Campaigners say “NO” to the Bristol North Somerset and South Gloucestershire STP

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December 1, 2016 by Protect Our NHS

Today, 1 December, campaigners will call upon councillors from across Bristol, South Gloucestershire and North Somerset (BNSSG) to oppose the Sustainability and Transformation Plan for the area footprint.

The plan has been produced in secret without any proper consultation with patients, the public or NHS staff. Bearing in mind the massive changes in the way services are going to be delivered in the future, this is contrary to law and the explicit requirements for consultation in the NHS constitution. It is a disgrace, and unless a thorough process of consultation begins soon, legal challenges are likely to be made.

Campaigners want their political representatives to do three things:

  1. Ask why detailed finances not included when they are required to be sent to NHS England by 23 December;
  2. Explain to the public what the health impact will be of these cuts and service changes;
  3. Refuse to support the STP as councillors in many other parts of the country have done.

 

Here is the briefing that all councillors will be given.

 

The Bristol, North Somerset and South Gloucestershire (BNSSG) Sustainability and Transformation Plan (STP) for Health – A brief analysis by Protect Our NHS

The National Picture

  • NHS currently underfunded to such an extent that most NHS organisations have been unable to keep to budgets. Quality targets cannot be achieved.
  • The National Audit Office[1] reports “the current financial state of the NHS is not sustainable”. Nevertheless the government is not prepared to maintain funding even at the current inadequate level.
  • The purpose of STPs: to reduce spending over the next five years, to cap annual spending [2] at £23 billion less than the NHS would need in 2020/21 to maintain the services provided in recent years.
  • This will lead to substantial cuts in NHS services across the country, including hospital closures, reduced GP services, longer waiting lists.
  • There are likely to be calls for additional patient charges [3], and personally-funded health insurance plans[4] for, and increased delays to, a range of treatments no longer provided, or rationed[5], by the NHS.
  • Health spending: way below the average of Western European countries as proportion of GDP. A recent report by the Nuffield Trust[6] makes clear that a properly-funded NHS is affordable. The government needs to return expenditure on the NHS to the levels of countries like France, Germany, Denmark and Sweden.

The BNSSG STP has been produced by all the “partners”: Clinical Commissioning Groups (CCGs), NHS Trusts and the three Councils. It was made public[7]on 21 November 2016. It runs to 340 pages. It involves massive change to local health systems and organisations, with major implications for patients.

Cuts

  • No assessment of what the health need will be in the coming years, either by population or condition, and therefore the plan almost certainly underestimates the demands on the NHS.
  • STP concentrates on capping expenditure. By 2020/21 £305 million has to be ‘saved’ to maintain government spending cap. £139 million of savings or cuts are identified; £104 million remain unidentified.
  • The £139 million cuts cover continuing care, commercial opportunities, estates, GP prescribing, operational productivity (the largest category of saving at £41 million), and pay.
  • Little detail in STP about how the savings will be achieved and what the impact on services for patients will be for each of these items.
  • The plan says that ‘these savings are subject to organisational risk assessment’, and ‘consideration still needs to be given to the impact on workforce, activity and any capital investment requirements’. Without further details it is impossible to judge what the impact on patients will be.
  • Table 1 of the plan lists by how much each of the major NHS trusts has to reduce projected spending.

– North Bristol Trust (NBT) must reduce spending by £65 million

– University Hospitals Bristol (UHBT) must reduce by £36 million

– Avon & Wiltshire Mental Health Partnership (AWP) by £5 million

– Weston Area Healthcare NHS Trust (WAHT) by £10 million

Realities and Unrealities

  • Acknowledging reality, STP says that £104 million of savings cannot be identified and therefore partially resists the NHS England and government demand for even more dangerous cuts.
  • It says fragmented health service produced by the Health and Social Care Act 2012 is organisationally unfit to produce a financial, or any strategic, plan for an area the size of BNSSG.
  • STP says failure to have a shared understanding of where NHS organisations are competing and collaborating can cause whole-system working to collapse.
  • In section on key risks it makes the related point that ‘organisational alignment is insufficient to deliver the system transformation at pace’; i.e. many parts of the NHS are doing their own thing and have little interest in joint working.
  • Many aspects of the STP are unrealistic: the new Integrated Model of Primary and Community Care is quite unconvincing. Health professionals and commentators have provided evidence that a sustainable 7-day model of primary care without proper resourcing is unachievable.
  • The Digital Roadmap – the ambitious plans for new digital and technology programmes – is an unreality, when no capital funding is identified.
  • The crisis in social and community care is barely mentioned. Councils will be responsible for leading the Prevention, Early Intervention and Self-Care workstream which represents one third of the STP’s transformational programme. No funding is identified for this.
  • There is already a social care crisis. Nearly 25% of beds at NBT NHS Trust are currently occupied by people who are fit to leave, but for whom there is inadequate social care in the community. The only way to achieve the STP’s ambitions is an increase in social and community care resources; such an increase is impossible in the light of cuts facing local authorities.
  • The STP is very light on inequalities: no mention of equality impact risk assessment. The word ‘vulnerable’ appears just once in the STP.
  • The STP includes references to developing an ‘accountable care organisation[8], to ‘demand management’, to reduction in ‘hospital admissions’, and to enabling the use of ‘personal care budgets’. This is all code for the restriction of treatments and the reduction of patient numbers. Moving to this kind of model (with its US-health insurance connotations) undermines the basic principle of the NHS to provide free treatment to all based on ‘clinical need’, a phrase, incidentally, that doesn’t appear once in the STP.
  • Conclusion: the plan does not provide a realistic basis for meeting the challenges of inadequate funding, increasing demand facing the NHS and social care and delivering more equal health services.

Consultation

The June 2016 draft STP submission said: ‘Subject to any feedback from this initial STP submission … we will engage more formally with the Boards and Governing Bodies of partner organisations including the three local Health and Wellbeing Boards’ [our underlining]. What engagement took place?

The plan has been produced in secret without any proper consultation with patients, the public or NHS staff. Bearing in mind the massive changes in the way services are going to be delivered in the future, this is contrary to law and the explicit requirements for consultation in the NHS constitution. It is a disgrace, and unless a thorough process of consultation begins soon, legal challenges are likely to be made.

We hope that our political representatives will to do three things:

  1. Ask why detailed finances not included when they are required to be sent to NHS England by 23 December[9];
  2. Explain to the public what the health impact will be of these cuts and service changes;
  3. Refuse to support the STP as councillors in many other parts of the country have done. 

Protect Our NHS (Bristol) 30 November 2016

[1] https://www.nao.org.uk/report/financial-sustainability-of-the-nhs/

[2] http://www.nuffieldtrust.org.uk/sites/files/nuffield/feeling_the_crunch_nhs_finances_to_2020_web.pdf

[3] http://www.mirror.co.uk/news/uk-news/patients-should-charged-10-every-7131270

[4] http://www.independent.co.uk/news/uk/politics/jeremy-hunt-privatise-nhs-tories-privatising-private-insurance-market-replacement-direct-democracy-a6865306.html

[5] http://www.telegraph.co.uk/news/2016/08/09/rising-numbers-could-face-crippling-pain-as-nhs-rationing-spread/

[6] http://www.nuffieldtrust.org.uk/media-centre/press-releases/nhs-still-affordable-2030-experts-conclude

[7] https://www.bristolccg.nhs.uk/library/sustainability-and-transformation-plan-documents/

[8] https://calderdaleandkirklees999callforthenhs.wordpress.com/2016/11/23/we-own-the-nhs-but-secret-theft-plans-want-to-steal-it-from-us/

[9] NHS England requires all NHS organisations to send them two year operational plans by 23rd Dec, that include templates that show the financial “trajectories for 2017-2019 that will deliver individual CCG and local system “footprint” financial control totals, implement local STP plans and achieve local targets to moderate demand growth and increase provider efficiencies (e.g. Right Care and Carter review).  This information about NHS planning guidance, NHS England operational plan submission requirements and Timetable for Operational Plan and STP is from the Leeds CCG report to 24 Nov 2016 Leeds HWB Board

 

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