Does Calderdale Health & Wellbeing Board know what it’s doing with NHS Sustainability and Transformation Plans?

On 25 August, Calderdale Health and Wellbeing Board meeting discussed 3 documents about Sustainability and Transformation Plans, in order to decide whether to accept the following recommendations that the Health and Wellbeing Board had previously made at a private, un-minuted meeting with Calderdale Clinical Commissioning Group on 11th August – that the Health and Wellbeing should:

  • “own” Calderdale’s contribution to the West Yorkshire Sustainability and Transformation Plan
  • agree a Calderdale Plan at a future meeting
  • establish a Calderdale Transformation Board to oversee the work on the development of a Calderdale Plan and report to the Health and Wellbeing Board.

Six weeks after the Health and Wellbeing Board meeting – and only two weeks before the 21st October deadline for submitting the final version of the Sustainability and Transformation Plan to NHS England – Cllr Tim Swift sent answers to 15 of the 38 questions about these three documents, that I had emailed to the Health and Wellbeing Board just before its meeting.

In his email, Cllr Tim Swift said:

“The questions you tabled went well beyond what we would normal [sic] take as public questions, and many of them in my view need to be addressed to specific partners or organisations outside of Calderdale.”

Private Health and Wellbeing Board meetings are not minuted

Cllr Tim Swift’s answers include the information that private meetings of the Health and Wellbeing Board are not minuted – and that meetings of West Yorkshire Health and Wellbeing Board Chairs and Council Leaders are not held in public, nor are the minutes made public.

This holds good for the meeting of Health and Wellbeing Board Chairs and Council Leaders to discuss any collective view on the WYSTP before the final submission on October 21st.

Here are the other questions that Cllr Swift answered

1. How do Councillors square their duty to represent and fully inform the public, with NHS England’s statement that: “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.”?

You have placed a lot of store in various articles and emails on the comments apparently made at a meeting of the Shropshire Clinical Commissioning Group by one person from NHS England. It seems to me that NHS England have given very mixed messages about the initial stages of producing STPs which have been confusing and unhelpful. Hopefully there more recent guidance will clear things up.

I asked Rob Webster [ the West Yorkshire & Harrogate Footprint Sustainability & Transformation Plan leader] about this issue and his response was quite different –

“There is no secrecy I would say. We have good engagement across the whole of West Yorks, Healthwatch are engaged in the early development of plans and HWBBs briefed. Any changes will aim to deliver better care and should be co- designed with staff and patients. Nothing to consult on or publish yet but our aim is always to do this well and properly. Hence subsidiarity principle and keeping things local”

Calderdale HWB sees itself as the place where there will be public discussion of the local Sustainability and Transformation Plans.

NHS England has required that Sustainability and Transformation Plans are produced for 44 ‘footprints’ across England. Calderdale sits within the West Yorkshire and Harrogate footprint.

It is clear that NHS England is setting some top-down expectations and these include addressing a significant financial gap. This is a serious issue which will have a major impact on services and the way that they are organised.

As the Chair of Calderdale Health and Wellbeing Board I feel strongly that there should be public debate about this, which is why I ensured that it was discussed at the recent meeting of the Health and Wellbeing Board and why I will ensure it will be on the agenda at future meetings so that the public can hear the discussion. There is nothing secret about this.

At the Health and Wellbeing Board we agreed to prepare a Calderdale Plan that will address the local requirements of the STP but more importantly will be a shared and public statement of how we in Calderdale want health and social care services to change in order to meet the needs of Calderdale people.

2. Why did Councillors think it was ok to hold a private meeting with Calderdale Clinical Commissioning Group to discuss the development of Calderdale and West Yorkshire STPs?

The HWB has regularly held informal meetings since it was first formed. These have been used to make sure the different agencies and individuals involved fully understand the developing role of the Board, and to provide an opportunity to share as much understanding as we can about the different demands and issues facing them.

No decisions are taken in such sessions, and anything that requires a decision would always be reported formally to the HWB.

3. Where are the Minutes of that meeting?

We don’t preduce [sic] minutes of the informal HWB meetings.

4. Where are the minutes of previous Health and Wellbeing Board  Sustainability and Transformation Plan workshops in May and June?

See previous answer

5. What is the proposed Transformation Forum, who are its members, what is its reason for existence, who is it accountable to?

Terms of Reference and Membership for the Transformation Board and the Integrated Commissioning Board will be discussed at a future meeting of the HWB.

6. Did the Health and Wellbeing Board approve the West Yorkshire “checkpoint” Sustainability and Transformation Plan which was sent to NHS England on 30th June?

No, in June the CCG governing body delegated authority to a subgroup of the governing body to review the STP and Local Digital Roadmap. (chair, deputy chair, lay advisor and chief officer) No authority was granted to approve, because the submission was a checkpoint submission, not a final plan.

7. Who will be on the Integrated Commissioning Board, what is its statutory authority – if any – and who is it accountable to?

See above

[Paul Butcher, the Calderdale Council Director of Public Health, has tweeted that no joint board has so far been established but that a report on benefits, terms of reference & risks is to go to the Health and Wellbeing Board on October 27th

[The Calderdale CCG 30th June Finance and Performance Committee Minutes say that the local STP will lead to a review of existing arrangements such as the Vanguard Programme Board, the Care Closer to Home Board and the Better Care Fund Board, to bring them all together. Is this what the Integrated Commissioning Board will do? Or is this Integrated Commissioning Board just to formalise the joint CCG and CMBC commissioning for the services they buy through the Better Care Fund? These are questions for the 27 October HWB meeting]

8 .When & where is the one-off meeting of Health and Wellbeing Board Chairs and Council Leaders being held, to discuss any collective view on the WYSTP before final submission?  Will it be held in public? Will the Minutes be publicly available?

Meetings of Health and Wellbeing Board Chairs and Council Leaders are not held in public. The minutes are not made publicly available.

9. On page 6 of the STP & SIngle Plan for Calderdale Development, for the 11 Aug HWB development session, have the WY STP “big decisions” already been taken? 

slide-6

No. They are more like areas where big decisions will have to be taken.

10 How is the HWB going to make sure that governance and decision making processes on service and finances at scale across West Yorkshire will “maintain democratic legitimacy”?

Particularly since there is no statutory basis for West Yorkshire STP, which is being drawn up by organisations operating without any formal governance process. As of the June meeting of Calderdale Clinical Commissioning Group Governing Body, no formal agreements on the West Yorkshire STP governance had been agreed except for the Memorandum of Understanding.

The West Yorkshire STP Update (Appendix 2) says that all health partner organisations have needed to establish relationships and governance to augment their current statutory authority.  So what legal processes have been undertaken to augment organisations’ statutory authority? And if no legal processes have been carried out, how are these augmentations of organisations statutory authority lawful?

To add further evidence to support my question, a report by the Centre for Health & the Public Interest (CHPI) says,

“the whole [STP] process has a markedly extra-legal character.”

Through the the imposition of STPs, the government has effectively undone laws created by the Health and Social Care Act 2012, without bothering to go through Parliament. The CHPI says
“…the resulting decision-making is governed by no statutory rules: it is not clear who will be accountable for the results in terms of service provision, or the accompanying redeployments of public funds, or the conflicts of interest or the opportunities for fraud which the process is liable to generate…Who is participating in each ‘local health system’, who they represent, how they are reporting back, where a record can be found of the meetings held and the decisions reached – this information at least should surely be systematised and made public if the process is to be considered in any way democratic. Independent published evaluations are also needed of what the various new models of care have acheived in practice, in terms both of patient care and productivity gains.”

To recap and repeat the question: how can this STP process have any democratic legitimacy and how can the HWB make sure that it does?

That is a reasonable point which I think you need to take up with central government and with NHS England, as we in local government have been doing. Local councils across the country have been concerned that there was no formal role for local government, whether through HWBs or otherwise, and pressing [sic] for that to be changed. That is why we are reporting on the West Yorkshire STP process to the HWB, and it is why I have personally insisted that the five West Yorkshire leaders and chairs of HWBs should have an opportunity to comment on the West Yorkshire STP before it is submitted.

My understanding is that formally any proposal included within the STP would still need to be approved through existing governance structures, I.e. CCG governing bodies, Trust Boards, etc, which is why our focus in Calderdale now is to achieve a common understanding of what we have to do to deliver the best health and care possible within the resources available.

11. Since commissioning will operate with a single arrangement between local authorities and NHS clinical commissioning groups (CCGs), and CCGs will morph into accountable care systems, working with local GP groups, social care, voluntary groups, and larger community providers – will local authorities be part of the accountable care organisations or systems?

I’m not sure where it says all of this … if we move towards ‘accountable care systems’ then the shape and governance of those is something that is a matter of further decision making, not something that is currently fixed.

12. What is the point in the West Yorks Sustainability and Transformation Plan organisation working with Local Economic Partnerships?

The health and care system collectively is a major employer, and hence has major impacts on future skills and training needs. It also has a significant economic impact. Health and wellbeing and employment are closely linked and the impact of heatlh on economic well being and vice versa has not been sufficiently recognized to date.

13. Please do NOT accept the recommendations of the 11 August Health and Wellbeing Board private meeting. Instead, please immediately publish:

  • the West Yorkshire “checkpoint” Sustainability and Transformation Plan which was sent to NHS England on 30th June – why has it not been published already? NW London has published theirs.
  • the current draft of the Calderdale STP and
  • the current draft of the final West Yorkshire STP – the final version is due to go to NHS England in October
  • the financial information from NHSI that will inform the October West Yorkshire STP

AND immediately submit the Calderdale STP documents to scrutiny by the Adults Health & Social Care Scrutiny Panel and West Yorks & Harrogate STP to the the West Yorks joint scrutiny committee

This is not a question.

14. The West Yorkshire Sustainability and Transformation Plan update says “engagement around the emerging WYSTP will start with our local communities and workforce as priorities and plans are agreed collectively by our Boards.” – But isn’t engagement supposed to happen at a formative stage?

In my opinion plans as they develop should reflect what different organisations already know about public views through previous consultations, ongoing dialogue, etc.

15.  The Future slide shows community services and CHFT acute reconfiguration but these  have been out to public consultation and the Clinical Commissioning Groups have not decided on what to do in response to the public consultation – or so they would like us to believe. Isn’t this clear evidence that the Clinical Commissioning Groups have predetermined the outcome of the consultation?

future-slide

No. Whatever the decision of the CCG’s is will be built into the future plans. The current plans reflect the CCGs proposals (Matt to check)

Here are the questions about the STP documents the 25 August HWB discussed, that Cllr Tim Swift was unable to answer

16. What is the total amount of money in the Sustainability and Transformation Fund for the West Yorkshire & Harrogate STP footprint, how and where is it being allocated, with what conditions?

I have asked officers to try to get an answer on this from those responsible for the West Yorkshire level work.

17. How is the “significant and material impact of WY acute trusts working together” going to affect the Right Care Right Time Right Place hospital services clinical model?

I have asked officers to try to get an answer on this from those responsible for the West Yorkshire level work.

18.  On p 7 of the STP & SIngle Plan for Calderdale Development, for the 11 Aug HWB development session:

  • what is the Plan for Calderdale? – P 11 says 3 elements have already been developed – where are they?
  • what is the Healthy Place initiative?

To be answered

19. p 12 of the STP & SIngle Plan for Calderdale Development, for the 11 Aug HWB development session says there is clarity on health gap & plans to close it, finance gap and plans to close it and quality gap and plans to solve it. Where is this clear info?

To be answered

20.  The Calderdale Single Plan is due to be finished on 16 Sept. It includes “Big Decisions we are making” about community services & primary care (cc2h/MCP/ACOs) and hospital services (acute configuration, partnerships) – but these items have been put out to public consultation and the CCGs are not due to make decisions about how to proceed with them until 20 October. So what “big decisions” will go into the 16 Sept Calderdale STP?

To be answered

21. Calderdale STP says another “Big decision” is dialogue with our communities – so how are you going to do this if you won’t even publish the draft plan?

To be answered

22. What is the Advisory Board offering international intelligence to Calderdale?

I have asked officers to try to get an answer on this from those responsible for the West Yorkshire level work.

23. The West Yorkshire Sustainability and Transformation Plan update says health partner organisations have developed new ways of working with regulatory bodies. Why has this been necessary and what are the new ways of working with regulatory bodies?
I have asked officers to try to get an answer on this from those responsible for the West Yorkshire level work.

24. Please supply a complete list of the West Yorkshire Sustainability and Transformation Plan Leadership Team members and Clinical Forum Members.

I have asked officers to try to get an answer on this from those responsible for the West Yorkshire level work

25. What contribution to closing financial and care quality gaps are collaborative programes and local plans going to make?

I assume this will be clearer once the final proposals at West Yorkshire level are available

26. Who from Calderdale went to the 2 August 2016 Leadership Day meeting of the Clinical Forum and Leadership Team

I have asked officers to try to get an answer on this from those responsible for the West Yorkshire level work

27. When will the HWB see the WY STP finance template before it is sent to NHSE on 31 August?

I have asked officers to try to get an answer on this from those responsible for the West Yorkshire level work

28. Who from Calderdale will go to 6 September Leadership Day meeting of the Clinical Forum and Leadership Team? When will they have sight of the key content of West Yorkshire Sustainability & Transformation Plan & draft comms and engagement strategy, in order to be able to decide whether to approve them? When will the Health and Wellbeing Board as a whole and the public see these docs?

I have asked officers to try to get an answer on this from those responsible for the West Yorkshire level work

29. What does it mean for CHFT, when the West Yorks Sustainability and Transformation Plan core narrative says “Local hospitals will work together in a group to better meet the needs of local people. This includes sharing clinical staff and resources, and making hospital care local and accessible, with a centre in every major urban area.”? Is CHFT going to have to share clinical staff and resources with other Trusts? If so, which? And what is a local hospital? Is it something different from a District General Hospital? If so, how?

I have asked officers to try to get an answer on this from those responsible for the West Yorkshire level work

30. Isn’t it ridiculous to claim that “Citizens will be actively engaged in the planning, design, delivery and governance of care” when the STPs are being planned in secret, under NHS England’s orders?

See answers above

31. Why isn’t there a website and contact details for the West Yorkshire STP programme board?

I have asked officers to try to get an answer on this from those responsible for the West Yorkshire level work

32. Have MPs been consulted about these West Yorks and Calderdale STPs?

I have asked officers to try to get an answer on this from those responsible for the West Yorkshire level work

33. How is CHFT going to meet the “control total” condition of its S&T Plan funding – that it must more than halve its planned £40.5m deficit this financial year, to £16.53m? What is it going to have to cut, to make this possible?

This seems to me to be a question to be addressed to CHFT.

34. What is the substance of the discussions about this and other Sustainability &Transformation Plan conditions that have been going on between NHS Improvement, NHS England and CHFT?

I have asked officers to try to get an answer on this from those responsible for the West Yorkshire level work

35.  How is CHFT going to meet the condition of S&T funding, that it must have a recovery plan in place that shows when they will break even, within a reasonable timeframe?Because the Right Care Right Time Right Place pre-consultation business case shows CHFT in deficit for at least the next decade; and no one during the public consultation drop ins was able to say at what point beyond 2026 CHFT might break even.

Again, this is a question for CHFT to respond to.

36. How will Calderdale Clinical Commissioning Group meet its commitment to uphold NHS Constitutional standards, when Matt Walsh told the August Calderdale Clinical Commissioning Group Governing Body meeting that in the light of NHS England’s STP “financial reset” document, the CCG should start “having conversations now to secure the financial position this year”, through restricting treatments? Examples he gave were:

  • only allowing one outpatient follow-up after an elective operation
  • stopping prescriptions for self-limiting illnesses and for vitamins, food supplements and gluten-free products
  • cherry picking patients for medical and surgical interventions that are “procedures of limited clinical value” – although “cherry picking” is not his term – which was:  “selecting patients most likely to benefit”

This is a question you need to address to the CCG

37. What is on Calderdale CCG’s list of Procedures of Limited Clinical Value? We need to know – particularly since the Royal College of Surgeons has said that: ‘Procedures of Limited Clinical Value’ (PLCV) is a term NHS managers have applied to a range of elective surgical procedures that they no longer wish to fund…[B]ecause of the current financial restrictions,…many proven operations known to enhance health and improve quality of life have been included in this category, and hence are being denied to patients who need them.”

This is a question you need to address to the CCG#

38. What do Calderdale Local Medical Committee think about the introduction, via the Sustainability & Transformation Plan, of the  Multispeciality Community Provider emerging care models and contracts for GPs and community care, that open the door to privatisation of community and primary care – as is already happening elsewhere, with companies like Virgin Care gobbling up community health & social care contracts and private companies taking over GP contracts? Has Calderdale LMC been consulted?  Local Medical Committees in many parts of the country, including Yorkshire, have complained about their exclusion from any consultation over the STPs in their areas.

This is a question you need to address to the LMC

Here are the 3 documents that the 25 August Health and Wellbeing Board discussed, and which my questions are about