Professor Ray Tallis of the Stockport NHS Watch Group, will make a presentation the Scrutiny Committee to highlight the group’s concerns about the effect of Government policies on the NHS, and about the transfer of care into the community.
Officer contact: Jonathan Vali, 0161 474 3201, jonathan.vali@stockport.gov.uk
Minutes:
Professor Ray Tallis, Emeritus Professor of Geriatric Medicine at Manchester University, attended the meeting to represent Stockport NHS Watch and to make a presentation to the Scrutiny Committee highlighting the group’s concerns about the effect of Government policies on the NHS, and about the transfer of care into the community.
The presentation covered the following areas:-
· The background to the NHS Watch group.
· The perceived threat to healthcare in Stockport from underfunding, reorganisations, loss of accountability and privatisation.
· The ‘attack’ on the health and wellbeing of residents in Stockport through staffing reductions and bed closures at Stepping Hill Hospital to address their budget deficit; concern about the plan to reduce the size of the hospital, and the role of KPMG; concern that the Stockport Together Business Case could mean reductions in outpatient and GP appointments; a £130m cut in health and social care up to 2020.
· The ‘attack’ on capacity to scrutinise changes through ‘spin’ of reductions as improvements in care.
· Concerns that little evidence that enhanced community care could reduce pressure on hospital; there was insufficient capacity for GPs and district nurses to provide this care; costs were often higher; exaggeration of the problem of inappropriateness of elderly patients in hospitals was ageist.
· In relation to the proposed Multi-Specialty Community Provider (MCP), no evidence that integration will reduce costs or improve care for some time; could block access to specialist medical care; centrality of GPs to the model but these already under pressure.
· The development of the Stockport Together and other programmes was surrounded by ‘spin’, was blurring the lines of accountability, with insufficient consultation, and leading to potential for privatisation of public services.
· Concerns about the process for developing Sustainability and Transformation Plans (STPs) and the danger of no clear definition of mandatory core services.
· The Scrutiny Committee should be worried by reorganisation necessitated by progressive under-funding; evidence base was lacking; cuts being spun as improvements; threat to comprehensive care free at the point of need; increasing privatisation inevitable; distance from government responsibility.
· Examples where local authorities had resisted the development of STPs and used the powers of Scrutiny Committees to delay cuts.
The following comments were made/ issues raised:-
· The underlying issues and concerns in the presentation were recognisable to the Committee.
· Providing effective health and social care also required prevention and public health, which some people did not appreciate, and these services had also been subject to financial reductions. Also important was social care, and the funding challenges were not confined to the NHS but also for social care.
· Concerns were expressed about the work of NHS Improvement with Foundation Trusts with financial challenges, and whether this was sustainable change or whether it would lead to sub-optimal or negatively impacted outcomes. It was queried whether sufficient independence was given to the Trusts involved to make genuine and meaningful change. Consultants were often taking money out of the system without providing effective solutions.
· Concern was also expressed about the potential negative impacts of the creation of a large Greater Manchester Health Trust that might subsume local Trusts.
· In order to affect proper transformation, there needed to be sufficient resources in the system.
· Good community care was not a cheap option, and the changes proposed locally would take time to implement but would ultimately prevent more costly hospital care.
· The challenge was in addressing shortfalls in core funding, and local solutions needed to be found, and where energies should be directed.
The Director of Public Health (Dr Steve Watkins) responded to the issues raised in the presentation. He acknowledged that the funding for the NHS was insufficient, and highlighted a range of evidence for this view. In particular he emphasised the cuts to funding for public health and prevention which he believed to be short-sighted. He also agreed that there was no evidence that marketization within the NHS was more effective, and in fact evidence suggested the contrary.
In relation to the MCP, Dr Watkins stated he disagreed strongly with the suggestions in the presentation. He emphasised his belief that a publically accountable organisation responsible for health and social care in Stockport would be best placed to apportion resources to where there was greatest need and fund the most efficient ways to do this, and that Stockport Together was the best way achieve this given the framework partners were operating within.
The Executive Councillor (Health) (Councillor Tom McGee) responded to the issues raised in the presentation. He also acknowledged concerns about funding and emphasised the challenges across the health economy. In relation to Stockport Together, he stated that this programme had begun prior to the ‘Devo Manc’ agenda. He acknowledged that the programme was not simple, and that further challenges would be faced in its implementation but emphasised that ‘doing nothing’ was not an option. It was hoped that because partners in Stockport had voluntarily embarked on a transformation programme, this would avoid the worst requirements of the STP and that partners were ‘in charge of their own destiny’. To abandon the Programme would leave a £13m shortfall in the Adult Social Care budget. It was also acknowledged that although the Programme was moving quickly, this was because of the need to address the significant challenges.
In relation to the potential involvement of private sector organisations in the future MCP arrangements, Cllr McGee commented that it would not be sensible to rule this out as there may be need in the future.
Cllr McGee also acknowledged the accountability challenge presented by the MCP, and gave assurance that partners were working to address this, recognising that there was a fundamental necessity to retain democratic accountability.
The significant challenge caused by the shortage of care beds in the community was also highlighted, although it was emphasised that this was not because of the desire to discharge hospital patients who were ill but for those patients who were well but could not safely be discharged.
Cllr McGee acknowledged that there were views opposed to the Stockport Together plans and the changes this would entail, but he stated that he firmly believed that doing nothing would lead to a worse outcome.
In response to the comments raised, Prof. Tallis acknowledged the value of prevention, but emphasised the longer term timescale of its impact; agreed with the suggestion that integration of health and social care was desirable but stated that the MCP model would only work with more resource, rather than less. He further acknowledged the crisis in social care beds. He also asked the Scrutiny Committee to recognise that the primary driver for this change was budgetary, and the danger that the pace of change would jeopardise care. Prof. Tallis emphasised the moral issues at the centre of this debate.
The Chair highlighted the common concerns between councillors and Stockport NHS Watch, in particular in relation to funding.
RESOLVED – That Professor Ray Tallis and the Stockport NHS Watch be thanked for their attendance and presentation.