Lancs STP leader says STP plans are 'meaningless' to public

Lancs & South Cumbria STP leader accepts her new NHS reform plans are almost 'meaningless' to the public. Lead planner says STP is 'not a plan'.

Speaking as part of a roundtable discussion earlier this month next to two prominent STP leads, Amanda Doyle and David Pearson, Mathew Swindells (National Director of Operations and Information NHS England) added that it’s “really up to local leaders” in the meantime to manage how they engage with their communities with respect to ongoing plans – but said NHS England would “discourage” people from publishing plans they’re still working on.

Commissioner chair claims Lancs & South Cumbria STP is "not a plan"

Adding to this, Doyle, who is the CCO at Blackpool CCG and Sustainability & Transformation Plan (STP) lead for Lancashire and South Cumbria, clarified that what her footprint has so far is “not a plan", a complete narrative that describes everything we’re going to do and what healthcare will look like in five years’ time”. Instead, it is a series of templates, government information and finance templates, most of which would be “almost meaningless” to the wider public.

Is the STP 'ask' really really difficult? Or impossible?

Doyle, who is also the co-chair of NHSCC*, argued that the STP ask is “really, really, difficult”, but necessary: “We’re not making any bones about that, and the message back to Matthew, Simon [Stevens] and Jim [Mackey] is that this is really hard to do in the time we’ve got. *NHS Clinical Commissioners is the membership organisation of clinical commissioning groups.

Lack of detail due to lack of public involvement?

“But we have got unlimited time to sort this out. We are not sustainable as we are. We do not have the luxury of two years to nail down every detail of everything. We have to get on and deliver, we have to improve health, we have to improve outcomes, and we have to be able to afford what we’re doing.”

Swindells agreed, adding that every day NHS leaders “decide to have another committee meeting” rather than “getting on and making a hard decision”, the system is “not delivering the optimum NHS and social care with the money that’s available”.

What do we know so far?

Well, the STP for Lancashire & South Cumbria is supposed to contain decisions that are part-fed from feedback from public events on Central Lancashire's 'Our Health Our Care' plan , the local delivery plan (i.e. the Central Lancashire submission towards the overall Lancs & South Cumbria STP.

Public had no input into their local plan or STP

THREE public 'listening events' were organised by local CCGs and their partners for November and December (2016), and March 2017. But NHS England brought forward the submission date for two year operational pans (for 2017/18) and the STP was published BEFORE the first public event.

Two of the events went ahead, but since the plans had already been submitted, program leaders attempted to deceive the public by talking around the options in the plan and instead concentrated on the lesser contentious issue of social care.

Doyle claims "We do not have the luxury of two years to nail down every detail of everything".

Yet her STP nails down absolutely no details whatsoever and isn't worth the paper its written on. A tweeter and well known author on NHS health policy recently tweeted Doyle's STP was 'rubbish'.

I'm inclined to agree, after reading the empty statements in the Lancashire STP I was left wondering if the public had been involved more detail could have been included.

But the fact is the public and local authorities haven't been included in the STP (draft or otherwise) leaving the whole 'transparency' issue in question.

Any plan rolled out in secret should be doomed to fail.

It looks like Doyle and her cronies wish to roll-out their ill-thought out STP and 'nail down' the details as they progress, with or without public involvement.

Not as long as we are here to fight against it they're not!

Campaign group "Protect Chorley Hospital from Cuts and Privatisation" are awaiting a reply from the local STP leaders on why the public have not been involved in the 2 year plans and STP local delivery plan.

Links & Sources

NHS Expo Dec 2016. Dr Doyle declares STP 'not a plan at all'.

Our Health, Who Cares?

I decided to leave the 2nd 'Our Health Our Care' [ohoc] event since it was getting farcical.
You really couldn't get any further from the truth about a new healthcare system.

I sat in at the afternoon event where the program slideshow presenter (clinical director LTH trust) said urgent care centre aside an A&E was a new model of care + he said privatisation wasn't on the agenda.

Fortunately he sat next to me, and luckily the CCG chief officer also sat at our table. I put him right about the UCC model being over 30 years old (it's an import from Denmark) + privatisation is a large part of the STP (as the health secretary said in his book about denationalising the NHS titled 'direct democracy').

Ironically, the presenter changed his tune at the evening presentation when he said privatisation in the NHS does exist and the UCC model is not new!

The story gets farcical. I also attended the evening event only to find the CCG couldn't get more people to promote their trash plan so they'd hired some non-de-plume to do their bidding. I asked the lady, who was sporting a badge titled 'OHOC', was she employed by the CCG or the hospital trust or other healthcare organisation and she said no. Nor, as far as I gathered, had she read the LDP (OHOC) submission as part of the STP for lancs & south cumbria. 

We can't afford the NHS but the CCG can splash out on an unknown to promote something they likely know little or nothing about? Farce.

After the slideshow the public were asked to devise a new healthcare system or come up with a solution to overcrowding at the A&E. I said well if Nuffield trust and King's fund can't solve it I can't help here.

There were no new options or models of care pathways proposed at the meetings, except questions such as just what do you think of bringing together (integrating) pharmacies, clinics and GPs?

Erm, they already exist, all you're talking about is getting them to federate with the GP practices.

It was clear at that point they were avoiding the more controversial issues of the OHOC LDP program and instead 'gauging the feeling' of how apathtic the public were.

There are over 313,000 people in Central Lancashire.
135 people replied to the OHOC program over 8 events, and apparently this is good?

There was NOTHING mentioned at the meeting about the true contents of the OHOC LDP 67 page document which was submitted to NHS England in November. Nothing about the MCP clinics or service closures, nothing about personal health budgets or hospital re-configurations, nothing!

Are we being deceived?

If you thought the STP was rushed through in secret then it's going to be an explosive time when the 'public consultation' for the STP does start.

I can tell ya one thing, I'll be there when it does start, and this time watch out London 2017, cause I'm heading your way too....

Suggested council tax increase to pay for Social care?

You can shove that idea you bunch of pansies! The problem of NHS underfunding, including social care can be wiped out with a 1p increase in National Insurance contributions. Yet once again the Tories want to pass the buck to local councils to throttle their citizens even more...

Suggested council tax increase to pay for Social care

On the news earlier, ask yourself why didn't the CCG suggest this in their contribution to the STP?

Instead, the CCGs rushed ahead claiming they would find a way but completely failed to say HOW they would solve the problem of pensioners stuck in hospital with no alternative out-of-hospital care on discharge.

Here's what the Chorley & South Ribble CCG want to do, even though they have no idea how to do it....from their Local Devlivery Plan (LDP) i.e. their contribution to the STP...

Outcome 3: Reducing the amount of time people spend avoidably in hospital through better and more integrated care in the community, outside of hospital – this means ensuring that alternative care is available so that fewer people have to go into hospital
Outcome 4: Increasing the proportion of older people living independently at home following discharge from hospital – this means ensuring that alternative care is available to support older people so that they can leave hospital sooner

NO ALTERNATIVE

So how do they 'ensure' alternative care is available if social care is already in crisis?
Integrated care has been a mantra for years yet like other areas its never had enough funding, and it certainly won't solve hospital overcrowding.

Indeed, the hospital trust board have already agreed to new care models, as long as it gets then out of deficit they don't seem to give 2 hoots... from page 9 of CCG Local Delivery Plan (LDP)...

"We [CCG] anticipate that once the models of care have been agreed and sized, and after any required consultation, that Lancashire Teaching Hospital will then start a process of modernising its hospital estate to ensure that it is efficient and fit for the future".

"By 2020/21 we plan to have moved away from a reactive hospital based-system of unplanned care, to preventative, anticipatory, whole person approach to care."

By its very nature a hospital is a reactive based system since it's never possible to predict accidents or when an emergency arises. To move to preventative whole-person simply means moving to an insurance-based system for patients with chronic conditions. The payment plan will initially be 'free' under what's called a 'personal health budget' (PHB). But as more services are lost from the NHS these will need to be obtained via a 'top-up' fee on the PHB.

So briefly....page 18

"The health economy is agreed that this Acute model of care will look different to its current and that it may well reduce in size from its current form. We are committed to shifting resources towards interventions that prevent ill health and reduce demand for hospital and residential care services."

Instead of expanding to accomodate the increase in population, the CCGs are actually proposing reducing the amount of secondary acute space available to children, adults and pensioners in desperate need!

Yes, it will reduce in size to a small acute/trauma hospital on the outskirts of Lostock. The other hospitals in Chorley and Preston will be sold-off for their estate value to pay for the smaller community 'Hub' clinics called 'multispecialty community provider' (MCP) clinics, run in the future by VirginCare or other private venture (there is no other way due to underfunding of the NHS).

Page 19 map = no hospital for Chorley
Page 20 map = no hospital for Preston
Page 21 map = only 20 GP practices on 3 sites/polyclinics for South Ribble

One of the most worrying features of the CCGs 'STP' delivery plan is that in its opening paragraph on page 24 it concludes the [STP] process with a pre-consultation business case.

It's nothing to do with clinical outcomes only financial stability, and as usual the patient has the last say...

So why has the Tory government decided to make up losses in Social care by proposing to increase Council Tax?

For a start, we've already been paying for social care through an increase in council tax, and it's been going disastrously wrong.

Wealthier areas with a higher council tax base raise as much as three times more than poorer areas where the need for social care is much higher. It's not hard to see how this increases 'inequality'

Despite the growing numbers of older people, council funding for social care has been slashed by £5bn since 2010. Many organisations that provide care are struggling to stay afloat and are handing contracts back to councils.  Click for More...

 

Download the CCG Local Delivery Plan, the CCGs STP submission..