North Yorkshire County Council’s health watchdog has raised serious concerns about National Health Service planning which threatens to marginalise the health needs of rural communities.
The Council’s Scrutiny of Health Committee members expressed their misgivings after meeting to consider NHS planning guidance for the next five years.
A key part of the guidance centres around Sustainability and Transformational Plans (STPs).
These place based plans divide North Yorkshire’s clinical commissioning groups into three urbanised regions for the delivery of health care services:
West Yorkshire (11 CCGs to include Harrogate and Rural District and Airedale, Wharfedale and Craven CCG);
Durham, Darlington, Tees, Hambleton Richmond and Whitby (6 CCGs);
Humber Coast and Vale (6 CCGs to include Scarborough and Ryedale CCG and the Vale of York).
Councillors have warned that STPs, which will become the funnel for funding transformation in health services, could concentrate spending in more densely populated urban areas. Healthcare services in North Yorkshire should not, they have stated, be unduly influenced by the challenges faced in providing services in the urban areas of Middlesborough, Leeds, Bradford and Hull.
Committee Chairman, County Councillor Jim Clark, said: “The challenges in these areas are entirely different to those of providing services to the rural and remote communities of North Yorkshire where we have a reliance on medium sized district hospitals, a history of the NHS financial deficits, low local government funding settlements and an underinvestment in community health services.”
In a letter to Moira Dumma, local team director for NHS England for Yorkshire and the Humber, Cllr Clark has warned that North Yorkshire’s challenges, which were due to factors associated with sparsity, risked being exacerbated under these new arrangements as funding would be further syphoned into urban areas.
He also warned that while the Committee supported the priority given to improving performance in acute services and their cost impact, members needed assurance that the importance of maintaining a whole-system approach “across all aspects of care, prevention and public health, primary care, community, hospital care, mental health and social care” received a fair share of funding through the CCGs “to address the challenges in this county.”
Members fear, he writes, that these new place planning arrangements will moreover threaten democratic accountability, creating yet another tier which “sits outside local and county-wide accountability arrangements”.
By contrast, Cllr Clark states, the NHS place planning guidance presents opportunities to develop new integrated models of primary care which would be local to where people live. These would help reduce referrals into secondary care and acute services. In this respect North Yorkshire was already pointing the way through its Public Health and Stronger Communities teams which work closely with community and voluntary groups to take a greater role in direct service provision through active citizenship. Greater emphasis on primary care and a less clinical approach would build on this greater emphasis on social and emotional needs “which are important to all of us, particularly for people with long term conditions.”
Cllr Clark said: “I hope these views expressed in my letter will be taken on board by the NHS. It is crucial that the health challenges faced by rural communities are not overlooked in these new place-based arrangements and that on the contrary, opportunities are created to enhance and extend into other areas the excellent, innovative and community approach to delivering primary care services currently being developed in North Yorkshire.”