Veronica Treacher of KONP, Speech to Health Overview and Scrutiny Committee, 2 Feb 2017

COUNCILLORS, without wanting to sound unduly dramatic in these portentous times – there is a crisis of democracy occurring in the process of implementation of the Sustainability and Transformation Plans. Whilst most health professionals and campaigners agree these mass infrastructure ‘reconfigurations’ are a convenient way to devolve £22 billion of cuts to already financially besieged localities, there is another damaging crisis enveloping the NHS administration.

Prior to the Five Year Forward View and STPs, the capacity of the public to influence management of health services was questionable: patient groups were always largely window dressing and toothless.

Now, despite expensive bureaucratic machinery surrounding ‘patient engagement’ exercises, the extent to which people can hold decision makers to account remains severely limited.

The NHS is framed by prescriptive, centrally driven sets of metrics – waiting times, audit regimes, control totals – command structures also imposed from the centre. These clearly restrict meaningful stakeholder participation.

Perhaps worst of all is the language barrier – slippery management-speak platitudes and ‘revolutionary new buzzwords’ – that dupe us into engaging like consumers rather than citizen-patients.

Plans are presented as a technical exercise with services having only instrumental value – a means to an end.

With the latest changes there has been a transformation from ‘questionable public accountability to no discernible public accountability at all’.

Under instructions from NHS England, the Buckinghamshire, Oxfordshire and West Berkshire STP largely remains secret. It has been termed – by respected organ of management, the Health Service Journal – ‘extra-legislative reform’. But among the plethora of management organisations involved, we cannot know who’s in charge, of what, or where responsibility resides.

Because the changes have already been decided, the STP itself is merely an explanation, so that consultation or engagement is essentially along the lines of ‘Let’s tell the people what the changes are.’

THIS IS NOT PUBLIC ENGAGEMENT

And the accelerating speed of implementation has meant the plans effectively have been ‘protected from too much scrutiny’ by the ignorant masses – us.

NO WONDER PEOPLE ARE ANGRY WHEN HOSPITALS AND GP SURGERIES ARE THREATENED

Hospitals and surgeries are more than just buildings. They are symbolic – wrapped up in identity and community – places of suffering, hopes, fears, anxieties, emotions, values, security – ‘existing at the junction of life and death.’ Places that have meanings way beyond the narrow instrumentalism and rationality of cost controls.

In other words, they are the embodiment of the NHS.

Real democracy must provide appropriate spaces for the expression of these voices and these meanings.

Reconfigurations must be properly and openly stress-tested to ensure they are credible and can be delivered by and for the very people who are most affected.

A STORM IS SIMMERING IN OXFORDSHIRE – where even a Tory MP is challenging the cuts and downgrades at the Banbury Horton.

THIS HOSC MUST TAKE A STAND

  • When public consultation is phased to ensure there will be no bad news – theoretically – until after the Council Elections
  • When consultation is partial and post hoc
  • When plans do not connect with the entire BOB STP – a bedpan dropped in Newbury can be heard rattling in Chipping Norton!
  • When plans fail to include detailed financial plans/appendices and the cost savings for every change of service
  • And when plans omit risk assessments for each change proposed.

THEN WE CALL ON YOU


  • To publish your findings and concerns
  • To refuse to rubber-stamp
  • To invoke your powers to hold managers to account
  • To block controversial changes pending a decision by the Secretary of State and
  • To demand a substantial increase in funding from government to save our local health services

AND THEN, COUNCILLORS,

The local democratic accountability vested in this Scrutiny Committee may be preserved.

Ends

[In the compilation of this address, Veronica Treacher and Oxfordshire KONP wish to acknowledge and reference a timely article by Dr Carl Walker of the University of Brighton, critiquing STPs and analysing the nature of the democratic crisis confronting local authorities across the country:

http://www.cost-ofliving.net/the-real-crisis-in-the-nhs-is-democratic/]

https://keepournhspublicoxfordshire.org.uk

secretary.konpox@gmail.com

February 2017

HOSC Starts to Earn its Name, 2 Feb 2017

Oxfordshire County Council’s Health Overview and Scrutiny Committee is really getting into gear. In a big blow to NHS managers’ plans for cuts in services, councillors voted to refer two different matters to the Secretary of State for Health, Jeremy Hunt.

In the morning, HOSC members voted unanimously to refer to the secretary of state the down-grading of the previously consultant-led maternity services at Banbury’s Horton General Hospital to a midwife led unit. The reference was made on the grounds of ‘failure to take adequate measures to recruit’. Mr Hunt has said on BBC South Today that he would pass the case to the Independent Review Panel (IRP) if HOSC referred the matter to him. The IRP ruled in 2008 that the journey from Banbury to Oxford was too far for a woman in labour, and extremely unwell adults and children to undertake.

 However, councillors and members of the public were shocked when it emerged that, contrary to the decision of the HOSC at its November meeting, the chair had not written to the Government calling for additional funding to be made available to the National Health Service in Oxfordshire. No reason was given for this by the chair, Councillor Yvonne Constance.

In another blow for Oxfordshire Clinical Commissioning Group, in its afternoon session the Committee voted to refer the closure of Deer Park surgery in Witney, due at the end of March, to the Secretary of State. In vain did Mr David Smith, chief executive of the OCCG, argue that ‘we are where we are’, that the closure was not a substantial change to services, and that Virgin Health had said it would close the surgery at the end of March, as the private company had rejected the financial terms offered by the CCG to continue running the surgery. Councillors voted unanimously, first that the closure was indeed a substantial change, and secondly to refer the closure to Mr Hunt.

 Chair of Oxfordshire Keep Our NHS Public, Dr Ken Williamson, said: ‘Today the Joint Health Overview and Scrutiny Committee has lived up to its name and held NHS managers to account. The County Council must now step up the pressure on the government to provide the necessary funding to prevent the cuts and closures proposed in the Oxfordshire Transformation Plan and the wider Sustainability and Transformation Plan.

Now it is important that we have the biggest possible turn out for the lobby of the 7th March meeting of the Scrutiny Committee, which will decide its position on local NHS managers’ plans, or should I say cuts.’ (starts 8.30 at County Hall.)

 As well as speakers from Banbury, Witney and Chipping Norton, Veronica Treacher of Oxfordshire Keep Our NHS Public made an eloquent defence of a publicly provided national health service, called for additional funding, and for managers to be accountable to the public. Her speech will be available on the Oxon KONP website.

 Contacts: Dr Ken Williamson, chair of Oxfordshire Keep Our NHS Public, Mobile: 07831 570936

Mark Ladbrooke, secretary 07501 071 526

Bill MacKeith, press officer 01865 558145

keepournhspublicoxfordshire.;   https://www.facebook.com/;  @keepNHS_oxon      

 

Stop cuts to health services, Oxfordshire Guardian, 21 Dec

‘Stop cuts to health services’

George Welch, Oxfordshire Guardian, 21 December 2016

Concerned campaigners have put pressure on Oxfordshire County Council to resist cuts to health services.

Dozens of protesters gathered outside county council buildings on Tuesday as council chiefs debated a motion on the cuts facing the NHS in Oxfordshire. In a leaked document released by Reading Borough Council last month, it was revealed that a secretive ‘sustainability and transformation plan’ (STP) predicts a deficit of £479m by 2020 across Oxfordshire, Buckinghamshire and West Berkshire (BOB).

With Oxfordshire set for a £247m deficit, campaigners say they are worried about the implications across the county’s health services. In particular, campaigners fear for the county’s adult social care and the potential closure of community hospitals.

Leader of the Green Group on Oxfordshire County Council (OCC) David Williams said: “We are urging the leader of the county council to write to the Secretary of State for health asking him how our very fragile NHS is expected to cope with demand in the future.”

Mr Williams added that the NHS needs more funding as Oxfordshire, with its ageing population, continues to grow.

He added: “We need more health spending to combat staff shortages, the collapse of adult social care spending, the gradual reduction in GP’s surgeries in the county and financial pressures on pharmacies.
“We need all other political parties to resist the continuing austerity measures in the NHS, committing to at least a four per cent in spending each year as a first step to a realistic level of NHS spending.”

The motion, which was passed, was put forward by Labour county councillor for Barton, Sandhills and Risinghurst, Cllr Glynis Phillips.

The motion read: “OCC is deeply concerned about the BOB STP.

“In particular we are concerned about the implications for adult social care in the county, and for our infrastructure as hospitals close and services are centralised.
“The consultation with Oxfordshire has been derisory with the full plan not having been made public during the numerous meetings which have been held.”

Oxfordshire Keep Our NHS Public chair Dr Ken Williamson said:

“We urge Oxfordshire’s Countym Councillors to insist on the plans being made available in full for public consultation.
“We urge our councillors to call a halt to the process by challenging NHS England and the Secretary of State for health. It is very worrying that no extra funding was agreed for the NHS and social care in the Chancellor’s Autumn Financial statement. We need to fund our health and social care at least as well as our European neighbours.”

About the author
George Welch
News and Sports Reporter for the Oxfordshire Guardian covering Didcot, Wantage and Witney and all news regarding Oxford United.
Call me on 01235 516912 or e-mail at george@taylornewspapers.co.uk

Lobby County Council on 13 December over Cuts in Healthcare

Tuesday 13th December from 8.45am, County Hall, New Rd, Oxford.

NHS officials, local hospitals and councils are being required to collaborate in a secret project to drive though a cuts programme called a Sustainability and Transformation Plan (STP).

On the 13th December Oxfordshire County Council meets and our councillors will need to determine their response. Campaigners from around the county will be lobbying the meeting.

The planned cuts will hit our community hospitals and the Horton in Banbury. Beds are being lost in acute hospitals. Even as officials claim healthcare will take place in the community, family doctors struggle under unprecedented workload and surgeries close – North Bicester, Middleton Cheney, Deer Park – and the purpose-built doctor’s surgery in Rose Hill remains unused despite glaring health inequalities in the city.

Some of the STP has now been leaked to the public. But the plans fail to describe how social care, public health and carers are to be supported. On top of this, information is to be released in stages. These proposals are to be signed off by 23rd December 2016 before consultation with the public!

Oxfordshire Keep Our NHS Public chair Dr Ken Williamson said: ‘We welcome the resolution on the STP carried by Oxford City Councillors on Monday. (see below) We now urge Oxfordshire County Councillors to insist on the plans being made available in full for public consultation. We urge them to demand that NHS England listens and acts on what the public have to say BEFORE changes are brought in. We urge our councillors to call a halt to the process by challenging NHS England and the Secretary of State for Health.

‘By 2020 almost half a billion pounds shortfall in funding of the National Health Service is expected across Buckinghamshire, Oxfordshire and West Berkshire.

‘It is very worrying that no extra funding was agreed for the NHS and social care in the Chancellor’s Autumn Financial statement. We need to fund our health and social care at least as well as our European neighbours.

Oxfordshire Keep Our National Health Service Public
Contacts: Dr Ken Williamson, chair 07831 570936
Mark Ladbrooke, secretary 07501 071 526
Bill MacKeith, press officer 01865 558145
keepournhspublicoxfordshire.org
facebook: keep our nhs public – oxford @keepNHS_oxon


Motion carried by Oxford City Council 5 December 2016 as it appears on the City Council website

This Council notes that the government is dividing the NHS in England into 44 areas or ‘footprints’, each of which has a ‘Sustainability and Transformation Plan’ (STP).

Government requires these STPs to collectively deliver cuts of at least £2.5bn nationally this year, and £22bn within the next five years, to wipe out the NHS’ so- called ‘financial deficit’ by implementing ‘new models of care’.

The former head of NHS commissioning, Julia Simon, has denounced the STP process as ‘shameful’, ‘mad’, ‘ridiculous’ and the plans as full of lies [1].

Locally, the Council notes that the Chief Exec of Oxfordshire Clinical Commissioning Group (Oxon CCG) has said that without changes to local NHS provision there will be a cumulative funding gap of about £200 million by 2020-21 and that the STP will need to change service provision to eliminate it [2]. Council further notes that local NHS employers face particular challenges from the high cost of housing locally, the mitigation of which may require investment.

Council considers that the Buckinghamshire Oxfordshire Berkshire West (BOB) STP

(a) Does not contain adequate or indeed any information on which a decision can be made about the future of NHS provision in what the STP refers to as ‘the BOB geography.’ It presents aspirations couched in meaningless jargon and suggests, without any evidence, that the unspecified STP Plan will result in the transformation of a projected deficit of £479m to a surplus of £11m by the end of 20/21.

(b)Establishes any basis for a consultation to be carried out with health professionals and members of the public. Indeed the timeline in the STP suggests no consultation is envisaged since ‘agreement on the plan’ is to be reached with NHS England in November/December, before any consultation is even planned.

Council believes is possible that the STP for the area which includes Oxfordshire (BOB- Bucks, Oxon and Berks) contains measures which could seriously impact on the health and welfare of the local population, and that the insistence by NHS England upon restricting early publication is leading to harmful speculation.

Council notes that wider consultation on the STP has not yet started, and calls for the immediate publication of the STP, in full, with proper consultation to take place with patients, interested public, private and community bodies, and staff. Council notes the frustration recently expressed by senior CCG officials about NHS England’s negative attitude to timely publication and consultation of the STP, and believes that, especially in difficult times for the NHS, early engagement of all stakeholders is vital, and exercises in secrecy prevent constructive engagement from public bodies and local communities, and foster an atmosphere of mistrust.

Council endorses the view recently expressed by the Oxfordshire Health Inequality Commission that significant investment in interventions to reduce health inequalities and prevent poor health and illness are very important, and believes that such services are at particular risk when pressures on the NHS are scheduled to rise faster than funding. It therefore asks the CCG to prioritise investments which will reduce health inequality and support services towards groups suffering from health inequalities.

Council rejects the suggestion that there is a safe way to reduce the current level of NHS provision by £200 million (the gap identified by the CCG) by 2020-21 and agrees to:

  • Ask the Oxon CCG to fully disclose to the public what changes are being considered with NHS England lifting its bar on publication

  • Provide what support it can to the STP consultation

  • Ask the Oxon CCG to start a full consultation as soon as possible on all aspects of the proposed changes

  • Encourage the public to make their views on the services reductions and changes known by promoting the consultation on the Council’s website, social media and through wider media communications

  • Invite the County & District Councils to work together with the City to oppose any changes which will harm patients

  • Write to the relevant Government Ministers to express Oxford’s grave concern about a plan which is being foisted upon NHS professionals and the public in this city without adequate or indeed any information about the change in the level of services which must be intended.

  • Write to the City’s MPs asking for their support


Press release: Keep our NHS Public Oxfordshire, 7 December 2016

Sustainability and Transformation Plan (STP): A Brief Summary

The Conservative Government is committed to a strategy of reduced state spending in the public sector (welfare, health, education) and the marketisation (privatisation), where possible, of public services. The Health and Social Care Act (2012) forced the Clinical Commissioning Groups which purchase health services locally to do its purchasing on the open market. STPs are another top-down reorganisation of the NHS which forces it to deliver services on a reduced budget. STP means cuts. In official language they are described as efficiency savings.

Nationally the NHS has to save £22 billion between now and 2020. To deliver these savings the country has been divided into 44 footprints. Our local footprint is the BOB (Buckinghamshire, Oxfordshire, West Berkshire) and here the NHS has to save £479 million.

Cuts to services
To achieve these savings, there are planned cuts to services:
• community hospitals will be closed
• beds at the John Radcliffe will be reduced
• the Horton Hospital in Banbury will become a day hospital

Other savings will be made in the following areas:

Workforce savings
The plan is to save £34 million on workforce costs.
– a smaller workforce that can be flexibly employed across the BOB
area
– a reduction in skill levels: reduction of nursing grades and increased use  of healthcare assistants
– recruit staff from outside the UK
– standardise pay and conditions across the BOB area

Since they are unlikely to achieve this saving through the employment of lower grade staff, it will have to mean a significant cut in staff relative to need. Without the planned efficiency measures, the STP document estimates that workforce numbers would need to increase by 4,527 (whole time equivalent) by 2020/21 to meet increased need. The STP plan would see an increase of just 978. This would be an effective reduction relative to the greater need.

Savings from working ‘at scale’
This would mean delivering services at fewer sites covering larger areas.
GP services will be reorganised in locality ‘hubs’ serving populations of 80,000 to 200,000
one central commissioning body will purchase services for the whole BOB area
specialised acute services (cancer treatment, complex surgery, etc) will be centralised in the larger hospital trusts

Savings in ‘specialised services’
The plan is for savings of £60.2 million in commissioning of specialised services (these are services usually found in larger hospital trusts such as dialysis, special cancer treatments, genetic disorders). It is unclear from the document what this would entail.

Savings from shifting patient care from acute services to primary care and social care
The plan here is to shift health care as much as possible from the expensive hospital sector into the community, to GP services, social care, and ‘self care’.
– ‘more care provided closer to home through strengthening the availability of services available within primary care’.
– ensuring that ‘patients, their families and carers are empowered to take more control over their own care and treatment’.

The problem here is that that both GP services and social care are in crisis. And this crisis is basically a product of underfunding. Without a dramatic increase in investment in social care, it’s hard to see how the social care sector could cope with increased demand.

Savings from sale of property
The document suggests that extra funds for the NHS could be had from property sales. There is no information on which property or the amount of capital anticipated from these sales. The suspicion is that community hospital sites could be sold off. The document speaks of ”community hospital buildings which require repair and are not fit for modern needs’.

Savings from ‘lower cost of services procured’
The plan promises savings from: ‘reduced CSU, CCG & Trust management time required and lower cost of services procured.’ It’s difficult to see how reduction in ‘time required’ for existing management of CCGs and hospital trusts on fixed salaries could produce savings but what is interesting here is ‘lower cost of services procured’. This has traditionally been a signal for procurement from private providers.

STP structure
At the top of STP are Trusts and Clinical Commissioning Groups (CCGs), Health and Wellbeing Boards, Local Authorities, NHS England, NHS Improvement.

Then comes the STP Oversight Board consisting of: CEOs of CCGs, NHS Trusts, Local Authority representatives, CEO of Academic Health Science Network (AHSN), Head of Health Education England, NHS England, NHS Improvement, Healthwatch, AgeUK, Fire service, Police

Below that is the STP Delivery Board involving AHSN, STP Lead, Finance, NHS England, NHS Improvement, Local Authorities and the three local system leaders (Stuart Bell, Neil Dardis, Cathy Winfield).

CCGs: A Commissioning Executive across the 7 CCGs in the BOB area has been established to improve commissioning efficiency further and support delivery of the STP plan. The Executive will initially focus on specialised commissioning, ambulance services, 111, mental health, and cancer.

Although statutory bodies are listed as being at the top of the STP structure, it must be noted that local authorities have not really functioned at that level. For instance, members of the Oxfordshire County Council’s Health Overview and Scrutiny Committee (HOSC), whose duty it is to scrutinise ‘substantial changes’ in the health service, were completely in the dark about the actual contents of the STP.

Constitutional Powers of the Health Overview and Scrutiny Committee
‘Under Regulation 4 of The Local Authority (Overview and Scrutiny
Committees Health Scrutiny Functions) Regulations 2002 a NHS body must consult the Committee, where it has under consideration any proposal for a substantial development of the Health Service or a substantial variation in the provision of such service…

The Committee may report to the Secretary of State in writing where it is not satisfied that: consultation has been adequate in relation to content or time allowed. …

Where the Committee considers that any proposal would not be in the interests of the health service in Oxfordshire, it may report in writing to the Secretary of State who may make a final decision on the proposal….’

What we object to in STP

1. Secrecy: STP involves a massive reorganisation of healthcare which was formulated in secret with no input from local authorities, GPs, patients, or public. At the same time, bodies with a heavy bias towards ‘public-private partnerships’, such as the Academic and Health Science Network, have been very influential in the preparation of STP and are involved in the leading its implementation.

2. It means cuts in services at a time when it is recognised that there is a growing need for healthcare services. There are cuts to community hospitals, hospital beds, and specialised services.

3. Reductions in healthcare staff in the face of increasing need.

4. Reductions in the quality of care through the reduction in nursing grades and increased use of healthcare assistants.

5. Absence of meaningful consultation with patients and the public and even failure to communicate STP information to the local authority’s Health Overview and Scrutiny Committee which has the legal duty to scrutinise any ‘substantial development’ or ‘substantial variation’ in health services.

6. Shift of hospital services to GPs and social care at a time when these are in profound crisis due to underfunding.

7. Centralisation of services in big hospital trusts and community hubs which move services further away from patients.

8. Dramatic increase in the acceptable norms for home-to-hospital
ambulance time. The document claims that ‘96.1% of the population is within 60 minutes’ drive time of acute services’. Patients in Banbury would have to be taken over 25 miles to the John Radcliffe. The STP document estimates that this would take 41 minutes.

See the short video: Sustainability or Cuts? A short video on STP by Community Glue

County Council Lobby 13 December

The Government plans £22 billion cuts from NHS funding by 2020 as demand increases and social care is slashed. There are plans to cut nearly half a billion pounds from local NHS services in Oxfordshire, Buckingham and Berkshire..

On 13 December the County Council will meet and discuss the cuts to NHS services proposed in the recently released Sustainability and Transformation Plan. Assemble at 8.45 to lobby councillors outside County Hall in New Road, Oxford.

stp-protest