STP

  • STPs and Five Year Forward View – the case of the missing evidence - by John Lister

    STPs and Five Year Forward View – the case of the missing evidence

    This is a very important and thorough, but brief (16 pages) summary of the problems as at April 2017 by John Lister, head of Health Emergency and Health Campaigns Together, who has monitored the NHS for 30 years.

    By way of praise I will borrow the following introduction by Eric Leach, of Ealing Save Our NHS, who edits "Our NHS in Crisis", as follows:

    "I have read some excellent pieces of research and writing in the five years I have been trying to make sense of the cost cutting/service change plans for local, regional and national care services.

    However one document now stands out in my mind as the most brilliant piece by piece, issue by issue, aspiration by aspiration shredding of the Government’s current plans and supporting evidence for delivering future financial savings and care services’ improvements.

    The document is attached. It’s written by John Lister and can also be viewed at www.healthcampaignstogether.com

    I realise it’s a long read at 16 pages, but I doubt anyone could cover the territory in fewer words/pages. His evidence base is authoritative, comprehensive and wide ranging. No sane person could conclude that there is any credible evidence that implementing the current plans will achieve either of the twin goals of extreme cost cutting and service improvement.

    If journalism is "early history" then John has documented in his paper why the STP/FYFV/ACO/Next Steps failed way before 2021".

  • Tories 'relaxed' about NHS crisis because they think election is won

    By Neil Roberts  From GPonline.com - 27th April 2017

    "The government is 'relaxed' about the crisis in general practice because it thinks Labour can't win the general election, a former GP and health commentator has said.

    Former GP Dr Phil Hammond, who covers health policy for Private Eye, said that ministers were ‘very relaxed’ about the NHS because they believe there is no effective opposition.

    Plans to create large-scale Accountable Care Organisations to run health and social care services across the NHS would eventually lead to all GPs becoming salaried employees, he added.

    Citing a source ‘close to Jeremy Hunt’ Dr Hammond told the annual conference of Londonwide LMCs (Local Medical Committee) on Thursday: ‘They don't believe that Labour is electable. They are very relaxed about the state of the NHS, very relaxed about the queues in casualty, waiting lists going up again, and the disaster in general practice, because they don't believe Labour offers a credible opposition.’

    Dr Hammond said the Conservative government viewed the NHS as ‘a service for poorer people’ and wanted those who can afford it to take out private medical insurance.

    NHS privatisation

    ‘They want private companies to do as much NHS work as possible. And they want the NHS to be allowed to do as much private work as it wants to do. That is their ideology and agenda and they don't believe there is an opposition fighting that.’

    Dr Hammond, who was one of the first journalists to expose the Bristol babies heart scandal in the 1990s, warned GPs that under NHS England drive towards accountable care systems they could all end up in a salaried service.

    The NHS, he said, was ‘keen to move to a model of accountable care organisations where we unify primary, secondary care, social care.’ 

    He added: ‘Ultimately this will make all GPs salaried and working for a large accountable care organisation in a particular area.’

    The Conservative Party did not respond to a request for comment".

     

    SOH  Comment:

    The vast majority of the electorate know nothing about this. It has not been alerted to the detail of Health and Social Care Act 2012 and Simon Stevens' plans from 2014 for co-called "Sustainability and Transformation Plans". The STPs include American-style "Accountable Care Organisations" - the stress is on the word "accountable" or "cost-controlling". They are part of an entirely new and untried, root-and-branch reorganisation of the NHS which the present Government is bringing in very, very quietly.

    The NHS will be unrecognisable. The National Health Service will disappear and be replaced by many Regional ("footprint"-based) organisations linking local federations of GPs, local acute services and local government authorities. Each "footprint" organisation (ACO) will have a capped budget - no more deficits, no more overspending. Gone over your budget? No more medical service.  The management of the local ACO will devote its energies to finding ways to "deny service". Uninsured and poor Americans know all about this.....

  • March 2017: Update on Councils opposing their STP

    Calderdale and Kirklees 999 Call for the NHS article dated beginning March 2017

     

    In early December 2016 Calderdale & Kirklees 999 Call for the NHS  posted a summary of 19 Councils’ negative responses to their “footprint” Sustainability and Transformation Plans after the Clinical Commissioning Groups  published them following submission to NHS England on October 21st.

    Since then Calderdale & Kirklees 999 Call for the NHS has had news of 13 more Councils’ negative responses to their Sustainability and Transformation Plans – which Defend our NHS campaigners have variously dubbed Switch to Private, Slash Trash and Privatise, and Secret Theft Plans.

    These Councils are:

    • Bristol City Council
    • Devon County Council
    • Isle of Wight Council
    • North Devon District Council
    • North Yorks County Council
    • Oxford County Council
    • Redcar and Cleveland
    • Sheffield City Council
    • Waltham Forest Borough Council
    • Warwickshire County Council
    • West Sussex County Council Health and Wellbeing Board
    • Wirral Council

    More details below.

  • Wake up to the Accountable Care Organisation threat!

    Calderdale and Kirklees 999 Call for the NHS article of 1st March 2017

     

    Simon Stevens, the NHS England Chief Executive,  just told the Public Accounts Committee that some Sustainability and Transformation Plans will soon get going as Accountable Care Organisations or systems.

    This sounds like more tedious, senseless jargonising.

    Indeed one MP, Anne Marie Morris, was so bemused by what Simon Stevens was saying, she asked if they were all smoking dope.

    But behind the jargon smokescreen – whether wacky baccy or not - setting up Sustainability and Transformation Plans to run the NHS as Accountable Care Organisations opens up the NHS to privatisation on a bigger scale than anything seen so far.

    And it is a mechanism for limiting the range of care that the NHS offers, and for denying care to patients who are judged to offer poor value for money.

    This would mean the end of the NHS as a service that provides the full range of health care to anyone who has a clinical need for it.

    How does this work?

    Sustainability and Transformation Plans require the speedy dismantling of the NHS to turn it into a health service that is based on American private health insurance systems – such as United Health,  the former employer of Simon Stevens, now NHS England’s Chief Executive.

  • Private firms receive £2.3m to draw up STP plan for North Central London

    Peter Blackburn for BMA 19th January 2017

     

    Private firms have been paid a ‘shocking’ £2.3m to draw up controversial plans which will cut health and social care spending by more than £1bn in a part of London.

    According to health leaders drawing up the North Central London STP (sustainability and transformation plan), six-figure sums were paid to eight different companies – including accountants Deloitte and management consultants McKinsey – for services stretching from ‘administrative support’ and ‘financial modelling’ to ‘communications support’.

    A firm called Consultants Methods Advisory Ltd, which describes itself as ‘shaping public services for the digital age’, racked up the biggest costs, invoicing £617,850 for ‘programme management office and strategy support’.

    Doctors leaders described the figures as ‘appalling’.

    BMA council chair Mark Porter said: ‘While hospitals fall into crisis, social care hits rock bottom and the Government blames hard-working GPs for its political choice to underfund the NHS, every penny of health service money becomes more desperately valuable and doctors will find it galling to see that so much vital resource has been handed to consultancy firms for their part in failing plans which, ultimately, may never come to fruition, while frontline staff struggle to provide safe patient care in a service increasingly becoming unfit for purpose.’

     

    Pick and choose

    BMA News analysis last year revealed that the STP process – which has seen England divided into 44 ‘footprint’ areas, with each asked to produce a plan to integrate and transform local services – will need to cut some £26bn from their budgets by 2021.

    And in December an NHS Improvement board paper revealedthat only projects which were ‘shovel ready’ would be likely to be funded – with capital resource too tight to pay for all the projects.

    Dr Porter added: ‘NHS Improvement has admitted that it will pick and choose the parts of these vast, bewildering plans it can actually put into action and, as such, it leads me to question whether all of this money handed out to private companies will be completely wasted – yet another example of vital resource being frittered away in a health service devoid of direction and leadership and lurching from one unnecessary crisis to another.’

    The North Central London STP – and its final iteration: a 68-page word document in PDF format – aims to combine ‘radical service transformation and incremental improvements’. It reveals that the area faces a funding shortfall of £1.2bn in 2020/21 if spending and funding levels continue as expected.

    In the plan, health leaders admit to ‘not having all the answers’ and still expects its NHS organisations to be in the red by £75m in five years – even after all the cuts.

     

    'Shocking, disgusting and appalling'

    Camden GP and local medical committee chair Farah Jameel said: 'As a practising GP struggling to meet patient needs with ever tighter resources, the words that come to mind when presented with these financial figures are shocking, disgusting, appalling and ultimately not surprising.

    'The Government should be held accountable for allowing this inappropriate use of funds and be encouraged to focus attention on addressing the very real challenges affecting those who work in and rely on the NHS.

    'We are in the midst of a winter crisis, the NHS has systematically been stripped of much needed resources translating into services performing under extreme pressure and stress, in this context these monies would be much better spent on frontline services like A&E's and General Practice.

    'I remain acutely aware of the Government's agenda to transform and reconfigure services to better suit the needs of the population within the constraints of a shrinking financial envelope.

    'With that in mind the absence of strong clinical input regarding service capacity and patient need in the planning process is frankly disappointing, especially given the large figures of tax payers' money involved.'

     

    A new norm?

    In total 17 different firms were paid for their involvement in putting together the STP.

    McKinsey and Company were given £360,000 for ‘strategy assessment’ and ‘financial modelling’ particularly related to mental health services and initiatives.

    Deloitte LLP was given £257,336 for ‘finance and activity modelling’.

    And recruitment specialists Hunter Healthcare Resourcing charged £282,518 for administrative support.

    Methods Advisory Ltd did not respond to BMA News’ request for comment. But a column on its website said: ‘We have worked in health and care for over 25 years, with all its incarnations and ambitions.

    'This gives us the ability to know what has worked (or not) before, alongside knowing what the potential… [to be] the "new normal” in health and care.’

     

    Leaked costs

    The revelations come months after a letter was leaked to the BBC revealing the cost of external providers to an STP in Cheshire and Merseyside.

    PricewaterhouseCoopers were paid £300,000 – less than a seventh of the total cost in North Central London – to help draw up the Cheshire and Merseyside STP, a plan which requires savings of £999m within five years.

    Explaining the costs, Louise Shepherd, lead for the Cheshire and Merseyside STP, said: ‘This is to provide additional capacity and expertise to help and support our clinicians and managers design our future care models while still delivering a very challenging “day job”.’

    NHS Improvement and the North Central STP lead have been contacted for comment.

    The North Central London patch includes: Barnet, Enfield and Haringey Mental Health NHS Trust; Camden and Islington NHS Foundation Trust; Central and North West London NHS Foundation Trust; Central London Community Health Care NHS Trust; Great Ormond Street Hospital; Moorfields Eye Hospital; North Middlesex University Hospital NHS Trust; Royal Free London NHS Foundation Trust; Royal National Orthopaedic Hospital; Tavistock and Portman NHS Foundation Trust; University College London; and Whittington Hospital.

     

  • Hugely successful demonstration by NHS campaigners in central London on 4th March 2017

    They came from all over the country united in their concern for the present state of the NHS and their fears for its future. Different sources estimate attendance from "tens of thousands" to 250,000.

    Three women dress in white medical suits and hold placards reading 'Slash Trash Privatise', 'Don't be a Silent Witness' and 'Death Closer to Home' near Russel Square today. The protesters are set to be rallied by Bernie Sanders's brother

    From "Save Our Services Cumbria" (Whitehaven Hospital), to "Hands off Huddersfield Royal Infirmary", to "Calderdale 999Call for the NHS" (above), to "Defend our NHS York", to "Bristol Protect our NHS", to "Sussex Defend the NHS", all were protesting about planned or actual A&E, acute units or whole hospitals closures. Health Campaigns Together  and the People's Assembly had done a superb job calling together dozens of NHS campaign groups and organizing the biggest NHS demonstration in central London in decades.

  • STP finance figures in spreadsheets and Delivery Plan "incorrect" - or not?

    At a presentation to Kensington and Chelsea Healthwatch members and residents on Tuesday 31st January, the STP team were challenged by Merril Hammer, Chair of Save Our Hospitals, about the figures revealed recently by a FOI request to NW London CCGs. The finance figures were contained in a "workbook", a set of spreadsheeets submitted with the Oct 2016 STP. Merril referred to the plans for the loss of 3,658 NHS jobs in NW London next year 17/18, rising to 7,753 job losses by 20/21.

    When NHSE, an executive body of the Dept of Health, publishes information, especially as a result of a Freedom of Information request, the public has a right to be able to rely on its contents.

    But in the question and answer session Christian Cubbitt, Director of Communications for NHS NW London Collaboration of CCGs, publicly retracted the figures. He said that they were "incorrect" and that there would not be nearly 8,000 job losses. He said that the "correct" figures would be produced, but did not give any deadline.

    Given that the objective of the STP is to find £1.3Bn of savings and that the template of the STP is set by the Dept of Health, it is impossible that the final numbers will be very different from the ones just published, using the same categories. SOH and its advisers have looked closely at all the pages in the workbook, including the "solutions" which are the balancing figures between the "Do Nothing" and the "Do Something" scenarios. Most of the solutions include words like "these costs have not been finalised". For Solution 4 (NHSE Specialised Commissioning) it says: "We have not yet developed the "solution" for closing the gap, however it is assumed that this gap will be closed. This is a placeholder".

    The Delivery Plan is obviously nearly right too.

    The denial by NW London CCGs is a clumsy attempt to limit the harm after the release of highly damaging information which should not have been disclosed on the grounds that its release would prejudice incomplete development of the plans. But then the FOI request would probably have been forwarded to the Information Commissioner and SOH would have made a big fuss about the refusal and about the fact that the figures were still being worked on three months after submission to NHSE on 21st October as a "final" version.

    That is why the current dispute about the status of the information produced by the NHS's NW London Collaboration of Clinical Commissioning Groups reveals even more than the figures themselves

    Brent Patient Voice have discussed the huge cuts in "Losing the power to shock".

  • Imperial CEO resigns

    The rising pressures on Imperial College Healthcare NHS Trust finally took their toll yesterday. Dr Tracey Batten, CEO of the trust with three of the busiest acute hospitals in west London, resigned after the Board meeting in public at Charing Cross yesterday, Wednesday 25th January 2017.

    The timing of this resignation could not be worse, with A&E attendances rising to unmanageable levels, a growing waiting list for surgery both emergency and elective, and a programme of redevelopment at a critical point at St Mary's and in the wider context of the "Shaping a Healthier Future" business plans.

    Dr Batten was brave and honest to allow the BBC full access to Imperial's hospitals over 6 weeks. The documentary series "Hospital" is being broadcast on BBC2 on Wednesdays at 9pm, available later on the i-player.

    The Trust is closely helped by PwC for day-to-day financial management, although we were assured at the Board meeting on Wednesday that it "can pay its bills".

    NW London is one of the 44  NHS "footprints" in the most advanced stages of preparation for the implementation of its "Sustainability and Transformation Plan". It is known to be closely watched by the Department of Health. The pressure of implementing completely unwarranted and impossible cuts has, it is believed, prompted this resignation. We look forward to Imperial acknowledging that the evidence shows increased demand for beds, not for cuts in beds and staff.

    Postscript:  On 6th February Dr Batten informed us that in 6 months she will be going back to spend time with her ageing parents in Australia.

     

     

  • Councils and residents close ranks to fight 'new ploy' to close Ealing and Charing Cross Hospitals

     

     

    Four hundred people came to Hammersmith Town Hall on a cold Tuesday night (29th November) to hear about the fight against NHS proposals which will force the closure of Ealing and Charing Cross Hospitals.

    Health services in the north west of London are already stretched after "Shaping a Healthier Future" (SaHF) plans (2012) resulted in the closure of Hammersmith and Central Middlesex Hospitals’ A&E departments in September 2014. Ealing lost its maternity unit in 2015 and its children's ward last June.

    In June 2016 local authorities in England were being asked to sign up to Sustainability and Transformation Plans ("STPs") but Ealing and Hammersmith and Fulham Councils have refused to do so, saying that this would see the end of their hospitals as major providers of vitally needed blue-light A&Es and acute beds.

    The meeting was chaired by Hammersmith and Fulham Council’s Vivienne Lukey, cabinet member for health and adult social care.

  • Response by Dr Christopher Wood to article by Prof Chris Ham The King's Fund 12th Sept 2016

     

    Christopher Wood

    Consultant HIV Physician

    North Middlesex University Hospital

    19 Sep 2016

     

    Professor Ham, thank you for your detailed, but much understated piece - notwithstanding the statement about STPs that..... 'they are attempting to undertake synchronised swimming against a rip tide'!

    The reality is that the current plans and timescales being imposed on STPs are reckless and dangerous. There should be an IMMEDIATE MORATORIUM called on STPs and other similar major re-organisations of the NHS that are in the pipeline.

    STPs may well be fine in theory - and that is debatable - but as you clearly state they are not a short-term answer to austerity and quickly delivered savings. In their current incarnation - with the expectation of immediate savings and transformation occurring in a fraction of a financial year they are a reckless and dangerous absurdity. The only sane solution is a moratorium. The NHS and its funding need a proper overall review with some bridging funding made available to meet the immediate needs of the NHS deficit and a proper cross-party/stakeholder consultation to decide its future.

    The need for the Acute sector cannot be 'wished away' as you make clear in your piece. I suspect that a lot of recent health policy has been made by fantasists in denial that acute illness really exists. The acute sector has been mistakenly marginalized since - at least - the introduction of the fatal Lansley 'Health and Social Care Act' and the Darzi report.

    It will take years of coordinated planning and investment to get prevention and social care to the point where they can make a real impact on hospital activity and the more acute and severe manifestations of ill-health. This certainly will not happen while the current mania for major uncoordinated and unfunded interventions is indulged by the detached and unaccountable elites currently making health policy.

    The leadership and vision that the NHS needs is completely lacking from the Secretary of State for Health, the DoH and NHS England - otherwise why would any serious health policy makers be endorsing the unsightly haste with which STPs are being pushed forward? It is a dangerous collective delusion in the context of an engineered funding crisis, collapse of workforce morale, years of austerity cuts and an arrogant policy-making elite who have no interest or respect for 'evidence', 'piloting' or consultation. I have to try and hope that many of them are likely to be well meaning, but many others seem to have serious problems with the original 'mission' and aims of the NHS and are impatient and opportunist in their desire to re-fashion it into something that I believe the great majority of the population that the NHS serves would find very disturbing.

    In summary, I believe that there needs to be an immediate moratorium on STPs and other major NHS re-organization, including the increasing role of the private sector. Bridging funds need to be made available to consolidate safe healthcare in the short-term while these issues are being sorted out to mitigate the impact of the current chaos.

    The debate will need to start with a public debate about the amount spent on health in the UK as a proportion of GDP, in order to ensure that 'affordability' for the NHS is decided by the population at large with a clear view of the wider political and other factors and choices that help to define 'affordability' and the 'limited' funding for the NHS.

    The King's Fund and the Nuffield Trust have already provided sufficient dispassionate and well-researched data and analysis to inform many of these issues and help start the process. However, unless the brakes are put on the current inchoate jumble of proposals and policies, the impact on the NHS and the nation's health will take years to unravel and will be the cause of much unnecessary human suffering.

    Sincerely yours,

    Dr Christopher Wood (with over 30 years service in the NHS, nearly 20 of those as a Hospital Consultant)

     

     

     

     

  • Overview of patient and public understanding of the NHS "Five Year Forward View" and the NW London STP

    By His Honour Judge Peter Latham (retired)

    13 September 2016

    His Honour Peter Latham is Chair of Willesden Locality PPG and a member of the CCG EDEN Committee. He is a retired barrister with a specialist medico/legal practice and a retired Circuit Judge who sat at central and north London county courts including Willesden. He has lived in and been an NHS GP patient in Willesden for over 45 years.

     

     

    1. Patients and public cannot reach conclusions about the overall merits of the NHSE Five Year Forward View NW London STP because the draft dated 30 June 2016 appears to be deliberately obscure and incomplete about key details: either because they have not yet been formulated, or to make public opposition difficult during the transformation. The main NHS Project Initiation Document (PID), the Business Case, Management Consultants' reports and other key documents have not been disclosed even to the small number of 'lay partner' patient representatives hand-picked to attend some NW London Collaboration of CCGs meetings.

    2. From a patient perspective from the time the NHS Act 1946 came into force on 5 July 1948 the model has changed remarkably little. Most NHS medical care is still obtained by visiting your GP who will refer you to hospital for specialist investigation and treatment when required. Most of the GP practices remain the same, and the hospitals mostly remain the same. Social care has been provided separately by the local council. The multiple NHS administrative shake-ups of Health Authorities etc. have barely been noticed by patients including the Health and Social Care 2012 Act's introduction of CCGs. The STP proposes the most radical changes to this structure since 1948 that appear to introduce a model that most GP's and almost all patients still do not understand and are mostly unaware of.

    3. The NHS Five Year Forward View and STP projects are major 'top down' policies that are clearly mostly focussed on reducing NHS costs to keep within a Government cost cap fixed by HM Treasury. It is an old joke that is funny because of its element of truth that the NHS is the last great Stalinist institution in Europe. The UK allocates about 9% of its GDP on the NHS where other developed counties obtain better outcomes as measured by survival rates for serious conditions on allocating about 11 % of GDP to healthcare. It is arguable that this is really the main problem.

    4. In seeking to transfer so much healthcare out of hospital into community services the NHSE Five Year Forward View and the STPs are swimming against the international tide of healthcare improvements obtained with new sophisticated investigations and treatments provided by increased hospital doctor specialisation. In 1948 hospital Consultants were mostly general surgeons and general physicians. Initially antibiotics delivered the great improvement in medical care. All over the world the secondary hospital landscape has changed out all recognition since 1948 with increased medical and surgical specialisation and sub-specialisation for both investigations and treatment. Granted, many special investigations such as resting ECG can now be carried out by the new generation of hospital trained GPs with machines that have become much smaller and cheaper. Many routine low-tech mass numbers hospital services such as diabetic clinics can be transferred out of of hospital to be provided in the community. It remains to be seen whether they will prove to be cheaper and more efficient. But it appears that the STP attempts to swing the pendulum too far.

    5. It is not clear what will happen to the traditional GP family doctor practice model under the STP. It has become fashionable amongst NHE executives and their business consultants to decry them as a 'cottage industry'. The core of structural change is the new Multi-speciality Community Provider (MCP) contract for over-arching primary care with 'intermediate' out-of hospital and new primary services provided at 'hubs' leading on to full Accountable Care Partnerships (ACP) by 2021. It is said that primary care will be delivered through networks, federations of practices, or super-practices working with partners. The NHS England publication 'Multi-specialty community provider (MCP) emerging care model and contract framework' published July 2016 at page 30 says:

    ”New models of accountable care provision will move the boundary between what is commissioning and what is provision. We are working with a number of MCP vanguards to establish which activities must always remain with the CCG (or other commissioners), and which activities an MCP would perform under contract.”

    6. No detail is provided of how MCPs and ACPs will work - or how they will affect the traditional NHS GP practice delivered by SMS and APMS contracts. No experience from any existing whole population state-funded model is identified. The King's Fund March 2014 paper on Accountable Care Organisations in the US and England pointed out that the US models on which this concept is based are all much smaller and with different sources of funding. It is arguable that the STP disregards the excellent value for that we obtain from our traditional GP practices - for all their faults – for about 9% of the total NHS budget. It appears that in these new over-arching structures the traditional SMS GP contract may be left to wither on the vine by re-allocating funding to make them unviable. It is arguable that a better, more achievable, and more cost effective solution could be obtained by simply putting more resources into the existing GP network. If the current STP is implemented in full it seems likely that in 10 years time the pendulum will swing again back on a new slogan 'Small is beautiful'.

    7. The STP integrated medical and social care proposals depend heavily on the individual patient information sharing duties in the Health and Social Care (Safety and Quality) Act 2015. NW London and Brent CCG posters have have already been put up in Brent GP practices. No date is stated for the start of the sharing, nor exactly what will be shared, nor with whom. The section on Integrated Care Record says:

    "The Integrated Care Record (ICR) will display a range of test results, medication, allergies and social or mental health information relevant to the care of that person. Information around people's cost of care may also be included as part of the ICR. It is expected that this will be a key enabler in improving decision making when determining people's care needs."

    The last sentence is disingenuous. When it speaks of 'care needs' it clearly does not mean investigation and treatment 'needs': it means cost-controlled investigation and treatment 'allocation'. Under the heading Service User Consent the poster says that "people are able to opt out of their information being shared at any point...." and goes on to claim that if you decide to opt out later the ICR will be re-created. We can find nothing in legislation that authorises this 'opt-out' model of purported implied consent by default. This appears to be an attempt to re-introduce the opt-out model on which the 'Care.data' failed. Doctors' misgivings about this 'opt-out' model are revealed by Brent CCG providing them with an indemnity against claims for breach of their doctor-patient duty of confidentiality, and penalties under the Data Protection Act 1998. But the indemnity will not protect them against strengthened criminal responsibility under this Act. Nor will it protect them on misconduct complaints to the GMC disciplinary committee for breach of their common law duty of patient confidentiality.

    8. An important under-pinning for the financial viability of the STP's ACP and MCP model is the choke being introduced on GP clinical independence on hospital referrals and patient choice. The new Brent Referrals Optimisation Service that started on 1 September 2016 attempts to impose a CCG-supervised clinical triage service through its provider Bexley Health Limited on all NHS GP patient referrals designed to steer all patients into cheaper relevant out-of-hospital community healthcare services where available. The patient information letters produced for this service do not inform patients about their NHS statutory and NHS contractual patient choice rights, and Brent CCG have rejected public consultation proposals that they be inserted. Without this under-pinning the CCG will not be able to assure providers that they will reliably deliver enough patients for their services to be viable financially.

    9. There are very big risks with pushing ahead so fast with such a big programme of new models that are as yet untried and untested, since the few Vanguard pilots have only recently started. It is arguably reckless to put so much into new models that have foreseeable but unquantifiable risks of financial insolvency and bankruptcy liquidations when all the responsibility would fall back onto the NHS for expensive crisis management. It appears unrealistic to think that the whole NW London Collaboration STP project can be delivered by 2020/21. Its parallel Shaping a Healthier Future programme (SaHF) became stalled when the capital costs of about £1 billion required to deliver it became clear. When Brent CCG, on commencing in 2014, tried to develop an ambitious Planned Care project for about 13 medical speciality 'out of hospital' community services this project also stalled on attempting to introduce an integrated multi-disciplinary MSK (musculo-skeletal) service as the third of the new services. Both these big projects have remained stalled.

    10. The STP proposes to transfer a large part of hospital care into community services commissioned by the CCGs through the new vehicle of one of the variants of the new Accountable Care Provider (ACP) models by the new Multi-speciality Community Provider (MCP) contract model. This appears to seriously weaken the statutory CCG governance model of the Health and Social Care Act 2016 just by administrative action without fresh statutory approval. The 2012 Act created major conflict of interest problems with GP members of the local CCG involved in providers tendering for contracts from the CCG. This conflict of interest is likely to be greatly increased with GPs encouraged by the STP to form large ACP-variant healthcare providers to tender for £multi-million community healthcare contracts from themselves wearing their CCG hats. Large public money scandals are predictable.

    11. It appears that there are major financial implications of the STP move to ACP and MCP that have not been disclosed. Why go to all the trouble of setting up the Accountable Care Partnership (ACP) and Multi-speciality Community Provider (MCP) structures ? It now appears that again this may be largely about an attempt to get big future financial liabilities for pensions and clinical negligence off the NHS books. All large employers are desperately seeking advice from lawyers and management consultants on how to do these things. It seems that the NHS now wants to do hat Sir Philip Green did for BHS pensions. Similarly with clinical negligence liability. The NHS clinical negligence compensation bill in 2015 was about £4 billion - up £1 billion on the previous year. It is very difficult to investigate these queries through the obscure finance sections of the NW London Collaboration draft STP dated 30 June 2016. It was the same story with the ill-fated PFI initiatives. When such liabilities are transferred to new contractors they inevitably have to increase their tender figure and add a safety margin. It is foreseeable that commercial professional liability insurers will quote very high premiums to cover such alarge and fast growing contingent liabilities.

    12. A great deal of the projected cost savings of the STP are highly suspect as unreliable and unrealistic. Many of the cost savings are projected from progammes to reduce long-lasting and increasing obstinately intractable conditions such as obesity and Type ll diabetes, and from preventive medicine projects. The results of the NHS accounting formulae for booking such projected savings are highly speculative. You can insert almost any figure you wish.

    13. The problems of rushing through such large structural changes are likely to be aggravated by the increasing loss of confidence of the clinical workforce: as evidenced by the current industrial action by the junior doctors. For 68 years the NHS has traded on exploiting the vocational commitment of its doctors. The NHS appears to be losing much of this goodwill.

    14. On 12 September 2016 the King's Fund Chief Executive Chris Ham published a commentary with muted criticism of what has been published to date about the STPs including his analysis that the ACP and MCP model is swimming against the statutory set-up tide of the Health and Social Care Act 2012 with CCGs of local GPs made responsible for promoting competition within the NHS healthcare economy - http://www.kingsfund.org.uk/blog/2016/09/stp-leaders-challenges-care-budgets?utm_source=linkedin&utm_medium=social&utm_term=thekingsfund.

    15. It is very unfortunate that there is so little informed public scrutiny of the STP. Because the changes are being introduced entirely by administrative action there have been none of the automatic debates in Parliament and committee scrutiny that would accompany primary legislation. The BMA and doctors' Royal Colleges have remained strangely silent about the STP. There is just no equivalent of academic and expert peer-review scrutiny. It is being left to a very few concerned individuals to provide devil's advocate scrutiny of the proposals from the limited and late information released, and to identify weaknesses and to voice public concern. In the fable it was only the naive little boy who dared contradict the court conspiracy of silence and speak out saying that the Emperor had no clothes.

    16. A major criticism of the NW London STP process is the failure to publish enough of the plans to enable the public to understand the radical changes afoot for delivery of NHS primary care. In the last analysis the default to be criticised is that by the local Clinical Commissioning Groups. Under section 14Z2 of the National Health Service Act 2006 (as amended by section 26 of the Health and Social Care Act 2012) the statutory duty remains with the CCG to involve and consult its patients and public in the planning of its commissioning arrangements and in the development and consideration of its proposals for changes in its commissioning arrangements where they would have an impact on the manner or in the range of health services available to them.

     

     

  • North Central London STP: Plan to save local NHS finances ‘not yet found’, health chief admits

    The man overseeing a radical plan to ward off a funding crisis in north London’s health services has said a solution has “not yet been found”. David Stout, director of the "North Central London Sustainability and Transformation Plan" (STP), today told Islington councillors – along with others from Camden, Haringey, Barnet and Enfield – that he did not know how to ward off an impending £876 million health budget deficit.

  • STPs risk 'starving services of resources' says BMA

    by Keith Cooper www.BMA.org.uk  (https://www.bma.org.uk/news/2016/november/discovery-of-cut-plans-adds-pressure-to-fix-stps)

     

    Ministers have been urged to sort out the ‘mess’ of the NHS STPs (sustainability and transformation plans) after BMA analysis found they must slash £22bn from health and social care costs in five years.

    The savings figures were found in papers from 42 of the 44 areas across England.

    Officials in each area have been asked by NHS England to predict the financial holes STPs face in their budgets in 2021 and set out how they can close them.

    A separate survey by the BMA reveals that most doctors (64 per cent) had not been consulted on STPs, despite many plans requiring significant changes to services to balance their books.

    BMA council chair Dr Mark Porter said he had serious concerns about the ‘impossible’ scale of savings demanded by STPs by an ‘unrealistic Government’ which had promised no further funding.

  • Don't Slash, Trash and Privatise our NHS

     

     

  • NHS hospitals suffer from chronic bed shortage, surgeons say

    Royal College of Surgeons calls for rethink after figures show 89% of beds are full overnight for fourth quarter in a row

    The Royal College of Surgeons has warned of a chronic shortage of NHS hospital beds in England, after occupancy rates for overnight stays topped 89% for a fourth successive quarter.

    The maximum occupancy rate for ensuring patients are well looked after and not exposed to health risks is considered to be 85%, a figure that has not been achieved since NHS England began publishing statistics in 2010.

    From July to September this year the percentage of beds occupied in wards open overnight was 89.1%, compared with 87% in the same period last year. That was the last time it was below 89%.

    The RCS said the figures, published on Thursday, made for alarming reading and indicated a failure to cope with the increasing number of older patients in hospital.

  • Half of London's doctors haven't heard of STPs, BMA survey finds

     BMA press release, 01 November 2016

    More than half of doctors in London have not heard of sustainability and transformation plans (STPs) due to be published by the end of this year, a BMA survey shows.

    Of the 615 consultants and GPs surveyed, a majority (59 per cent)  said they had not heard of STPs - five year plans detailing how areas will work together to implement NHS England’s Five Year Forward View.

    The BMA asked GPs and consultants in London about their involvement in the creation of the four STPs footprints for the city, made up of clinical commissioning groups (CCGs), local authorities, NHS trusts and other health and care organisations. 

    When asked if doctors felt they could influence decisions made by their clinical commissioning group (CCG), more than four in five (82 per cent) said they did not feel they could, even though CCGs are membership organisations.

  • Public meeting on Tuesday 29th November, 7pm, at Town Hall: H&F rejects NHS "STP" plans to downgrade Charing Cross and Ealing

    Please come to a public meeting at 7pm at Hammersmith Town Hall on Tuesday 29th November to hear and discuss the response of H&F Council to the latest proposals for cuts in health services in NW London called the "Sustainability and Transformation Plan" or STP.

    The plan involves a complete upheaval of every service, from community care to mental health services to GPs to A&E departments to acute beds in the major hospitals, in NW London. The central aim of the plan is, we are told, to save money: a staggering £1.3 billion over the period to April 2021.

    Hammersmith and Fulham Council strongly opposes the STP and has voiced its opposition to the NHS bodies concerned.

  • Join the protest at Imperial NHS Trust AGM 14th Sept 2016

     

  • STPs will let in more private sector companies as the NHS is stripped of funds

     

     

    Letter to the Guardian from John Furse and others, 38 Degrees Chelsea and Fulham

    We’re disturbed by David Babbs’s article (Politicians have failed the NHS. We need people power to save it, 26 August). The 38 Degrees report on NHS “Sustainability and Transformation Plans” to which he refers doesn’t point to what’s behind NHS England’s carrot-and-stick strategy.

    By offering additional funding for NHS commissioners who satisfactorily reduce their deficits and by threatening punitive “special measures” for those who don’t, the STPs will serve private sector interests. NHS cuts to reduce deficits will mean the NHS, and the public, having to seek more services from the private sector. More public money will benefit private companies whose services cost far more than a publicly funded, publicly run NHS. Less accessible services and longer waiting times will push the public to pay for private health insurance.

    Babbs omits to mention US influence in NHS restructuring, which Jeremy Hunt has acknowledged. Major US consultancies and healthcare corporations like McKinsey and UnitedHealth are heavily involved. But he confirms that 38 Degrees commissioned Incisive Health, lobbyists for Virgin Healthcare and the privatisers’ NHS Partners Network, to produce its crowdfunded report. It’s not surprising it glosses over what the STPs prefigure – the replacement of an NHS once recognised as world leading in cost-effective public healthcare by a privatised system whose providers’ financial interests will have undue sway. As members of 38 Degrees, we think it’s vital that it isn’t seen as an NHS privatisers’ tool.


    John Furse,Barbara Beese, Julia Campbell, Verite Reily Collins, Jim Grealy, Merril Hammer, Karl Hevera, Ian Irvine, Tina Mackenzie, Craig Nicol, John Ralph, Linda Robinson, Teresa Schaefer, Heinz Schumi, Margaret Spector, Alexandra Veres, Martin Woodford
    38 Degrees Chelsea and Fulham Group

  • This is the biggest change to the NHS you've never heard of: "STP"s

    The NHS has lost over 50 percent of its bed capacity in the past 25 years. Our bed to population ratios are now below Eastern European countries. Further hospital closures will simply be disastrous.

     

    The government's Sustainability & Transformation Plans (STP) have been shrouded in secrecy. Despite being the biggest change to the NHS since the Health & Social Care Act 2012, they will not be voted on in parliament.

    So what exactly are the STPs? The NHS will be divided up into 44 footprints, but you need a glossary to translate these terms. Sustainability means cuts. This is part of the drive towards £22bn in cuts by 2020 – bearing in mind that we've already had £15bn in NHS cuts in the last parliament generating a manufactured crisis. Cuts mean a massive programme of hospital closures across the country and it will also lead to mergers and permanently selling off the NHS estate of land and assets.

    The bogus narrative around unsustainability and unaffordability has been spun by the private healthcare and insurance industry, captured politicians and the media. In truth, we spend much less on healthcare than other advanced economies.

    In order for these footprints to receive funds, there are strings attached. The footprints will have to sign up to transformation, which basically means privatisation. The footprints will have to adopt unproven models of care.

    The bigger picture here is integrated healthcare. It sounds great but it's imported from the US. The NHS five year plan – the Five Year Forward View – specifically states that the NHS should emulate US style integrated or accountable care. Integrated care organisations are springing up all over the place.

    This is all being sold as care in the community, but there are no extra resources for GP and community services.

    In fact, we already have a major bed crisis. The NHS has lost over 50 per cent of its bed capacity in the past 25 years. Our bed to population ratios are now below Eastern European countries. Further hospital closures will simply be disastrous.

  • STOP the new plans to dismantle our NHS

     

    Please sign the 38Degrees petition HERE

    To: Jeremy Hunt, Secretary of State for Health and Simon Stevens, CEO NHS England

    STOP the destruction of our NHS. Call a halt to the Sustainability and Transformation Plans NOW

    Why is this important?

    This is the biggest attack on the NHS you've never heard of.