The NHS in England is having a ‘top-down’ total reorganisation.
This is because of a government decision not to give it the regular annual funding increase it needs to stand still. Since the 1950s the NHS has needed an average of 4% extra funds each year to cover medical technology costs and a growing population’s need for services.
BUT – since 2010 governments have cut this from and average 4% to an average 1.1% annual increase.
Three years ago NHS England, that runs the NHS in England on behalf of the government, decided that to keep the NHS working and financially ‘sustainable’ in England there would need to be major ‘transformation‘ of how services are provided.
They produced the Five Year Forward View, a plan which described how the NHS could be run with hardly any extra money each year from the government, to help keep up with the usual increasing costs.
This extra money is needed for all the new technology now used for diagnosis and treatment and for all the extra illness that the growing population suffers from. However the government is refusing to give the NHS the money it will need for the next few years. So the NHS has to run much more cheaply.
You will have heard about the need for the NHS to save £22 million by 2020/21. This is the extra money the NHS needs (to meet the usual costs) but that the government is refusing to provide.
In England there are over 200 NHS commissioners, over 250 NHS providers, nearly 7,500 GP practices and over 800 independent NHS providers (including the private providers). There are also more than 350 councils in England, each providing social care and public health services.
SO – two years ago, to carry out their plan for more ‘efficient’ (cheaper) health and care services, NHS England told all these public bodies in England to reorganise themselves into just 44 areas across England. They were told to work together to decide how to deliver services in a cheaper way in their area.
This was a massive reorganisation that was imposed (i.e. ‘top down’), and it introduces ‘post code’ access to services and takes away the ‘National’ nature of the NHS , but without any legislation or Parliamentary debate.
And – a year ago, each of the 44 areas had to submit a plan a year ago – an STP, (Sustainability and Transformation Plan) that said how they would provide the services more cheaply in their area, for a much larger population and how they intended to change all their management and decision-making structures to make it happen.
Going Further Faster!
In June 2017 NHS England announced that 9 of the 44 areas will be given the go ahead to put their STP into practice – and to ‘go further faster‘ into an Accountable Care System. This means the public bodies in these 9 STP areas would now collaborate formally in a partnership way to start carrying out the restructure of their local services.
South Yorkshire & Bassetlaw STP was one of the 9 areas ‘going further faster’!
In South Yorkshire and Bassetlaw the STP, now an Accountable Care System (SYBACS), has to make £571 million ‘efficiency savings’ before 2021. In other words this is the money the NHS would normally be getting to cover increasing equipment costs and population need for services.
But remember this ‘efficiency saving’ is only being made by cutting back on service delivery costs so they don’t spend the extra money needed to pay for more people, with more illness, and more need for medical technology for diagnosis and treatment.
So how will this SYBACS involve us – the people of SYB?
In the eleven months since they submitted their STP the now SYBACS, has made many decisions – in secret – about the future of our local services. These decisions were made by NHS and Local Government Officers, at the SYB Collaboration Partnership Board, where the plans of how to make the changes were made. But there were no democratically elected councillors or MPs involved.
The public weren’t involved either – even though there is a legal duty for commissioners (those who plan and buy NHS services) to involve the public in their commissioning arrangements, plans, proposals for change and decisions.
The local Healthwatches have been sat around the table at the SYB Collaboration Partnership Board all this time, but they don’t share any of this information with the public. They also make little attempt to inform the public about it all or to find out what the public think, to allow them to represent any public concern when they sit at the ‘top table’ listening to all the proposals to change our local services.
There is now a plan to have five members of the public to ‘represent’ the rest of us on a Citizens Panel – that will be created to advise the SYBACS on ‘public engagement’. However these 5 people are not required to have any knowledge or experience of public involvement best practice, nor are they required to demonstrate how they can represent the wider public views.
This is not following the legal duty to involve the public, as there is no recognition of the need for these five people to have meaningful discussions with the public to enable them to “offer a fair reflection of the views of others”, which is what the law requires commissioners to do.
CCGs are the Clinical Commissioning Group responsible for planning and buying local NHS services. There are 5 CCGs in the SYBACS responsible now collaboratively, for the ‘system wide’ commissioning of NHS services planned to be happening by next summer.
The 5 public members on the SYBACS Citizens Panel are NOT required to have knowledge or expertise in public involvement best practice (a CCG legal duty) but they are appointed to ADVISE the SYBACS on public engagement!
There is no suggestion that these 5 public members are expected to be accountable to the public for anything they say on or behalf!
And HOW will the move from STP to ACS affect us?
The first thing we have noticed, as patient activists, is that the speed of making changes has stepped up and our local services will look totally different by this time next year.
- As patients and as carers we will need to travel ‘further‘ to be treated
- Many local services will be closed – once closed they will be difficult to reopen
- The hospitals taking more patients could become ‘overcrowded’ and ‘unsafe’
- There is a staff shortage so to treat everyone we will not be seen any ‘faster’
- The relationship and trust between patient & health professional could be lost
Many of the decisions have already been made and are already happening – or about to happen very soon:
- Barnsley Emergency Stroke service closed about a year ago
- Bassetlaw Children’s ward closed at night some time ago
- Much children’s surgery is to close in three of the five ‘places’ in early 2018
- There is no out-of-hours GP service in parts of Bassetlaw NOW – at all
The following decisions are already being considered and are planned before or by April 2018:
- Bassetlaw & Rotherham Emergency Stroke services will close too
- Many local hospitals’ overnight stays for ‘ Acutely Unwell Children’ will stop
- All local hospital services in SYB are being reviewed for ‘sustainability’ with a report in April 2018 on those services found to be unsustainable (to be closed)
WHO will be responsible if any of these changes go wrong?
The agreement for the former SYB STP now called the South Yorkshire & Bassetlaw Accountable Care System (SYBACS) excludes councils from decion-making – they only get to ‘agree the direction of travel’ of the SYBACS.
The SYBACS agreement also states clearly that it has no legal status but that the individual NHS bodies, specifically the Clinical Commissioning Groups, responsible for local NHS commissioning, carry all legal accountability, and liability.
The SYBACS (non-legal) agreement – the Memorandum of Understanding (MoU) – says:
“Our health and care organisations are already coming together to form partnerships in Place; integrating health and care, commissioning and providing, including voluntary, community, GP, mental health and hospital services. These are taking varying forms and the governance and how this best supported in an overall ACS will be a key priority in 2017/18 and will be an area for which we will receive national guidance and support.”
By PLACE they mean the 5 Council & CCG areas: Barnsley, Bassetlaw, Doncaster, Rotherham and Sheffield.
The MoU also says that: “All of this ‘pushes’ at the boundaries of the existing legal frameworks…”
THIS IMPLIES THEY ARE MAKING IT UP AS THEY GO ALONG!
BUT IN SECRET!
THE SYBACS IS DEFINITELY NOT PUBLICALLY ACCOUNTABLE!
Someone said – DONT GET ANGRY – GET ORGANISED!
So please join us and help us to tell the people of SYB what is happenning, how secretly it’s being done and how FAST!