient safety. How come NHS England assured these plans, when they don’t even pass their own test?)

Downgrading district general hospitals into local hospitals networked with centralised specialist hospitals – all organised by a West Yorkshire Association of Acute Trusts committee that meets in private and doesn’t publish its minutes.

Staffing the region’s hospitals on the basis of a Clinical Network that sounds like consultants’ and other key specialist clinicians’ equivalent of hot desking.

A new skill mix that emphasises patient self care, new grades of less qualified and non-clinical staff and a whole population behaviour change agenda – which seems to be based on the misguided belief that many illnesses are the result of bad lifestyle choices.

So campaigners are pleased that the governance paper for the Joint Health Scrutiny Committee meeting advocates establishing  a Statutory scrutiny sub-committee, with the power to tell the Integrated Care System to consult the public on the Integrated Care System and its plans for transforming NHS, social care and public heatlh services across the region. They urge the Committee to use this power asap.

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