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Issue: 39 <\/b><\/p>\n
August 2016<\/b><\/p>\n
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This occasional newsletter is researched, written and edited by a group of concerned residents in Ealing, West London who want to preserve our NHS. We view the wholesale engagement of private, for-profit healthcare service suppliers as unnecessary, profligate and dangerous. Process improvement is what is needed in our NHS \u2013 not revolution.<\/span><\/p>\n <\/p>\n The Secret Planning of Healthcare and Social Care Services:<\/b><\/p>\n The Sustainability and Transformation Plan (STP):<\/b><\/p>\n An Update<\/b><\/p>\n At the 6 July 2016 Ealing Clinical Commissioning Group (ECCG) public meeting hard copies of nine NW London STP slides were handed out. In December 2015 NHS England announced that England would be divided up into 44 \u2018Footprints\u2019. Each Footprint (let\u2019s call them regions) would create a five year plan (an STP) for delivering cost cutting in the provision of healthcare services and social care services. Each region would pull together a supergroup of all its Local Authorities, NHS CCGs and NHS Trusts to work together collectively to create the plan. These supergroups meet in secret and have no Parliamentary mandate. <\/span><\/p>\n <\/p>\n As well as massive cost cutting, each of the 44 STPs must deliver healthcare services seven days a week. The number of Acute hospital beds must be reduced and more Acute care delivered in the home and in the community. All historic healthcare debts must be eliminated and healthcare services and social care services must be integrated. A fundamental flaw in trying to integrate healthcare and social care in England is that the former is free at the point of use and the latter is means tested.<\/span><\/p>\n <\/p>\n The deadline for submitting the first draft of the 44 STPs was 30 June 2016. However in typical NHS style this deadline was slipped in early June to October \/November 2016.<\/span><\/p>\n <\/p>\n Our region is North West London. Our STP supergroup numbers over 30 public bodies. On 5 April 2016 a summary version of our STP was created. An early draft dribbled out into the public domain in June. In April the debt target was \u00a31.1 billion. Now the debt to be cleared appears to be \u00a31.3 billion. On a pro rata basis this would mean an annual reduction in healthcare and social care spend in Ealing of \u00a3160 million. In order to comprehend the difficulty of meeting this cost cutting target, let\u2019s look not for the first time at the 2012 NHS NW London \u2018Shaping a Healthier Future\u2019 plan (SaHF). SaHF\u2019s cost saving target was 4% per year. So by now SaHF should have a saved over \u00a3400 million on the NHS NW London costs. Not once over the last three years has the SaHF brotherhood announced any savings achieved whatsoever.<\/span><\/p>\n <\/p>\n I can find no reference in any of the April or July NW London STP drafts about the projected population increase and how this has been factored into the plan. ONS\/GLA figures calculate a current population of 2,093,972. By 2022 they predict it will have risen to 2,206,451 \u2013 a rise of 112, 479 people. This equates to adding the population of a city the size of Carlisle or Worcester to our regional population. The population increase for Ealing alone is just under 20,000.<\/span><\/p>\n <\/p>\n Bed Losses: Changing Numbers<\/b><\/p>\n Bed losses are on the agenda. In a 15 April 2016 STP document it states the target bed loss is 500 Acute beds. In a 27 May 2016 STP document it states a bed loss of 592. However on 1 June 2016 Carolyn Downs boss of Brent Council and one of the NW London STP hotshots said that the closure of 500 beds target had been dropped.<\/span><\/p>\n <\/p>\n Carolyn Downs is the Local Authority (LA) STP lead for all the eight LAs in NW London. She also said that the three guiding principles of the NW London STP were 1) prevention 2) integration of health and social care and 3) innovation via technology. She voiced LA concerns about closure of Acute beds when alternative community provision was not in place. Also LAs are worried about funding the social care aspects of the STP mandated requirements.<\/span><\/p>\n <\/p>\n Net savings apparently total \u00a3328 million This presumably must be annual savings for year one. Apparently \u00a3208.9 million will be saved by \u2018improving consistency in patient outcomes and experiences regardless of the day of the week that services are accessed\u2019. This clearly is where seven day working is implemented. But seven day working means employing more staff at the weekend and overnight or reducing service levels Monday through Friday. How over \u00a3200 million can be saved in this scenario \u2013 without massive service deterioration – is beyond my comprehension.<\/span><\/p>\n <\/p>\n Outsourcing Mental Health?<\/b><\/p>\n Are the STPs being set up to fail so that the private health companies (\u2018the cavalry\u2019) can then charge in and rescue our healthcare and social care services? Well, perhaps not. The small print shows us that the cavalry are actually being planned into the STP. Nestling inside \u2018Delivery Area 4: Improving outcomes for children and adults with mental health needs\u2019 (net savings of \u00a311.8 million) is \u2018implement accountable care partnerships\u2019(ACPs). The ACP idea has been around for a while in the NHS. It is England\u2019s version of the American Accountable Care Organisation which first emerged 10 years ago. (ACO) ACPs are a vehicle for introducing private care companies into the delivery of public care services. \u00a0A contract is drawn up with often private care providers, Primary, Acute and social care providers to provide all care for a given population for a defined (long!) period of time. Very often there are tight performance parameters and financial incentives in place when targets are met. The jury is still out in America as to whether ACOs are effective or even cost-effective. Critics of the ACO\/ACP approach see them as a means of destroying single payer national care systems. . <\/span><\/p>\n <\/p>\n There are yet again scant details on social care savings or initiatives. Nothing on social workers, personal care, protection or social support services to children and adults with needs arising from illness, old age or poverty. There are clearly planned changes on how the total spend cake will be sliced in 2020\/21 compared with 2015\/16. However even if, for example the slice for \u2018Community\u2019 rises from 9% to 13% there may well be less cash This is because \u00a0the total cake is just over \u00a34 billion now but will be less than \u00a33 billion in 2020\/21. Astonishingly there is no slice of the total spend cake labeled \u2018Social Care\u2019 or even \u2018Social Care and Healthcare Integration\u2019.<\/span><\/p>\n <\/p>\n On the mental health front the slice of the cake will stay at the current 8% of total spend in 2020\/21. This will represent a serious annual drop in real cash terms of some \u00a380 million. On a pro rata basis that would cut the annual mental health spend in Ealing by \u00a310 million. There is a quite incredible projection about how there will be a 1% fall in serious and long term mental health needs over the next five years. I can find no clinical or research data to back up this claim.<\/span><\/p>\n <\/p>\n The plan for addressing social isolation is amazingly \u2018Address Social Isolation\u2019. This really is pathetic. In \u2018Socially Excluded Groups\u2019 the only data – and partial data at that -concerns rough sleepers. If the STP creators think rough sleepers are the only socially excluded people they are the wrong folks to be creating my STP.<\/span><\/p>\n <\/p>\n In the plan delivery section it states \u2018\u2026delivery to ensure it (the STP) sustains investment on the things that keep people healthy and out of hospital\u2019. Well blow me down with a feather \u2026isn\u2019t that what the NHS was created for in 1948? Also in this section we find that at least 178 NHS and Local Authority staff in north west London are working on our STP. However the number could be over 200. Nationally there might well be over 8,000 paid public servants working on the 44 STPs as well as many \u00a3millions being spent on management consultants.<\/span><\/p>\n <\/p>\n There\u2019s reference to \u2018joint governance\u2019 and \u2018joint accountability\u2019. This is so much nonsense. I keep meeting STP \/SaHF staff who tell me that they are being paid and employed by both the Local Authority<\/span> and<\/span> the NHS. This sends me berserk. You can only have one boss. You can only be accountable to one bunch of shareholders and one organisation.<\/span><\/p>\n <\/p>\n Multi-Speciality Community Provider: The Outsourcing Vehicle<\/b><\/p>\n On 22 July another public NW London STP event took place. Labelled as a workshop so many residents asked questions that the workshop format was abandoned. Allegedly a NW London STP public event will take place in Ealing Town Hall in September or October 2016. There are no explicit plans to involve the local Healthwatch organisations in any NW London STP plan making or public engagement. More emerged on ACPs (see above) and on them being \u2018delivered through Multi-Speciality Community Providers (MCPs). I first referred to these MCPs in May 2016 when discussing Devo-Manc Health (in Manchester). The scary idea emerging from the jargon littered verbiage is that traditional GP surgeries might well be closed down. They would be replaced by MCPs \/\u2019superhubs\u2019\/\u2019networks with shared infrastructure\u2019 which will \u2013 using the GP surgery patient lists – \u2018provide\u2026the full breadth of services \u2026.including primary medicine and community services\u2019. How this will threaten or destroy the traditional GP surgery is unclear. However in Brent, all the GPs have joined a newly created limited company. It\u2019s no surprise that the directors of that company are GPs who serve on the Brent CCG Governing Body.<\/span><\/p>\n <\/p>\n NW London STP, following the lead of the monster STPs in Manchester and Liverpool, wants a devolved budget. A recent Localis survey says 78% of NHS and Local Authority bosses want this. New London Mayor Sadiq Khan says he wants it for a London STP. However devolving health and social care could create a patchwork quilt of differing approaches and arrangements. It could wreck the NHS as a consistent, universal healthcare service. To give, as some have suggested, tax raising powers to the 44 unelected STP cabals \u2013 even with the blessing of Parliament – would destroy this country as a representative democracy.<\/span><\/p>\n <\/p>\n Believe me STP will end in tears \u2013 in fact it\u2019s starting in tears. Rumours abound that in my region two of the Local Authorities (LAs) have refused to \u2018sign off\u2019 on the latest draft STP. They were recently given a two page STP summary to sign their names to. The two LA bosses refused, saying no-one had showed them the latest full draft. They were then shown the 51 pages of draft version 39 and given just three hours to peruse and sign. Again they refused. NW London STP bosses then told the two LAs that they would \u2018take money away from community health services for local people\u2019. The two LAs are the London Borough of Hammersmith & Fulham and the London Borough of Ealing \u2013 the areas still most threatened by Major Hospital closures under the 2012 SaHF declaration.<\/span><\/p>\n <\/p>\n The Judicial Review Option<\/b><\/p>\n