The future shape of NHS services in Sheffield

Sheffield CCG has been running a series of workshops in Sheffield entitled Changing the Balance - A 2020 Vision of Health and Social Care in Sheffield.

Changing the Balance - A 2020 Vision of Health and Social Care in Sheffield; (Health and Wellbeing Board) The notes of the first 2020 vision meeting in May are here. There are further similar events coming up on 12th August and in early September. See here. The introduction highlighted an expected £65m funding gap for the NHS in Sheffield by 2020 and set increasing demand caused by an ageing society, more long-term conditions and increasing expectations against supply issues: increasing costs of provision; limits to productivity gains; and reducing public expenditure. On an electronic poll most participants agreed that the NHS had to change but the changes were all discussed in terms of improving services within the current context of public provision and increased VCF participation.

This is certainly not the case in most areas outside Sheffield especially for those CCGs and parts of NHS England for whom only the private sector can deliver more cheaply and for those who continue to drive moves to an insurance based system (which the forms of Simon Stevens' Five Year Forward View' fit nicely). Sheffield may be one of the few places where there is still sufficient expertise, resource and collective commitment to make a realistic stab at delivering on its joint strategies but the history of attempts to make savings through integration, moving services into the community, increasing productivity, seven day working etc is pretty grim. See this Morning Star article by John Lister of London Health Emergency.

None of Sheffield's current rush of consultations touches the overall shape of services, decision making and accountability. The position of the biggest provider, the Sheffield Teaching Hospitals Trust, which also runs many community services, is difficult to assess and, for the first time, it expects to report a deficit this year because of the national tariff reforms. The Health and Social Care Trust is so concerned at the erosion of what others think of as its 'non-core' care services that it is considering setting up a company to bid more cheaply.

but things must shortly come to a head as the city-region faces up to George Osborne's challenges about devolution and his demand for a local decision before his autumn financial statement. Both the CCG and the Trusts are joining wider groups of similar bodies to make more regional decisions. Could 'local' (i.e. sub-regional as opposed to national) decision making (let's leave the mayor question for the moment) help Sheffield become safer in trying to pursue a continuation of publicly provided services or will the region be cast off with limited budgets, internal squabbling about financial allocations, unaccountable local processes and the final condition that the Secretary of State can prevent any action which he or she dislikes? And does devolution of NHS services itself mean the fragmentation of the NHS as a national service? The issue of localism in the NHS has tended to surface only in terms of the postcode lottery. The Medical Practitioners Union is one group arguing that moves to localism only make sense in the context of restoring the Secretary of State's duty to provide a comprehensive health service, but that won't happen for at least five years now. There is also widespread concern that this will mean local government and local politicians controlling NHS spending See John Lister again.

Locally Sheffield for Democracy has over the last year been raising significant questions about the format of the city region and its decision making, and is now taking these concerns into the devolution debate. SSONHS will also be tackling these issues in the coming weeks and raising questions for the CCG, the Council and other relevant bodies.