Cheshire and Merseyside Sustainability and Transformation Plan

http://pdfsr.com/pdf/final-cheshire-merseyside-stp-21-oct-submission-version-3.3-26oct2016-copy-2-.pdf

Cheshire and Merseyside
Sustainability and Transformation Plan 
October 2016

A plan for Cheshire and Merseyside - from Crewe to Southport, Macclesfiled to Chester. This hardly maps onto any clear elected agency and it's hard to decipher just who is accountable for the plan (STP) for all its radical implications. It is the product of a network of (people seconded from) agencies (of many very unequal sizes) and it states an awareness of public concern and even opposition to change, with an intention to engage actively in seeking public support or understanding, but it all has the wispy air of virtual reality, a project team that could be disbanded tomorrow as though it never existed. It insists that all budgets and all practical actions will fall to local level agencies, not to the higher level virtual body making the plan, so again it seems likely that the public will only encounter this plan at that local level as it affects specific services - but of course a regional plan cannot be understood in that way. It is like the toes of an elephant. Maybe someone can explain "governance" who is better informed about NHS structures.

The plan boldly declares it will address key health issues and forces for change. Obviously any organisation must adapt to its changing environment. However, the items listed really are in the environment and not particularly within the scope of the health services to do anything other than respond intelligently and flexibly. What are they? The ageing population - not a surprise, we knew about this decades ago and discussed its implications decades ago. Rising alcohol related illesses - the unsurprising consequence of changes in the way alcohol is sold and consumed. Teenage pregnancy - a shameful product of insipid if not totally absent sexual health education, alongside the impacts of sexualisation in the media of all forms and the counter attacks against feminism. Obesity - the plan omits mention of the food industry and does not address school sports, leisure facilities or the impact of a stressful and harmful workplace environment, and is therefore unlikely to change anything whatsoever. The slimming industry has prospered with the food industry (the owners are sometimes the same) selling remedies that fail consistently and predictably and profitably. Diabetes and its related woes - see obesity but notice that the popular delusion that obesity = diabetes is dishonest, false and offensive, while distracting from the real health issues. Will the NHS really take on this rising tide effectively and who is listening? I suggest that as long as these issues are identified as problems for the NHS to solve, then the only solution is to fund additional services for a growing demand. Is someone really suggesting that the health consequences of social inequality - that is what they really represent - are not in fact going to be ameliorated by a responsive health service? (I suggest that is the case).

The "do nothing affordabiility gap" is said to be £908m but - and this may be my failing - there is no total expenditure figure and no comment of what proportion of the total this gap represents. I find absolute numbers like this hard to evaluate. The "do something" plans to save money are summarised in a table on page 50 in a graph that means nothing because it is entirely abstract. Money willl be saved through "Transformation" or through "Speciality Commissioning" etc. What matters to me is that the savings are not identified as resulting from one of the strategic issues identified earlier - for example, how much will be saved through prevention of teenage pregnancies, how much through alcohol harm reduction, how much by preventing or curing obesity, how much through stopping people from growing old? Is that because the savings will have to come from the blindingly obvious places, the places where money is spent, without regard to the wish fulfilment and fantasy of a plan to overcome social inequality with an NHS pill?

Perhaps the biggest risk identified in the plan (but perhaps understated) is this - in order to save money by transforming services and innovation we need to invest in our new priorities, we need additional capital which is not on offer at all, while even the process of putting together a credible plan capable of even opening a debate on the complex issues involved itself consumes the limited time available in which savings must be made. We have no time to plan, and no time for public consultation, because whatever decisions must be taken in order to achieve massive savings in a terribly short space of time (five years is only a long time to a politician) those decisions must be taken this year, by the random bunch of people able to spare the time from their other urgent duties, not least providing health care now. And nobody has yet discussed the disrupting effects of change - even in a well managed and well resourced programme they can be serious, but in the chaos that is a financially driven crisis, this entirely top down process -- the type we were promised would not happen again - is going to cause severe problems. Finally, the whole point of identifying risks in a plan, who do we turn to when the plan goes wrong? See governance above.