From April – October 2016, the West Yorkshire Sustainability and Transformation Plan Programme Management Office has been run by a private sector consultancy company called Attain, at a cost to the NHS of £377,976 for work. 12% of this will be Attain’s profit, according to its website. Attain’s Chief Executive, Martin Wilson, is a former partner in KPMG.
It has been drawn up in considerable secrecy, and will only be published after NHS England has made it fit for public consumption. This is a change of plan. Until last week, when NHS England issued the instruction to Clinical Commissioning Groups not to publish their STPs until NHS England has seen them and commented on them, the plan was for the West Yorkshire STP to be published on October 23rd or 24th.
Now, according to Debbie Graham, Head of Service Improvement at Calderdale CCG, the WY STP will be published “on a more flexible timeline”. Dr Alan Brook, Chair of Calderdale CCG Governing Body joked.
“The only clarity is that things are unclear.”
Debbie Graham confirmed the lack of clarity by saying that Calderdale CCG had been told to submit two slides to the “Healthy Futures” STP but,
“We’re not sure what the exam question is.”
However she said that there are 9 priorities for “work at scale” – ie provision of services across the West Yorkshire and Harrogate STP “footprint” – that the STP is “interested in” for financial control.
Cheif finance officer warns STP means questions over whether statutory NHS services can survive
The Chief Finance Officer had grim news for Calderdale Clinical Commissioning Group about the effects of the WY STP. He said that,
“The control total across the patch is going to be extremely challenging”
“The cash draw down for WY STP next year puts the QIPP requirement to 3% – a huge challenge. This is a huge ask.”
QIPP is Quality Innovation Productivity and Performance, the euphemism for the £30bn so-called NHS efficiency cuts over the five years to 2015. This was introduced by McKinsey at the invitation of the New Labour government, following the banksters crash of the global financial sector, and implemented by the Coalition government in 2010. STP is QIPP mark 2, requiring cuts to meet the £22bn funding shortfall by 2020/21.
The Chief Finance Officer went on to say that a meeting on STPs with Chief Finance Officers and NHS England had found that the cash draw down requirement was causing problems acorss the North, including for Greater Huddersfield and Airedale CCGs. The assumption is that the STP footprints “will make balance” – ie eliminate deficits in 1 year.
“The huge pressure the whole system is going though is driving towards difficult decisions about what the budget can buy in the Health and Social Care system.
We have to resolve this across the whole system.”
He said that the “huge asks’’ for QIPP or efficiency cuts have to deliver around A&E and the 18 week referral for cancer treatments and added,
“Where does the balance come between quality and money?”
So the STP means: the WY and Harrogate NHS can no longer afford a comprehensive health care system and there are threats to the quality of the services it has to provide.
He asked if the STP allowed the CCG to “meet the statutory asks” or not. This is about the range and standards of health services that the CCGs have a legal requirement to provide. He gave as examples of this question that,
“A lot of STP investments in mental health are net figures and it is assuming they come out of acute providers’ savings.”
“The level of savings at CHFT is unattainable. This is why WY STP discussion is vital, we are entering difficult dilemma time.”
At this point the Chair Dr Alan Brook headed him off by saying
“We have to remove costs from the system – not just from one part of the system.”
“Governance issues” for STP includes how to involve CCGs’ GPs in “providing clinical support and engagement”
Before the Governing Body Chair shut him up in this way, the Chief Finance Officer said that “part of the governance issues” for the WY STP was how to involve GPs on the Governing Body in “providing clinical support and engagement”.
This is code for having medical considerations as well as financial questions at the heart of the STP.
“I don’t have an answer about how best to involve GPs.”
It is somewhat strange that the GP Chair of the Governing Body was not interested in opening up discussion of this, and instead shut the discussion down when the Cheif Finance Officer raise the point that discussion of WY STP is vital due to the need to tackle difficult dilemmas.
No sign off process for West Yorkshire STP, says communications lead
Debbie Graham told Calderdale Clinical Commissioning Group that they needed to delegate the sign off of the two Calderdale STP slides, to the Chief Finance Officer, the Chief Officer and the Governing Body Chair.
The Chair proposed, and it was agreed, that this delegation should include Dr Steven Cleasby, who is also vice chair of Calderdale Health and Wellbeing Board.
This means that the Governing Body has neither sight nor say over the CCG’s submission to the WY STP.
As for formal sign off of the West Yorkshire STP: according to the WY STP communications lead, there is none. No meeting of the Healthy Futures Joint Committee – aka 11 Commissioning Collaborative – or anything. Karen Coleman told an NHS campaigner that the Clinical Commissioning Groups send in their own locality STP and this gets sent off to NHSE.
So we have a WY STP that generates “difficult dilemmas” about whether our NHS Commissioners can meet their statutory duties, and whether it has the governance processes in place to allow GPs to discuss and make decisions about these dilemmas, and that has been prepared by a commercial consultancy firm.
Attain consultancy – the crowbar to smash apart the NHS in our area
Apart from the issue of lining Attain’s corporate pockets with profits that should pay for public services, there is the issue of what the wearers of the corporate suits are telling our NHS in West Yorkshire and Harrogate to do.
In my previous working life as an arts administrator, I quickly learned that arts funding organisations paid for consultancies when they wanted their funded clients to change in ways that they knew their management boards would never agree to. It was an open joke that consultants were employed when this was the only way for things to be said and done, that no one in the organisation would be able or willing to say or do themselves.
So consultants are kind of like a crowbar that a paymaster bangs into a client organisation to break it up and reassemble it.
In December 2015 the government’s quango NHS England told Clinical Commissioning Groups to prepare a so-called Sustainability and Transformation Plan that would cut and privatise NHS services in line with NHS England’s 5 Year Forward View and the sustainability and transformation funding announced in the government’s Autumn 2015 Comprehensive Spending Review.
At a February 2016 meeting the 11 Clinical Commissioning Groups in West Yorkshire and Harrogate decided to commission Attain on a short-term interim basis to work alongside NHS staff as part of the West Yorkshire Sustainability and Transformation plan – also known as the Healthy Futures programme.
(The name Healthy Futures seems to have been stolen from an American “Physician Guided Wellness Program Customized to Meet Your Health and Wellness Needs” where:
“Insurance Verification is required before you enter the program… so you are fully aware of your financial obligation, including any co-pays, deductibles, and/or co-insurance.” )
Attain’s role was to give immediate, short term support following NHS England planning guidelines issued in December 2015. The £377,976 contract has been funded by the 11 CCGs. Here is Attain’s case study description of what they’ve done
Attain’s “case study” of its work says that there are more than 40 stakeholders involved in WY STP planning. Since there are 11 CCGs, 6 acute hospitals and 3 mental health providers, who are the other 20?
The WY STP team’s communications lead told me that “Healthy Futures” – the assemblage of 11 Clinical Commissioning Groups – sticks to NHS guidelines around procurement and awarding contracts. They awarded Attain the contract through access to a local framework arrangement for the use of external consultants.
Attain says that it has brought providers and wider stakeholders “within the sphere of influence” of the 11 CCGs’ “commissioning collaborative” – aka Healthy Futures. What does this mean? How are these wider stakeholders involved in the WY STP “collaborative and decision making process”?
Attain also claims to have developed “role descriptors” for “change agents”. Who are these change agents? From which organisations? And what are their roles?
Attain says it has delivered “key Programme Director and Manager roles on an interim basis”.
So commercial sector consultants have been in the driving seat in setting up the West Yorkshire and Harrogate NHS Sustainability and Transformation Plan. Attain has also apparently chosen who is to take up permanent jobs in the STP programme management office, since it has
“ supported the recruitment of substantive posts within the PMO and across priority programmes to ensure continued effective delivery of the Healthy Futures ambitions.”
Attain have the STP Programme management all sewn up then.
It says that the outcome of its consultancy is that the STP submissions have been made in line with national requirements.
Its WY STP case study is filed under QIPP – which as already mentioned, is Quality Innovation Productivity and Performance, the euphemism for massive so-called efficiency cuts – another euphemism. – So lets just call a spade a spade and say the NHS has been underfunded by £30bn over the five years to 2015 and is now facing a £22bn funding shortfall by 2020/21.
The consultancy contract with Attain ends in October and, as of a couple of weeks ago, a small team of seven people were working across the West Yorkshire and Harrogate area in the Programme Management Office.
The way the WY STP team’s communications lead described Attain’s role in the STP Programme Management Office as:
“Attain have worked closely with existing staff to build both capacity and capability to take forward the work of the STP, so that it becomes very much part of everyone’s day job.”
Their job has been to bring together various partners from across the region to come up with proposals for how make cuts to services in line with the significant funding shortage identified the NHS England’s Five Year Forward View, while simultaneously improving people’s health and well being and the quality of the health care they receive.
The WY STP communications lead said,
“This has included establishing collaborative programmes of work across West Yorkshire, developing project management systems and governance arrangements to ensure we all work together to develop a credible plan to meet NHS England requirements.”
The governance arrangements are about how to make it possible for 11 separate organisations to make decisions together when there is no legal basis for them to do so. And to do so in secret before the public finds out what they’re up to and revolts.
A look at the Attain website shows that they tell NHS organisations how to do all the things that NHS England boss Simon Stevens is imposing on them, at speed, via the STPs, in order to carry out his Five Year Forward View.
As well as impossibly tight budget constraints that just about everyone concerned admits means the end of the NHS as a comprehensive health service that is free at the point of use and based on patients’ clinical needs, the STPs require the speedy dismantling of NHS to turn it into a health service that is based on private health insurance systems like those operated by Simon Stevens’ former employer, United Health.
These systems called “new models of care” and require a “modern” – de-skilled and de-professionalised (cheaper) – workforce, lots and lots of costly digital technology and new types of contracting that involve setting a fixed per capita budget for a population, that is handed to a “lead provider” who then subcontracts to many smaller contractors – many of which will be unskilled, unqualified voluntary and community groups.
To manage this ridiculous way of running a health service – famous in the USA for its costliness and ineffectiveness – Clinical Commissioning Groups will dissolve into Accountable Care Organisations or Accountable Care Partnerships.
Attain’s commercial team sets up these new models of care and the Accountable Care Organisations that run them. They have already set up a Barnsley Accountable Care partnership board that will become an accountable care organisation in 2017-18,
“underpinned by a multispeciality community provider contract. ”
A multispeciality community provider is a large scale primary and community care provider that blurs the boundaries between hospital and GP/community care, as hospital services are transferred into the “community” and very large scale GP/community services operate across a big population, which can mean that far from Care Closer to Home, primary and community care could be anywhere in rather a large area. And hospital care could be anywhere in an even larger area, as more and more hospital departments are closed and District general hospitals become husks of their former selves, as is happening rapidly with Dewsbury District Hospital.
So basically the NHS commissioners in West Yorkshire and Harrogate have just paid a commercial private sector consultancy company to turn it inside out so it is ripe for cuts and privatisation. And is at risk of not being able to meet what Calderdale Chief Finance Officer called its “statutory asks.”
This is why we must stop the STPs.
The Leeds Keep our NHS Public conference on Satuday 15th October came up with a campaign plan to Stop West Yorkshire STP. You can email firstname.lastname@example.org for more info, or go to the Stop STPs facebook group or Calderdale & Kirklees 999 Call for the NHS.