Baroness Jane Scott, leader of Wiltshire Council, believes that the latest reorganisation of the NHS has already taken a wrong turning – concentrating too much on finances and not enough on making services meet changing populations and medical conditions.
The scheme joins Bath-North-East-Somerset, Swindon and Wiltshire into one NHS area to plan ahead for five years. These areas are called ‘footprints’ and ours is known for short as BSW.
She told Wiltshire’s Health and Wellbeing Board (April 14), which she chairs, that at first she found the plans ‘quite exciting’: “But I actually think it’s gone backwards. There is nothing about children – our health service starts at pre-birth. We’ve missed a trick – the brief has changed.”
“It’s a great shame – there’s no point whingeing – it’s where we are – and we must get on with it.”
Jane Scott also had to face the fact that the Health and Wellbeing Board’s role in this new scheme has been downgraded: “We thought we were going to be a lead, but now we’re only a consultee…our role is not as strong as it was going to be originally.”
Several people at the meeting were aghast at this new project’s name: The Sustainability and Transformation Plan – or STP for short. Laughing, Baroness Scott said that it sounds like a sexually transmitted disease – agreeing with Marlborough.News‘ earlier report.
This reorganisation inserts an extra layer of bureaucracy and planning above CCGs – some people are likening it to Strategic Health Authorities, which were killed off by Andrew Lansley. Until its plans win NHS England approval and a share of the £2.1 billion STP fund for 2016-2017, it appears it has to operate without a budget and on borrowed hours from leaders of its many member organisations.
The leader of the local group, James Scott, who is chief executive of the Royal United Hospitals in Bath, was not able to be at the meeting to answer these criticisms. But Deborah Fielding, Chief Officer of Wiltshire Clinical Commissioning Group (CCG), explained the ‘fast moving developments’ at the STP’s board meetings.
First, the board has grown in size.
Secondly it has decided that its number one target is the financial part of its ‘triple aim’ remit (improved health and wellbeing, transformed quality of care delivery, and sustainable finances.) This means giving preference to tackling the £140 million shortfall in government funding for the BSW area over the next five years.
This decision did not please Baroness Scott: “It’s stopped the T [transformation] side and is just worrying about the S [sustainability].”
Would the scheme shift decision-making away from local areas? Wiltshire CCG Chairman, Peter Jenkins: “There is a real worry it could lead to a change in where decisions are being made.” If the Health and Wellbeing Board feels threatened, so do the clinical commissioners.
This may partly be a fear that CCGs are fast losing their clout. But it is also a belief that NHS England’s imperative that the STPs should be “developing a shared vision with the local community” is simply unachievable.
It was also raised at the Health and Wellbeing Board meeting that the scheme might well undermine local democracy.
Everyone agreed that the tasks ahead for the STP were ‘difficult’ or ‘very difficult’. One major hurdle is the very idea of imposing new geographical boundaries.
When the meeting turned to primary care and the shortage of GPs, Baroness Scott made it quite plain that the priority was to make Wiltshire as attractive a place as possible for doctors to work and to live in.
So far STP meetings appear to be held in secret. Certainly NHS England cannot tell Marlborough.News whether these meetings are supposed to be public or whether minutes of them are available to the public.
Mental health services for young people
The Health and Wellbeing Board also heard a progress report on the transformation of mental health services for children and young people with £854,489 of new, ring-fenced money provided each year till 2020.
One of the doctors present reported a new peak in young people self-harming. This and other increasing signs of mental health problems among the young was stretching the service: “There’s a huge escalation from when we were young.”
Indeed it was said that “If we referred all those who self-harm, the service would fall over tomorrow.”
The were new difficulties for the service’s work in schools – 23 out of Wiltshire’s 29 secondary schools are now academies. As Wiltshire Council’s Julia Cramp put it: “Sadly when they are academies we can no longer go in a say what they should be doing.”
Academies do not have to say how much money they are spending on counselling and similar mental health services. It was suggested that if mental health care was re-badged as ‘child safeguarding’ it might still be possible to get full access to academies.
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