Huge new cuts to our hospitals from October

At their August 11th meeting (2pm, Shay Stadium, Halifax), Calderdale Clinical Commissioning Group Governing Body will face truly chilling facts about the effects of so-called Sustainability and Transformation Plans, which will start to be carried out in October/November this year.

If you think this is all a VERY BAD IDEA, please tell your MP and Councillors. And get in touch with Calderdale and 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) force NHS commissioners, hospitals and GPs to 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.

The Chief Officer’s Report to the Calderdale CCG Governing Body sketches information about implementation of the STPs, that NHS England and NHS Improvement recently snuck out after Parliament went on holiday, so avoiding scrutiny by MPs.

STPs are being drawn up in conditions of secrecy imposed by NHS England – as one of their staff, 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.”

Despite the secrecy, the huge scale, rapid pace and punitive nature of the cuts and sell offs are now becoming much clearer.

Huge cuts to hospital Trust spending

NHS England’s and NHS Improvement’s STP document Strengthening Financial Accountability 2016-17 shows that Calderdale and Huddersfield hospitals Trust must more than halve the planned deficit this financial year – from £40.5m (only achievable after making £14m efficiency cuts), to a “control total” deficit of £16.153m.

The Trust needed to make £14m efficiency cuts to keep the deficit at £40.5m – so what more cuts is it going to have to make to bring the deficit down to less than half that amount? How the hell is it going to do it?

In return for keeping the deficit within the “control total”, the hospitals Trust is to receive  £11.3m Sustainability and Transformation Funding from NHS England in 2016-17. This is not the only condition attached to the ST Funding; there are others, and penalties for not meeting them are dire.

Worse, it looks as if at least one of the conditions is unachievable.

CHFT’s Sustainability and Transformation Funding is conditional on a recovery plan showing it will break even “within a reasonable timeframe”

To receive the Sustainability and Transformation Funding, Calderdale & Huddersfield hospitals Trust (CHFT)  must have a recovery plan in place that shows when they will break even, within a reasonable timeframe.

But the hospital cuts Pre consultation Business Case shows CHFT in deficit for at least the next decade; and no one during the consultation drop ins was able to say at what point beyond 2026 CHFT might break even.

So does this Sustainability and Transformation Funding condition means that all the financial plans that underpin the proposed hospital cuts and changes go out the window?

The 11th September report to the Governing Body on the hospital cuts and care closer to home consultation deliberation  says NOWT about this.

Safe staffing goes out the window

This “control total”  threatens safe staffing levels, by cutting £2.37m off planned paybill growth from October.

How will safe staffing levels be maintained in our hospitals under NHSE’s and NHSI’s knife? What staff that CHFT needs will be dispensed with? How will that affect both staff and patient safety?

Our hospitals Trust must “share” “clinically and financially unsustainable services” with other hospitals, as well as back office (admin) and pathology services

West Yorkshire and Harrogate STP footprint lead (Rob Webster) has told CHFT and other hospital trusts in the “footprint” to produce a rapid summary of the opportunities for consolidation of back office and pathology services and send it to NHSI.STPFootprintResponses@nhs.net by 31 July.

But CHFT admin staff say there is nothing left to cut, in terms of back office staff and support.

Consolidating “clinically and financially unsustainable” services is to be done, for instance, where there is insufficient capacity and/or a high reliance of temporary and agency staff – with the same requirement for CHFT to produce a summary of the “opportunities” by 31 July.

What services are CHFT proposing to cut and send patients to other hospitals for?

By the end of August, NHSI will provide a business template for STPs to help them assemble their business case for consolidation by end of September 2016.

Why aren’t we being consulted about this? It is all clearly a significant service change.

NHS England  and NHS Improvement are setting up Trusts to fail.

CHFT is not alone in its “control total” dilemma. One hospital trust finance director told the House of Commons Public Accounts Committee in February this year:

“…the regulator’s control total is for a deficit some £5-£10 million lower than what the Board considers it can realistically, and more importantly, safely achieve…The regulators have provided no explanation as to how they arrived at their control total for my Trust…I have already been in contact with the FDs of almost a dozen other acute trusts, all of whom have control total gaps in their draft 2016/17 plans of between £5m and £20m. My real concern is that Boards are being pressured into accepting a 2016/17 control total that they do not yet have plans to achieve.”

It is clear why NHS Improvement and NHS England are setting up Trusts to fail, once you look at the penalties for failure (see below, CHFT’s “agreement with NHSI”), and at the Autumn 2015 Spending Review’s commitment to increasing private sector provision of NHS services. (This commitment is repeated in the NHSI Business Plan 2016/17 – one of the two documents NHSI and NHSE have snuck out since Parliament went on holiday ).

CHFT’s “agreement with NHSI”

Not mentioned in Matt Walsh’s report – but in the Minutes of one of the Calderdale CCG Committees – discussions are taking place with NHS England:

“in relation to the impact of the CHFT agreement with NHSI which enables CHFT to access Sustainability and Transformation funding for 16-17.”

I have asked the Governing Body meeting a question about what the content of these discussions are.

Update: The Calderdale Clinical Commissioning Group Chief Officer, Matt Walsh, told me that for specifics in relation to the conversation between NHS Improvement,  NHS England and CHFT, my question would be better directed to them, but that Calderdale CCG’s position in is that the CCG will uphold NHS constitutional standards, but will report more throughout year.

I’m assuming the CHFT “agreement” with NHSI refers to the special measures that NHSI – formerly Monitor – has placed on CHFT because of its deficit.

In the NHSE/NHSI “Strengthening Financial performance 2016-17” document, Annex H is “Guidance on financial special measures for NHS providers.”

This Guidance says (12) that when a provider is in financial special measures, NHSI will provide so-called mandated support. This includes things like:

  • imposed changes to the Trust Board,
  • Dept of Health financing provided in exchange for assets, eg transfer of ownership of land, rather than loans,
  • accelerated proposals on service consolidation and closure, workforce review etc – by end of Month 1.

According to this Guidance, if the provider doesn’t get itself out of financial special measures on time, NHSI can require the provider to “enter a foundation group” or NHSI can

“initiate a wider local health economy process if the issues are structural.”

Who knows what this means? But it sounds like what CHFT Chief Exec Owen Williams was talking about at hospital cuts public consultation meetings, when he said that if CHFT didn’t make the proposed cuts and changes, NHS Improvement could come in and make them a lot worse..

Another feature of the STP is that national fines have been replaced with Trust-specific incentives linked to “performance improvements” that will “kickstart a multi-year recovery and redesign of A&E & elective care.” This is all about meeting the NHS constitution standards, which CHFT – along with most other hospitals – currently doesn’t.

“Scary, depressing, management speak bollocks” about future of primary care

The STPs don’t just affect hospitals. GPs have warned on social media that STP proposals put forward to Health and Wellbeing Boards mention primary care being run by accountable care organisations – a kind of public/private partnership for running services as well as constructing buildings – and bang on about “GPs at scale” to offer extended hours and hubs and “lots of shiny new pathways – scary, depressing, management speak bollocks”. Pulse reports that GPs are being denied sight of the STP plans for their areas.

The Calderdale CCG Governing Body meeting on 11th August is to hear about some how this STP “management speak bollocks” about primary care is being put into action. I will do a separate post on this.

If you think this is all a VERY BAD IDEA, please tell your MP and Councillors. And get in touch with Calderdale and 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.

Information and papers for the 11 August 2016 Calderdale CCG Governing Body meeting are online here.

The Chief Officer’s Report is downloadable here.