Open Letter to Gloucestershire County Councillors regarding our concerns about the NHS 'Sustainability and Transformation Plan' for Gloucestershire
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
Questions for Gloucestershire County Council on the future of local NHS services
Last Updated ( 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.
Support the NHS Reinstatement Bill (in Parliament on Nov 4th)
Last Updated ( 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
Our Submission to Gloucestershire Review of Minor Injuries and Illness Units in Gloucestershire
Last Updated ( Wednesday, 07 September 2016 12:25 )
Below is the letter we sent to Gloucestershire Care Services (GCS) as part of their Review of Minor Injuries and Illness Units (MIIUs) in Gloucestershire. The public engagement period concluded on Wednesday August 31st, and a final decision on new - reduced - opening hours at local MIIUs will be made at the next board meeting of GCS (the next Board Meeting of Gloucestershire Care Services NHS Trust will be held on Tuesday 20 September 2016 at the Stroud Subscription Rooms, George Street, Stroud. The meeting will run from 1.45pm). The letter includes questions we have requested answers to under Freedom of Information, and was also sent to Gloucestershire Clinical Commissioning Group.
Wednesday 31st August
Paul Jennings, Chief Executive Officer of Gloucestershire Care Services and Mary Hutton, Chief Officer of Gloucestershire Clinical Commissioning Group
Re: Review of Minor Injuries and Illness Units (MIIUs) in Gloucestershire, including reduction in opening hours of Stroud MIIU
Dear Mr Jennings and Ms Hutton,
We have been troubled by the recent sporadic overnight closures of Stroud (and Cirencester) MIIU, and are not reassured by statements in the booklet that the proposed changes in opening hours are related to a “lack of available staff”, and “attendances between 11pm and 8am [being] comparatively few”. We would like to express our strong disappointment that 24 hour opening is not an option for Stroud or Cirencester. We do not believe you have public support for removing services unless you have shown how other local services will fill the gap, or at least until you have explained in detail what impact of a reduction in opening hours you expect on the emerging chaos and crisis in urgent care in Gloucestershire, and what steps have been taken to mitigate this.
As such, we would like clarity regarding the impact of these changes on other local healthcare services. The booklet states that “this review does recognise that by reducing access to MIIUs, there may be some additional minor pressure upon other parts of the urgent care system: this impact has already been discussed with the Trust’s partners”. We believe it is essential that the outcome of these discussions is public. Specifically, we ask: what have Gloucestershire Care Services and the Gloucestershire Clinical Commissioning Group done to assess the impact of changes to MIIU opening hours on Out Of Hours and urgent care services in Stroud and Gloucestershire?
We note that local Out of Hours provision is already in turmoil, with the service having been closed for 560 hours at The Dilke, and 195 hours here in Stroud in a single year, and South West Ambulance Service Foundation Trust say they “do not believe we can continue to offer this service effectively, and within the current contractual constraints, the trust does not have the resources to improve the service to a level that is satisfactory for ourselves, patients or commissioners”. We further note that the relatively recent downgrading of Cheltenham A&E has predictably contributed to a worsening situation with regard to Gloucestershire Hospitals NHS Trust meeting its target to treat 95% of Accident & Emergency (A&E) patients within four hours, which has been missed every month for a year.
We believe there was a rationale for the Stroud and Cirencester service being open 24 hours in the past, or this would not be the situation prior to this review. Our position is that 24 hour opening is important to ensure universal provision that can catch occasional need and that it further provides important reassurance for the local population that care is available nearby if needed. It is clear to us that GCS itself felt 24 hour opening at Stroud was important when opening hours at the Vale Hospital were reduced in 2014, as Susan Field (then Director of Service Transformation) publicly stated at the time that this change was partly about “enabling us to keep the MIU service at Stroud General Hospital running 24 hours a day.” We would appreciate further detail on attendances over this time period and ask for data on full year attendances at Stroud, Cirencester, Lydney and the Dilke as individual MIIUs annually from 2010 to 2015.
We support the sentiment behind David Miller, Chairman of Stroud Hospital League of Friends, endorsement of Option 2 in your review, which would keep Stroud and Cirencester MIIUs open for the longest possible hours with least impact on other units, but also his comment in a letter to the Stroud New and Journal: “Ideally we would like to continue opening for 24 hours but if this is unacceptable then at least until midnight.” While we have been encouraging people to sign local petitions to make clear the level or desire for 24 hour opening and support for MIIUs, we understand that this has not been included as an option for a reason. Our desire is to make clear our opposition to the erosion of NHS services locally. We note that at time of writing 2,325 people have signed Liberal Democrat County Councillor for Cirencester Cllr Joe Harris’ petition to “Keep Cirencester Hospital open overnight”, and 700 people have signed the Labour Party petition online to “Ensure 24 hour, urgent care is provided at the Minor Injuries Unit at Stroud Hospital” – with around 1,000 more signing the same petition in paper form. Regardless of the reasons and the justification for them, we see these changes in opening hours as a cuts that undermine the NHS principles of universal, comprehensive, easy to access care – and as such we wish to convey our clear opposition to them. We do not wish to endorse options which involve a reduction in opening hours, nor can we support an outcome which preserves Stroud’s MIIU at the expense of services in other parts of the county. We wish to communicate our concern that people be expected to travel greater distances, which is expensive at best and out of reach to many who are unable to drive, or to afford taxi fares. We are troubled by the way in which GCS treats increased travel distances by suggesting that because “the two sites [in the Forest of Dean] are less than 9 miles apart”, “there is sufficient capacity to handle demand in just one of the MIIUs”, particularly given the difficulties SWASFT is having in meeting Ambulance response time targets and poor performance of the Non-Emergency Ambulance Service.
We hope our desire for the longest possible opening hours across all MIIUs is clear, despite 24 hour opening apparently no longer being possible. Nonetheless, we wish to emphasise our understanding of the importance of appropriate numbers of sufficiently qualified and competent staff. In Stroud Against the Cuts we have supported the 4:1 campaign that seeks mandatory minimum staffing ratios, and joined Sir Robert Francis in criticising the decision to halt work into safe staffing by the National Institute for Health and Care Excellence. We appreciate that “qualified nurses and especially Emergency Nurse Practitioners are in short supply nationwide”, but would request that GCS and GCCG make public statements regarding their understanding of the causes of this shortage and policies that can either contribute to help or hinder it in future. We note that, according to the Royal College of Nursing, pay has fallen by at least 14% in real terms thanks to the government's public sector pay freeze. RCN Chief Executive, Janet Davies, says the current shortage of nurses was “a preventable crisis, caused by years of cuts to student nurse commissions and a lack of long-term workforce planning. It could be worsened by the Government’s untested gamble with student nurse funding, which our members are clear will have a negative impact on the future supply of graduate nurses”. We believe that GCS and GCCG should make a clear statement that they oppose the changes to student nurse funding, and the imposition of contracts on healthcare workers outside of collective bargaining in general and specifically with regard to the current junior doctors’ contract – both policies which threaten to exacerbate staffing problems.
We would also like to know precise numbers regarding how many nurses have responded to recruitment offers by GCS in recent years, how many have been interviewed, and how many recruited?
The Gloucestershire Care Services booklet accompanying the review states that the proposals “are not about cost-cutting, as each option requires additional investment of between £210,000 and £460,000”. We would like to ask what period this additional investment applies to – is it annually or over a longer period? How does it relate to the existing budget for the MIIUs in Gloucestershire, and their budget in real terms over the past decade? Most importantly, we would like to ask about the future budget for Gloucestershire Care Services and encourage the Trust to state publicly any concerns about planned funding and demands for ‘efficiency savings’ over the next 5 years. In Stroud Against the Cuts, we fear for the future of local NHS services under the latest round of reorganisation and demand that Gloucestershire’s ‘Sustainability and Transformation Plan’ is made public as soon as possible, and GCS communicate swiftly any additional potential changes to either MIIU provision in the county or services at Stroud Hospital.
Finally, we note with disappointment that all the engagement events organised by Gloucestershire Care Services in Stroud have taken place during working hours and in the week, that they occurred with short notice, and that there was no advertising outside Trinity Church either before or indeed during the previous events. We would like to know how many people in total have attended these events as we believe it to be little more than a handful.
In summary, we would like responses to the following queries. Please treat these as Freedom of Information requests if necessary:
1. a) What has Gloucestershire Care Services done to assess the impact of changes to MIIU opening hours on Out of Hours and urgent care services in Stroud and Gloucestershire?
1. b) What has Gloucestershire Clinical Commissioning Group done to ensure a full impact assessment of changes to MIIU opening hours on Out of Hours and urgent care services in Stroud and Gloucestershire has been undertaken?
2. Please provide further details on numbers attending the county’s MIIUs from 2010 – 2015, broken down for Stroud, Cirencester, Lydney and the Dilke, by hour.
3. Please provide precise numbers regarding how many nurses have responded to recruitment offers by GCS in recent years, how many have been interviewed, and how many recruited?
4. What period does the “additional investment of between £210,000 and £460,000” cover? Is it annually or over a longer period? How does it relate to the existing budget for the MIIUs in Gloucestershire, and their budget in real terms over the past decade?
5. Please inform us of how many people in total have attended the engagement events in Stroud.
We also restate the following requests:
1. Please make public statements regarding GCS and GCCGs understanding of the causes of the MIIU staffing shortage and national policies that can either contribute to help or hinder it in future.
2. Please make a clear statement of opposition to the changes to student nurse funding, and the imposition of contracts on healthcare workers outside of collective bargaining in general and specifically with regard to the current junior doctors’ contract.
3. a) Please could you state publicly any concerns about planned funding and demands for ‘efficiency savings’ over the next 5 years?
b) Please make public Gloucestershire’s ‘Sustainability and Transformation Plan, or any aspects of it that relate to Gloucestershire Care Services.
Stroud Against the Cuts
| 07734 058789