Questions are raised locally about the latest reorganisation plan for the NHS in England
The 'backdoor' reorganisation of the NHS in England goes - as Marlborough News Online has reported - by the cute name of the Sustainability and Transformation Plan. It has already been responsible for putting two more NHS acronyms into the mix - its very own 'STP' and our local-ish 'BSW'.
BSW stands for Banes (already the acronym for Bath and North-East Somerset), Swindon and Wiltshire. Those three local authorities and the three Clinical Commissioning Groups (CCGs) that sit within their borders, will form the STP 'footprint' that will provide a larger chessboard for health service decision-making.
Larger scale commissioning and organisation will, it is said, be more efficient and save money. The footprints include not just commissioners and local authorities, but also acute hospitals.
It was confirmed at the Wiltshire CCG board meeting (March 22) that James Scott - the chief executive of Royal United Hospitals in Bath - will chair the BSW STP. He is a history graduate with long and senior experience as an NHS manager. He has been chief exec at RUH since 2007 and before that was chief exec at Yeovil Hospital.
The outline aims of the BSW STP (just get used to it!) were presented to the board meeting. They are heavy on action words and abstracts like 'vision'. They are all about closing gaps in three main targets areas: health and wellbeing, care and quality and finance and efficiency.
The board was told by the their chief officer, Deborah Fielding, that behind those aims there was an ambition to 'change the infrastructure - across all partners': "Only by working together and with the three councils can we make the transformation. The timescales are not in our favour - it is being rushed through like an express train - all ridiculously tight."
Talking to people involved, it must be said quite clearly that not everyone likes STP or thinks it can work. For a start it is side-lining the CCGs. And in the process it is seen as side-lining the clinicians - the very people the Lansley reorganisation put into the commissioning driving seat.
It is, in its present state, simply inserting another layer into the NHS structure and so demoting CCGs. This, one senior NHS executive (not in Wiltshire) told me, is "adding duplication and will create confusion" and, she added, it appears to be undermining the locally targeted commissioning that many CCGs - including Wiltshire's - are so keen on.
At the board meeting, Dr Richard Sandford-Hill, who chairs the CCG's West Wiltshire group of practices, wondered whether James Scott might not be 'best placed' to chair the BSW STP: "I think we need GP and secondary care clinical input. Is James Scott going to take the clinicians with him?"
To which the CCG's finance director, Simon Truelove, responded: "It has to be clinically led. Without them you have conversations and it doesn't get delivered."
He added: "There has to be one message from the top - if NHS Improvement are saying one thing to one part of the system and one thing to another - it will fail."
While Dr Chet Seth (of the CCG's Sarum group of practices) thought that the CCG would have to use the STP to its advantage, he added: "If we don't work with clinicians we won't ever get care in the community."
Getting care out of the acute hospitals into the community and closer to people's homes remains the CCG's great aim. And it is now seen as a financial imperative: "We've got," said a CCG executive, "to stop so much of our finances going to the acutes."
This will lead to some interesting exchanges in the STP 'footprint' meetings which will include the three acute hospitals - Great Western, Royal United and Salisbury -which serve the three CCGs which have now been yoked together.
Rescue plans for NHS finances?
No new money for the NHS was announced in the Chancellor's budget. In 2015-2016 many providers have overspent to protect quality and safety, and their collective deficit is expected to reach £2.8bn by the end of the financial year.
There is a much talked about risk that the Department of Health may breach its budget for 2015-2016 - this would mean that the overspend would be deducted from the promised funding for next year (2016-2017.)
In a desperate attempt to avoid an overspend, the Department of Health are paying the big four accountancy firms to search twenty NHS organisations to see whether they can unlock money being held through 'overly prudent' accounting practices such as provisions for restructuring.
One of the drains on Department of health budget is the NHS England plan to rescue shore-up the finances of the country's overspent hospitals. Great Western Hospital has signed up to the Sustainability and Transformation Fund (NOT to be confused with the S&T Plan.)
GWH will receive £8.9m. And the CCGs are involved - just - in the payment of this money.
The GWH will have to earn this money by submitting quarterly improvement milestones in such areas as reaching cost savings, access targets (like the A&E waiting time target) and the transformation of its services. These have to be approved by NHS Improvement, NHS England, the Department of Health and the Treasury.
The CCG cannot add any conditions of their own. The CCG will act as a route for payments - as the Department of Health is not allowed to pay money directly to providers. Just another task for the CCGs at a time when they are trying to cut their own bureaucracy.