Dear Gloucestershire County Councillors,
We are extremely concerned by the disparity between the level of information, including financial information, contained in the Gloucestershire NHS plan (known as the ‘Sustainability and Transformation Plan’ or STP) as published by Gloucestershire Clinical Commissioning Group (CCG), including the appendices, and the details contained in STP submissions in other “footprints” using the same financial template.
Information that has not been published in Gloucestershire, though it has been published in other areas, includes:
• the estates strategy for the county’s hospitals
• projected county-wide bed figures
• projected county-side staffing/workforce figures
• figures for the future projected deficits of each of the four main NHS Trusts providing healthcare to Gloucestershire, and the impact on them of these plans
• a proper Risk Register of planned productivity improvements
We note with deep concern that the plan contains no guarantee that current levels of hospital provision will be protected.
We further note with deep concern that assumptions are made throughout the plan that may well undermine still further, the provision of hospital and other NHS care in Gloucestershire in future. Notably, the plan makes many assertions about the potential for arrangements for self-care, active communities, and the benefits of digital investment, without citing one single piece of evidence to justify any of those assertions. It claims that Gloucestershire can become above average (compared to similar counties) in simply everything, without explaining why or how this is possible, let alone how it will save £72.2m, on top of another £70m of ‘provider efficiencies’.
Perhaps most worryingly of all, the plan is riven with holes in the capital budget. It makes clear that the savings are ‘capital dependent’ but where the approximately £150m investment is to come from, is left largely unspecified. In both the financial segment of the main plan, and the appendices (notably the digital appendix) we are told that this investment is to come partially from small central government pots, but also from ‘3rd party developer capital’ (private finance initiative?) and from ‘unknown’ sources. Given the lack of guarantees about estates and workforce, the suspicion must be that these holes will be filled with further cuts and sell offs of our much loved and vital hospitals, and greater reliance on private patients.
Our concerns about this process are shared by NHS insiders up and down the country – for example Julia Simon, former head of NHS England Commissioning, recently denounced the process as ‘shameful’ and ‘mad’. (1)
We are certain that Gloucestershire CCG will hold more detailed information on the financial, operational, estates and workforce plans, more in line with that information provided in other areas, which they have not disclosed. For you to even consider allowing your paid officers to approve a plan whose details you have not been allowed to see, while contracts are due to be signed by 23 December, would be a dereliction of duty. We call on you to reject the plan, pending its full disclosure followed by a full, statutory 3 month consultation with the public and all interested parties, including NHS staff and their unions
We will be working with others to ensure that county councillors attention to the future of our local health services is highlighted in the forthcoming county council elections, and to this end have copied the local press in to this email. We thank you for your urgent attention to this matter.
Chair, Stroud Against the Cuts
Co-ordinator, Stroud Against the Cuts, and Editor, OurNHS openDemocracy
(1) 'Shameful' pace of STP rollout risks financial meltdown, warns former NHS commissioning chief, GP Online, 28th September 2016
Last Updated on Tuesday, 25 October 2016 15:47
Stroud Against the Cuts supports the Campaign for an NHS Reinstatement Bill.
We have been running stalls recently to build support for the NHS Reinstatement Bill - a piece of legistation designed to deal with the problems that have been created in our health service. The Bill will be in Parliament on the 4th November, and we have been encouraging people to write to local MP Neil Carmichael to encourage him to attend the debate and support the bill [You can copy and edit or send this text to Neil Carmichael via email orpost to him at House of Commons, London, SW1A 0AA]. Below is a copy of the letter, followed by further information about why the Bill is needed and what is happening to our NHS.
We will visit Neil Carmichael on Friday 28th October, and hold stalls on Saturday 29th. If you can attend/help, please contact Christine Stockwell: chris [AT] candmstockwell [DOT NET], or phone James Beecher on 07734 058789. We would particularly like to hear from people able to help with stalls in Dursley, Nailsworth, and Stonehouse.
Letter to Neil Carmichael
Dear Neil Carmichael,
The NHS Reinstatement Bill is scheduled for its second reading on 4th November 2016. I urge you to ensure it is granted time for debate in the House of Commons, and to support this Bill - which has cross party support.
The NHS Bill will provide the legal framework to:
Ø Restore the NHS as an accountable public service
Ø Reverse 25 years of marketisation in the NHS
Ø End contracting out of services, which destabilises and fragments the NHS; enabling billions of pounds currently spent on “transaction costs” to be re-directed to frontline services
Ø Support integration of health with social care
Ø Remove the NHS from EU competition law
Ø Restore the duty of government to provide health services across England
The present costly, chaotic, fragmented and ineffective system urgently needs to be replaced by one that will allocate resources according to need, through a fair, democratically accountable and integrated planning system, removing the market and competition from the NHS. The Government’s current Sustainability and Transformation Plans will only perpetuate the market system. We need our services to be comprehensive, transparent, equitable and affordable. The only way all these goals can be attained is through full public ownership of our NHS. Such a change requires legislation to win back our NHS in England. Please support the bill.
I look forward to hearing from you as soon as possible
Stroud Against the Cuts
Why do we need an NHS Reinstatement bill?
The NHS has been undermined as a public service over the last 25 years with increased outsourcing of services to private companies. From the privatisation of cleaning in hospitals which led to a rise in hospital super-bugs (MRSA); to the setting up of an expensive system of buying and selling services within the NHS (purchaser/ provider split); through costly PFI mortgages on new NHS buildings; through the expensively-run privatised social care of our elderly and more vulnerable adults; closures and transfers, many hospitals in Gloucestershire reducing beds by 100s; NHS money going on new private facilities instead of put in to the current ones; NHS trusts being run by private companies; the fully marketised structure introduced by the 2012 Act; the reduction of our A&E services and the privatisation of many services locally and nationally.
The Health and Social Care Act 2012 broke up the national system for needs-based health care planning in England, replacing it with a market model, which is destabilising and fragmenting NHS provision, AND which costs more to run than the public system. The NHS Reinstatement bill has cross-party support. It will restore the NHS as an accountable public service, where taxpayer’s money goes to care not profit.
Can we afford the National Health Service?
According to the national press, NHS trusts are running a deficit of anything up to £3 billion. Apparently, drastic action must be undertaken or services will break down as hospitals become bankrupt. In spite of this, the NHS is being made to find savings of £22 billion. Yet an analysis of the Department of Health’s latest Annual Report and Accounts by Health Care Audit, a group of finance and business consultants, show that the DoH does have adequate money to cover the deficit. They simply choose not to. Only one side of the finance story is being printed in our national papers.
We are the world’s sixth richest country. We CAN afford a comprehensive health service for all, which will maintain the health of the nation and contribute to our economic well-being.
What are Sustainability and Transformation Plans (STPs)?
In her speech introducing the bill, Margaret Greenwood MP explained:
“England has been divided into 44 areas, each of which is required to come up with an STP. The first priority for the STP is that Clinical Commissioning Groups and providers must cut expenditure, stay within budget for 2016-17 and continue to do so for the next 4 years in order to be entitled to access centrally controlled transformation funding. They will face tough choices – they could sell assets, cut services, ration services or actually charge for services. …. we can expect to see hospitals taking private patients to generate extra cash, putting NHS patients at the back of the queue.
The concept of a comprehensive service free at the point of use will be lost within a generation, and we will all face the real possibility of having to buy health insurance, just as people do in America.
….these hospitals are ours. They have been paid for out of our taxes and are run by our NHS staff – they are not the Government’s to give away. This bill provides a viable alternative to the current system.”
√ Yes to
Public ownership of NHS assets
Comprehensive care from high quality staff
Enough Doctors and Nurses to keep our hospitals open and safe
Legally protected from dodgy deals like TTIP
An NHS that’s for everyone without discrimination –its founding vision
Health Secretary has the duty to provide a comprehensive, secure NHS
X No to
Private companies cherry picking easy operations, quick procedures, easy cash
Competing NHS trusts, fighting off bids from private companies like Virgin
Longer waiting times; more bed closures, rationing of operations & aids
Dangerously underfunded emergency & maternity services
Expanding insurance based care
Last Updated on Monday, 19 September 2016 17:52
On Saturday 17th September, a few members of Stroud Against the Cuts travelled to the Health Campaigns Together conference on NHS 'Sustainability and Transformation Plans' that are being drawn up at present. The conference passed the following statement which summarises the issues. As soon as we are able we will publish some video from the conference on our YouTube channel. In the meantime please have a look at our tweets from the conference (including a clip from the speech by Shadow Secretary of Health Diane Abbott and comment by organisers John Lister and Tony O'Sullivan of Keep Our NHS Public).
Joint statement – Challenging the STPs
"As amended and agreed by 150 campaigners attending Health Campaigns Together conference, Birmingham September 17
As campaigners across England, we are sounding the alarm over the potential impact on health care services of the 44 Sustainability & Transformation Plans being drawn up in secret at the behest of NHS England.
Drafts of all 44 plans were submitted in July: but as of this weekend only 6 relatively complete drafts have been published – for North West London, Hampshire and Isle of Wight, Dorset, the Black Country, Wider Devon and Shropshire.
These plans all centre on achieving drastic “efficiency” savings, to stave off projected “gaps” between needs and resources reaching into hundreds of millions of pounds.
The North West London draft makes clear that most of the core savings are to come from old fashioned cuts – closing hospitals, centralising services, squeezing more “productivity” from already hard-pressed hospital staff, redundancies and dumping more unpaid tasks onto GPs and primary care services, as well as onto family carers, overwhelmingly women.
The proposed new models of “out of hospital care” will also open the door to selling off NHS estate to fund the NHS deficit, as well as further privatisation – contracting out for US-style “accountable care partnerships” and for “Multispecialty Community Providers”. We do not oppose genuine integration of health and social care but reject any moves towards “innovations” that involve replacing highly trained professional staff with fewer, cheaper, lower skilled staff, or contracting out or privatisation of health care provision. We note the current disastrous fragmentation, underfunding and widespread privatisation of social care, making a comprehensive integrated service impossible.
We note the impact and partial victories that have been won by broad-based campaigns in various areas – defending Manchester mental health, in Shropshire challenging the ‘Future fit’ proposals, in Staffordshire & Cambridgeshire exposing “lead provider” contracts, in NW London linking with two boroughs to fight closures, and more – and the success of campaigners in mobilising large protests in Bristol, Huddersfield, and Banbury.
We welcome the courageous stand that has been made in NW London by Ealing and Hammersmith & Fulham councils, refusing to sign up to an STP that would close important local hospitals – and urge other local councils to take a similar stand wherever services are at risk.
The relentless squeeze on funding, initiated in 2010 by George Osborne, is set to continue until 2020, freezing health spending in real terms and effectively each year falling behind the increases in population and upward cost pressures on the NHS.
The delegates here oppose the STP plans as fundamentally flawed, driven by cuts and by undemocratic NHS managers. We believe they will further fragment and privatise the NHS. We call for:
- The full re-instatement of a comprehensive, universal, publicly funded, publicly owned, publicly provided and publicly accountable, national health service which is free at the point of use and has the resources needed to provide excellent health care for all on a long term, sustainable basis.
- Immediate publication of all 44 draft STPs and a full and comprehensive public consultation on their proposals
- A halt to the cash squeeze and for additional government funding, from progressive taxation, to restore the real terms budget of the NHS.
- Councils to refuse to sign up to STPs until a satisfactory conclusion to the public consultation is reached, and work with the local public to develop clear red lines around all NHS services.
We will seek to work cooperatively:
- With trade unions and other partners to increase the level of awareness among health workers, professional bodies and health trade unions of the dangers of STPs. It is clear from the STP Drafts that the bulk of future savings are to come from closures, job losses and further demands on NHS staff, whose real terms wages have already been reduced by upwards of 16% since 2010.
- With broad based campaigns within communities, encouraging links with health workers in hospitals, primary care, community and other settings in defence of their jobs, pay, safe staffing levels and conditions.
- With political Parties at local and national level to build active campaigning. We will build STP Watch as a resource and build the broadest possible united campaign to prevent STPs undermining access to local services and the quality and quantity of health & social care for all.
We will organise a national day of local action in opposition to STPs.
We also support the struggle of the junior doctors against the contract being imposed on them by NHS England. They are in the forefront of the fight to defend the conditions of service of all public sector workers within the NHS.
STP Conference, Health Campaigns Together.
September 17 2016
Last Updated on Monday, 19 September 2016 18:31
Stroud Against the Cuts member Caroline Molloy submitted questions to the Gloucestershire County Council meeting on Wednesday 14th September. The same council meeting featured a debate on this topic prompted by a submission of petitions seeking to retain 24 hour opening at Stroud and Cirencester MIUs totalling 5,345 signatures (read more about Stroud Against the Cuts' position in our submission to the Gloucestershire Care Services' Review of Minor Injuries and Illness Units). The answers have now been published (see the full set of public questions and answers via a PDF)
Question: Minor Injury Unit proposed closures, Sustainability & Transformation Plans.
Gloucestershire’s emergency services have already had cuts to Cheltenham A&E provision. We now face proposed widespread cuts to district hospitals acute/urgent provisions, AND a separate Out of Hours healthcare review with no guarantees that the same level of local service provision will be maintained, AND a separate ‘Sustainability and Transformation Plan’ being prepared now, in unminuted meetings of chief executives and so on, which is explicitly about delivering £100s of millions of cuts to NHS services locally as part of the Five Year Forward View. Whilst recognising the short term issue is one of staff shortages, and pressure from central government to come up with heroic levels of savings, I would like to ask the council's position on the following:
1. The Kings Fund have said “major acute sector reconfiguration rarely saves – and frequently costs – money, and sometimes also fails to improve quality”. The Kings Fund has also said: “Some reconfigurations make bold assumptions about managing demand and reducing length of stay. There is certainly scope to do this but experience suggests it is difficult and that unless very significant reductions in overhead costs can be made, it cannot be assumed that out of hospital alternatives are any cheaper. The direct costs of hospital care may in fact be lower unless significant costs can be shifted to carers or social care – neither of which are easy. In any case, switching to community settings just to save money risks increasing the burden on carers and adding to pressures on social care services, or disguising what are effectively poorer quality services”. Can the council advise how these risks will be avoided?
ANSWER (via Cllr Dorcas Binns): Acute Sector reconfiguration is something which the council has been a consultee on in the past, and where, in the case of Cheltenham Accident and Emergency night time closure, councillors have expressed concerns. Ultimately, however, these are matters which the council has no power to decide, and are the responsibility of the NHS
2. Nigel Edwards of Nuffield Trust said this month that healthcare senior financial managers think there are “big risks around implementation and governance” of these Sustainability and Transformation Plans and adds “Later in the process, some of the proposals may come as an unpleasant surprise to patients and communities.” My research into these plans nationally leads me to fear the closures of minor injury units at night, coming on top of the Cheltenham A&E downgrade and as yet unspecified further cuts to face to face healthcare services and units in Gloucestershire as part of the Sustainability and Transformation Plan, threaten the long term survival of many of our district hospitals. I fear they become nothing more than glorified nursing homes/pharmacists - or flogged off and sold for housing. Can the council guarantee that we will not lose our district hospitals, as full hospitals with medical beds and acute treatment options? What will it do to make sure this doesn’t happen?
Answer (via Cllr Dorcas Binns): The Council does not control the NHS. Questions about their future plans should be addressed to Gloucestershire Care Services NHS Trust.
3. What opportunity have councillors had to see the Sustainability and Transformation Plans as they are developed (drafts submitted to NHS centrally in Jan, April and June)? Does the council feel it has been able to fulfil its democratic obligations to represent the public, given the widespread criticisms of this planning process?
Answer (via Cllr Dorcas Binns): Gloucestershire’s STP is the responsibility of the NHS, rather than the County Council, although we do input into them, particularly on issues like adult socialcare, which are our responsibility. I expect that the NHS will publish the plan when it is completed, but it would be unusual to publish a document in draft. No doubt when it is published they will invite a wide variety of stakeholders to comment, including councillors.