By Lawrence Dunhill, 23 January 2018
Unison has issued an indicative ballot asking staff if they are prepared to take industrial action. Staff concerns present further difficulties for a project which has already been scaled back from initial plans. Questions raised about projected reductions in hospital activity, as well as the involvement of the former chief of the UnitingCare Partnership. A vanguard project in Greater Manchester is facing a threat of industrial action by staff affected by the new care model.
HSJ has learned the Unison union, representing 230 council and NHS staff involved in the Stockport Together vanguard, has issued an indicative ballot asking staff if they are prepared to take industrial action.
Stockport Council staff are no longer transferring to the foundation trust
The staff’s concerns present further difficulties for a project that has already been scaled back from the initial plans to form a single accountable care organisation.
The partners, including Stockport Foundation Trust, Stockport Council and Stockport CCG are now working to establish integrated community teams working under an “alliance contract” between providers. The project has been allocated £23m of transformation fundingover four years by national and regional leaders.
However, union members are concerned about a planned expansion of unqualified support workers, as well as changes to hours and working practices that the union says are not being mirrored in surrounding services.
Questions have also been raised about assumptions made in the Stockport Together business case, which includes several ambitious projections around reductions in hospital activity (see analysis box), as well as the involvement in the project of the former chief executive of the failed UnitingCare Partnership in Cambridgeshire.
Wendy Allison, a regional organiser for Unison, said: “The staffing plans don’t involve reduction in staff, but there would be a higher proportion of non-qualified staff to provide social care packages and community care. This will mean qualified staff, more thinly spread will have to spend more time supporting colleagues.
“They’ve also been unable to evidence how other social care providers will lengthen their hours. There’s little point in having social workers, eg working until 8pm if they can’t commission a package of care until the following morning.
“You need home care provider offices to be open, home managers to be in all the time, the acute trust to make sure the right people are in.
They’re asking people to extend their operating hours when the services around them won’t be available. They need to devise a timetable that will involve all the partners in the borough.”
She said plans to transfer council staff into Stockport FT have been shelved due to concerns about the trust’s financial and operational problems.
Ms Allison also raised concerns that Keith Spencer, who has been involved in the project since May 2016, most recently as interim managing director, was previously chief executive of the UnitingCare Partnership. The company was formed by two trusts that took on a £700m contract for out of hospital care in April 2015, which collapsed after eight months due to financial difficulties.
The union believes there are “echoes of what happened in Cambridgeshire” with some of the work in Stockport, eg the financial planning; a “lack of understanding about services currently being delivered; and an unwillingness to take on board the legitimate concerns raised by staff”.
In a joint statement, the council and the trust said: “We have recently concluded a consultation exercise with around 600 community adult health and social care staff regarding changes to working patterns to enable the provision of services across 7 days. This will see more of our services provided over weekends and extended hours in the week.
“This is part of the significant investment that is being made in local services as part of our integration programme, and improving the community service provision so our patients can have more care at home, rather than in hospital.
“We are working with trade unions and staff concerned to try and resolve the concerns that they have expressed about these proposals, and very much hope this can be achieved.”
The indicative ballot closes on January 26.
Tim Ryley, strategy director at Stockport CCG, said of Mr Spencer, whose contract ends shortly: “[He] has been part of a big team and we see his experience in Cambridgeshire as an asset. He’s provided real drive and energy to get services integrated and delivering effectively.
“What went wrong in Cambridgeshire was largely down to the single contract that was put in place between the commissioner and the providers… We have not rushed into anything and we are doing this on an alliance model basis ensuring the continuing involvement of all the partners.”
Analysis: The vanguard’s business case
The economic business case for Stockport Together, which is partly based on modelling by consultancy firm PwC, estimates enhanced community services can lead to several large reductions in acute activity.
The reductions are expected to deliver recurrent savings of almost £40m by 2021.
They include a projection that overall accident and emergency attendances for the Stockport CCG population would drop by 23% by 2020-21,
compared to the 2016-17 baseline (representing a 32% reduction against expected activity growth in the “do nothing” scenario).
Most of the reduction was expected to be delivered in 2017-18 (18%), but in the 9 months to January 2018, attendances have increased compared to the same period last year.
Outpatient activity and non-elective spells are projected to reduce by 25% and 20% respectively by 2020-21 against the 2016-17
baseline (40% and 28% against expected activity growth in the “do nothing scenario”). Again, the reductions were expected to start
this year but NHS England data suggests activity has increased.
The business case says the non-elective projections drew on findings from the Fylde Coast vanguard project, referencing a 25 per cent reduction in non-elective admissions and a 19 per cent drop in A&E attendances. The
reductions achieved on the Fylde Coast have been within a subset of patients benefitting from the service, rather than the population overall.
Mr Ryley defended the projections, saying they were the result of an “in depth and rigorous piece of work from all the partners involved”, and said Stockport was starting from a “much higher base in terms of our A&E and
non-elective admissions so we think there is more scope for reductions”.
He said: “The numbers are up on A&E attendances and absolutely we haven’t achieved the scale of changes we would have wished for in the first year. Non-electives admissions are behind but length of stay is down.
“We’ve been successful in diverting patients from A&E into ambulatory care, which counts as an admission and is currently included within our attendance numbers. I think emergency bed days would be a better indicator of how we are doing there, and the impact on how we currently measure is being looked at across Greater Manchester.”
He said the partners “didn’t start out with a required financial savings target and go backwards”, but had asked “what it would be possible to do to improve the health outcomes for our communities”.