Monthly Archives: November 2014
You Can Build Aircraft But Can You Treat Patients?
From the Independent
The Myth of Intgegrated Care
The NHS is expected to face a £30bn gap in its finances by 2020. Photograph: Graeme Robertson/Getty Images
KONP Updates 10/11/14
NHS finances ‘absolutely on the knife edge’. The health service is “absolutely on the knife edge” with no reserve left to cushion against unforeseen pressures, NHS England officials have warned. Speaking at the organisation’s board meeting yesterday, chief finance officer Paul Baumann said there was “no reserve left which will cater for things which we haven’t anticipated in the risk and mitigation analysis we’ve done”. He described 2014-15 as “the year in which we are absolutely on the knife edge of balancing or not balancing against the position we’ve got”. At month six he said the NHS was £184m off-plan, which accounted for 0.2 per cent of its total budget. The figures are “to be taken seriously, but not a vast deviation” from where the health service is expected to be”, he explained. Mr Baumann said the health service has “overall a good chance of squaring its [financial] position in most foreseeable scenarios through to the end of the year”. He said it was “really, really important that we contain our expenditure”, but “at the moment I can see ways in which it should be possible to do that”. “What I can’t guarantee is that there will be nothing that transpires between now and the end of the year that I wasn’t expecting, either in terms of activity trends going faster than we’ve got in the forecast, or any other calamities or disasters,” he warned.In other years it might have been possible to say don’t worry about that too much, because I’ve got a reserve over here of a couple of hundred million that will deal with the inevitable bumps and turns that the NHS throws up in the course of given year.
Bedford refuses to sign Circle MSK contract. An NHS hospital has pledged to compete with Circle Partnership, the private provider appointed to run Bedfordshire’s £120m integrated musculoskeletal service, after refusing to become its subcontractor, HSJ can reveal. Bedford Hospital Trust has refused to sign the contract after seeing the number of MSK referrals plunge 30 per cent after Circle took over the service in April. The trust claims the service’s arrangement “endangers the viability” of its trauma and accident and emergency services and could undermine its capacity to retain the seven trauma surgeons it employs. Circle was awarded the five year “prime provider” contract by Bedfordshire Clinical Commissioning Group in April. The deal consolidates 20 separate contracts into a single service and gave Circle the role of running it. Bedford Hospital’s board papers say it “would not be in the trust’s best interests to sign a contract without any mitigation to the consequent impact on trauma and linked services.The significant reduction in referrals since April, and associated potential loss of income (assuming these convert to elective work) mean a direct impact on the viability of the trauma service which in turn will undermine the ability of A&E to see and admit trauma patients,” they say.
The risk of fraud in the new NHS: lessons from the USA and the need for a response in England. The NHS’s embarrassing failure to prevent large-scale malpractice by Serco in its out-of-hours contract in Cornwall has raised in a very public way the question of the Department of Health’s strategy for countering the risk of fraud posed by contracts with private providers. The issue has been taken up extensively in the media, reinforced by the Home Office’s even more embarrassing failure to notice that Serco and G4S had billed it for almost £200 for tagging prisoners who had already been released or had even died. The Department of Health, however, has remained silent. In July the Health Service Journal reported, based on a leaked document, that the Department of Health was planning ‘to establish its own fraud investigation function by poaching senior officers from NHS Protect, shrinking the national body’s size significantly as a result’. But the Department declined to comment and has made no further statement on the issue. The Cornwall case, however, and the reported problems of quality cuts and overbilling in Serco’s contract for diagnostic tests at Guy’s and Thomas’ hospitals in London, illustrate the way opportunities for both errors and fraud become much greater with complex and lengthy contracts. This is especially true of contracts with multifarious performance requirements linked to payments, which are typical of NHS clinical outsourcing contracts. This creates multiple opportunities for mistakes to be made which can often lead to overcharging. However, added to this complexity is the influence of profit.
Third of CCGs have requested powers to police GP contracts. A third of CCG leaders have requested new powers to performance manage the GP contract, in a radical move that could see them taking contractual action against their member practices. A Pulse analysis of proposals submitted by 145 CCGs in June found that 32% had signalled they wanted to take on performance management of the GP contract. At least 15% of CCGs said they wanted to take over complete control of the GMS contract from NHS England and 60% said they wanted a role with regards to PMS contracts, including negotiation of terms and PMS reviews. The analysis shows that local commissioners across the country are keen to take control of huge chunks of the GP budget, when they are given the green light in April next year. NHS Leicester City CCG said that a survey of member practices and the public showed that 53% supported CCG taking on a performance management role and deciding on sanctions, while NHS Surrey Downs CCG said that ‘performance measurement tools’ would demonstrate that ‘new innovations are not impacting on core service delivery’. CCGs are expected to submit their final co-commissioning applications to local area teams in January, with the intention for level two commissioning to begin from 1 March and level three from April. But the Pulse analysis gives the first indication of what additional powers they may be asking for.
Virgin boss Sir Richard Branson bids to take over cancer and end of life care in NHS privatisation deal worth £1.2billion. Virgin boss Sir Richard Branson is bidding to take over cancer and end of life care on the NHS in a privatisation deal worth more than £1.2 billion, it emerged today. The tycoon is looking to secure a controversial £689 million contract to provide treatment for terminally ill patients at four NHS clinical commissioning groups (CCGs). It will be the first time cancer care in the NHS has ever been privatised and the move has been described as the health service’s biggest ever outsourcing of resources. The deal would see the private sector delivering all cancer and end-of-life treatment for children and adults across Staffordshire and Stoke on Trent. On Wednesday the four CCGs involved – which care for more than 767,000 patients – announced which organisations have pre-qualified for the 10-year contracts. Five bidders, including Sir Richard’s Virgin Care Ltd, have now been short-listed for cancer care-while seven companies, including Virgin Care Ltd, are in the running for end-of-life services.
Tuesday 11th November 2014
· Hinchingbrooke Hospital: Unison calls for health firm Circle to be ‘sacked’.
A union is calling on the NHS to end the controversial contract which put private health firm Circle in charge of Hinchingbrooke Hospital. Unison, the biggest health union which represents staff at the Huntingdon hospital, said Hinchingbrooke was facing penalty payments running into hundreds of thousands of pounds for missing targets. But Circle said the union had misinterpreted the figures and offered to meet representatives to discuss the situation. Tracey Lambert, Unison’s regional head of health, said: “It is time for NHS England to step in and sack Circle. The whole franchise has been a farce from the beginning. The franchising experiment is now damaging staff, patients and the reputation of a previously well-respected local hospital.” Circle was brought in to run the hospital which had been branded a “basket case” with £40 million debts. The union said papers for the Hinchingbrooke health trust’s October meeting showed potential penalties of up to £200,000 a month for failure to meet targets for patients waiting longer than four hours in the accident and emergency department, more big penalties for failing to reach electronic discharge summary targets which already stand at £138,000 and £150,000 for failing to increase the number of patients discharged at weekends. Unison said the trust estimated that contract penalties and deductions could add up to £1.6 million over a full year, a further £800,000 could be clawed back if the trust lost out on validation of invoices and that a rising caseload in accident and emergency could trigger more penalties. It said this could push Circle’s support payment above a £5 million ceiling which could trigger a renegotiation of the contract or Circle’s withdrawal. Unison also said that staff were demoralised and leaving, with a turnover of more than 13 per cent. It said spending on agency staff could reach £2.4 million by the end of the year. Unison is calling for the hospital to be taken over by the Trust Development Agency and returned to professional NHS managers. But a spokesman for Circle said: “We would be happy to meet with Unison as we are sure this is an honest misinterpretation of Circle’s track record.”
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· Private firms battling for £284,000,000 NHS deal for Huddersfield and Kirklees.
NHS activists in Huddersfield have said there “is no place for private profit in the provision of health and social care” and called on Kirklees and Calderdale councils to use their powers to stop the tendering process. A host of private health firms are battling for a £284m NHS contract for Kirklees. Greater Huddersfield Clinical Commissioning Group (GHCCG) and North Kirklees Clinical Commissioning Group (NKCCG) have embarked on a project to overhaul how health services are provided. They have now put out the multi-million tender for the so called “Care Closer to Home” community health services. NHS activists in Huddersfield have said there “is no place for private profit in the provision of health and social care” and called on Kirklees and Calderdale councils to use their powers to stop the tendering process. The new scheme will expand on the services currently provided by Batley-based community nursing firm Locala, whose contract expires in March next year. The CCGs held a “market sounding” open day for potential providers last week in a bid to probe what services could be provided as part of the £284m contract. The identities of companies competing for the five to seven year deal are not being revealed for commercial reasons. NHS organisations such as Calderdale and Huddersfield NHS Foundation Trust (CHFT), which runs the hospitals, are also allowed to compete for the lucrative deal. CHFT recently lost a contract to continue to run wheelchair services for Kirklees and Calderdale after it was undercut by private firm Opcare by several million pounds.
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· NHS facing £700m black hole over failing Better Care Fund.
A pioneering plan to save the health service £1 billion a year by keeping patients out of hospital has been branded a “shambles” after the Government’s spending watchdog found at best it would save less than a third of the amount projected at best. In a highly critical report, the National Audit Office said proposals to transfer nearly £2 billion of NHS funding to social care in a bid to reduce hospital admissions had been inadequately thought through and could have left the health service with a massive budget black hole. It added the plans had been based on “optimism rather than evidence”. Even after the scheme was redesigned to reduce the financial risk to the NHS, the NAO said it was still far from convinced that the Better Care Fund would result in its primary aim of reducing emergency admissions to hospital. The report is embarrassing for ministers as the Better Care Fund is seen as critical to the Government’s attempt to control rising healthcare costs, reduce waiting times for operations and plug the gaps in social care resulting from cuts to council budgets. But the NAO found early local plans for the fund, which will pool £5.3 billion of existing NHS and local authority funding from next year, would only deliver £55 million of deliverable financial savings compared to the £1 billion factored in by the Treasury.
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Campaigners are to erect estate agency-style boards across the country today, as part of protests against a controversial trade deal. Houses in nine constituencies will display the boards opposing the Transatlantic Trade and Investment Partnership (TTIP), which is currently being negotiated between the European Union and the United States. Groups, including the Royal College of Nursing, have previously claimed that the deal would lead to more privatisation of health services and argued that the NHS should be excluded from any agreement. In the latest move, campaign group People’s NHS has erected “stop the sale” boards. Spokesman Brian Colman said: “Thousands of households across the UK are delivering a clear message by raising ‘stop the sale signs’ outside their homes in protest over the sell-off of their health services and David Cameron’s refusal to veto the NHS from the dangerous trade deal called TTIP. David Cameron never told us on the campaign trail in 2010 that his party was going to embark on the mass privatisation of the NHS. The government had no mandate to sell off the NHS,” he said. “This is a clear message to our MP and to the government that it’s time to take the ‘for sale’ sign down from our hospitals and GP services and put our cherished NHS back into public hands,” he added.
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Practices will be awarded £15.87 per in-hours GP consultation and £60 per home visit for patients registered away from where they live, under the out-of-area registration DES. The enhanced service, designed by NHS England, will support the updated choice of GP practice arrangements that will be introduced from 5 January 2015. From this date, all practices will be able to register patients who live outside of their traditional boundaries, without being required to provide home visits or out-of-hours care. Practices will not be obliged to participate in the scheme, and will remain able to refuse registrations from out-of-area patients. They will also not be obliged to offer home visits for patients registered elsewhere. The GPC warned it had ‘lots of concerns’ about the plans and said practices would have to ‘carefully consider’ whether the remuneration on offer was ‘enough to cover their costs’. NHS England expects around 0.4% of the population – 200,000 people – to register with a practice outside of their local area, ‘although this might grow over time’. Any patient who requires ‘urgent and local care’ and cannot reasonably travel to their out-of-area practice will be able to access primary medical services nearer their home, under the new enhanced service. Practices participating in the DES will be expected to provide home visits to registered out-of-area patients in their appointed boundary area, where it is clinically required. If any practice chooses not to sign up for the DES, neighbouring practices that have signed up may have to provide services for wider areas. Patients registered out-of-area will be given a review to decide whether it would be more appropriate for them to be registered with a practice nearer their home, should they arrange at least four consultations under the DES within a 12-month period. This will also be triggered if they receive two home visits within the same period. GPC deputy chairman Dr Richard Vautrey said: ‘Those practices that have lost patients, but are then invited to look after them again when they are too sick to travel to their new practice, will have understandable concerns about doing so.’
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The size of the financial black hole facing the NHS in Devon – £430 million – is staggering. That is more than 5% of the total £8bn national funding shortfall the head of NHS England, Simon Stevens, recently warned would hit the NHS in the next Parliament if the next Government fails to act. The consequences for Devon are here already: worrying proposals to ration some services and end or close others completely. Now Devon Clinical Commissioning Group – the body now responsible for commissioning or “buying” services on behalf of the public, is planning to deny operations to people who are overweight or smoke, restrict treatment for varicose veins, only allow cataract operations in one eye and end all IVF treatment for couples desperate to have children. National guidance from the National Institute for Clinical Excellence says people should be entitled to three courses of IVF. The CCG is also proposing to close our very popular and well used Walk-In Centre in Sidwell Street. This, despite the fact it has seen big increases in patients every year since it opened and it reduces pressure on our hard pressed A& E and local GPs. I haven’t spoken to a single local GP who thinks closing the Walk-In Centre is a good idea. They also tell me that the weight criteria proposed for operations would, in some cases, affect more than half of their patients and even some GPs themselves. The national Royal College of Surgeons has condemned the plan as “unacceptable”. We also had the decision by North Devon NHS, who, under the new structures, run community services in Exeter, to centralise stroke services in Ottery St Mary, not Exeter. Everyone agrees it makes sense to have stroke services as close to the RD& E as possible, yet now stroke patients and their families from as far away as Okehampton are going to have to trek to Ottery.
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Jeremy Hunt is to tell the NHS to save £10bn a year by using fewer temporary staff and management consultants, selling off unused buildings and reducing drug errors. The health secretary will warn an audience of NHS leaders on Thurday that the service must undertake a “fundamental rethink” of how it spends its £110bn budget in order to remain viable in the face of unprecedented demand for care. He will demand action to tackle the soaring cost of hospitals’ use of temporary staff – mainly nurses – who have been supplied by employment agencies to cover shifts in order to ensure wards are fully-staffed and patients receive good quality care. The bill has risen by £1bn under the coalition to almost £2.5bn a year as hospitals have increasingly struggled to recruit enough staff at a time of greater scrutiny of care standards and demands to provide “safe staffing”.Speaking to the Guardian, Hunt said: “[Then NHS chief executive] David Nicholson came up with the ‘Nicholson Challenge’ in 2009 to save £20bn by 2015. That has more or less been delivered. We now need to have a £22bn ‘Forward View challenge’.” However, while freezing staff pay and awarding them 1% pay rises has helped deliver that £20bn, Hunt said that saving the extra £10bn would have to come through innovation and greater use of technology to improve healthcare.
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Nigel Farage has been caught on camera telling Ukip supporters that the state-funded NHS should move towards an insurance-based system run by private companies. The recording shows Farage saying he believes the marketplace could deliver better value for money when it comes to spending on the NHS. Farage’s remarks, made in September 2012 on his Common Sense tour of the UK, contrast with Ukip’s new claims that it is opposed to privatisation of the NHS. The Guardian examined videos of Farage touring the country in an effort to establish some of the Ukip leader’s views on issues other than immigration or Europe. Other footage showed him proposing that the BBC should not be completely dismantled but slimmed down to concentrate on radio rather than television, with a licence fee slashed to £40 or £50. He also suggested that benefit claimants could be made to clean up litter after six months, and that there was a big problem with employee rights and protections such as maternity leave for small firms. However, his comments about the NHS were the most striking, leading Labour to claim it was now “plain for all to see that a vote for Ukip is a vote for the privatisation of the NHS”. Speaking at a meeting in East Sussex, Farage said: “Frankly, I would feel more comfortable that my money would return value if I was able to do that through the market place of an insurance company than just us trustingly giving £100bn a year to central government and expecting them to organise the healthcare service from cradle to grave for us. But a Ukip spokesman said the NHS was an area where the party’s policy has developed the most over the past few years and Farage’s comments in East Sussex no longer represented his views. He also pointed out Ukip had taken the radical step of aligning with the trade unions to oppose TTIP (Transatlantic Trade and Investment Partnership) – a US-EU trade deal that its opponents say could allow American private health firms into the NHS. Farage’s party fought the Heywood & Middleton byelection and is battling to win Rochester & Strood next week on a platform of protecting the NHS. However, Labour has pointed out in its leaflets that Ukip MEP Paul Nuttall posted a letter on his website a few years ago praising the coalition for bringing a “whiff of privatisation to the NHS”.
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Protect our NHS new Frome group launched to save the local NHS. A ‘Protect Our NHS’ group has been launched in the town and is already gaining wide support. Local campaigns have been set up in cities and communities across England and Wales to defend what they see as the growing privatisation of the publicly-owned and publicly-accountable NHS. Now, support has gathered enough locally for a Frome ‘Protect our NHS’ group to be formed. Last week Mike Campbell, coordinator of the Bristol ‘Protect our NHS’ group, joined the audience at the Westway Cinema to see Ken Loach’s ‘Spirit of ’45’ and to support the launch of a ‘Protect Our NHS’ group in Frome. Mike said, “It is fantastic that towns such as Frome with its local community hospital are forming campaigning groups. “It’s essential that local community NHS services are defended as they are equally vulnerable to privatisation. Many of us close to the health service believe that bad press is also deliberately orchestrated by the government to undermine the service’s credibility.” The Frome group is being supported by the mayor, cllr Peter Macfadyen, who believes that Frome is “fantastically” served by the NHS and the Frome Medical Practice. Rebecca Yea from Frome is also supporting the new group. She said, “The group is still forming but the support from the town has been very encouraging and it seems there is a lot of people who want to be involved. At the recent Ken Loach talk more than 100 people showed an interest.
Hospitals and A&Es to get extra £300m to combat ‘unprecedented’ winter pressure. Suffers of coughs and colds are being urged to visit their high street pharmacy instead of using their GP or attending their local A&E unit, as part of plan to help the NHS manage unsustainable pressures this winter. The call for patients to take the pressure off doctors came as the Health Secretary announced that hospitals and A&E units across England will receive £300m to help see them through “unprecedented extra demand” this winter. Health Secretary Jeremy Hunt said the new funding could provide the equivalent of up to 1,000 extra doctors, 2,000 extra nurses and 2,500 extra bed spaces. With many A&E units already running at “full stretch”, the injection of funds and call for patients to turn to their pharmacies reflects ongoing anxiety among health officials that the NHS is set to face a challenging winter with rising levels of flu and ward closures from norovirus outbreaks. Mr Hunt said: “Winter has always been particularly challenging for the NHS. We have been thinking about it particularly hard this year because of the growing pressure on A&E departments. ”Emergency admissions are growing about three to four per cent year in, year out. We are very aware that over this winter there is going to be some real pressure there.”
The National Audit Office’s (NAO) forensic dissection of the Better Care Fund fiasco is a harsh lesson in the dangers of ministerial interference in health and care systems under stress. Its report Planning for the Better Care Fund – published this week – exposes how the government mishandled the entire project. The fund was the coalition’s gambit in the battle with Labour over who would integrate the NHS and social care. Launched as a flagship policy in the 2013 Autumn Statement, it was a triumph of presentation over strategic thinking – big, bold, long on rhetoric, short on delivery detail and recycling old money as extra funding. It soon hit trouble. NHS England and the Local Government Association (LGA) published guidance on how it would work that December, and all local areas submitted bids by April on how they would spend their cut in 2015-16. Ministers then scrapped the guidance, dumped the bids and restarted the whole process. The broken wire at the heart of the machine was that the Department of Health and NHS England were planning on securing £1bn of savings on the back of the £3.8bn Better Care Fund, but robust thinking to achieve this was not put at the core of guidance for the 151 local bids.
“Clinical need not cost should determine routine NHS surgery”. A royal college has called on NHS England to investigate a CCG which is proposing to limit access to surgical services. Devon CCG has said it will deny routine surgery to smokers and the morbidly obese unless they quit or lose weight. The GP-led Northern, Eastern and Western Devon Clinical Commissioning Group says the measures are “urgent and necessary” as it faces a £14.5m deficit and needs to reduce costs. However, Miss Clare Marx, president of the Royal College of Surgeons, said: “Access to routine surgery should always be based on an individual’s clinical need. “The government has been clear that restricting clinically necessary treatment on the basis of financial considerations is unacceptable. We urge the Department of Health and NHS England to review the situation in Devon if the CCG is indeed intending to deny patients treatment without enabling the clinicians and patients involved to make informed choices about their care.” Rebecca Harriott, the Devon CCG chief officer, said it would be prioritising services in the NHS Constitution. The group says hernia treatment, botox injections and cataract operations are also under review. Ms Harriott said: “We must act to protect essential services through our busiest winter months and ensure that care is there for our patients when they really need it.
This morning Health Secretary Jeremy Hunt told NHS leaders that the service must undertake a ‘fundamental rethink’ of how it spends its £110bn budget. He has warned that the NHS needs to save £10bn a year by using fewer temporary staff and management consultants. Just how much NHS leaders are spending on, for example, management consultants is something that Hunt knows, but we don’t… yet. NHS England, unlike all other government agencies, does not make public how it spends our money. A petition launched this week, which has so far been signed by 68,000 people, is demanding that NHS England publishes its spending data without delay. (It said it would publish its receipts in September, then October. It has yet to). This would reveal how much of NHS funds are going on management consultants, lawyers, accountants, PR campaigns and private healthcare companies. Is Hunt trying to distance himself from NHS England by calling now for a “fundamental rethink” of how it spends our money? Hunt cannot absolve himself of responsibility, however. It was the reforms brought in by this government that created NHS England, stewards of the NHS budget. The policies it has since pursued have been set out and encouraged by the Coalition. Whatever NHS England is doing with our money is Hunt’s responsibility. We just now need to find out what Hunt knows and we don’t. Sign the petition here.
Private GP providers will have to publish pay. GMS contract requirements to make GPs publish their pay will also be placed upon any primary care providers commissioned by NHS England or CCGs, including private APMS practices, NHS England has said. At the NHS England board meeting on Thursday, national director of commissioning strategy Ian Dodge laid out measures for the co-commissioning of primary care and said it was important for CCGs to ensure ‘consistency across different contractual reforms’, specifically citing the publishing of pay. His comments were made as part of the discussion on what co-commissioning involves, which also revealed that NHS England would be publishing statutory guidance on CCGs avoiding potential conflicts of interest. Pulse’
Stop transatlantic trade deal threatening NHS. A free trade agreement between the European Union and USA is designed to meet the interests of corporations rather than patients and must be stopped in its tracks. This is the conclusion of an editorial in The BMJ this week. The Transatlantic Trade and Investment Partnership (TTIP) is a series of trade negotiations currently being carried out – in secret – between the EU and US. John Hilary, executive director of campaign group War on Want, says its main aim is to reduce regulatory barriers to trade for businesses on both sides of the Atlantic and includes things like food safety rules, environmental legislation and banking regulations. Public services like the NHS are also to be opened up to competition under TTIP. Hilary warns that the market liberalisation introduced by the 2012 Health and Social Care Act “ensures it will be effectively impossible to take the NHS back into public hands if the EU-US deal goes through”. Furthermore, he says both the UK government and the European Commission “have confirmed that TTIP’s investor protection provisions would grant US corporations the power to sue any future administration over such a move”. Hospital Doctor
The NHS five year forward view – a wish-list for privatisers? Stevens’ “Five Year Forward View”, published last week by NHS England, is a collaboration between the six main organisations now running the NHS – Monitor, Health Education England, the NHS Trust Development Authority, Public Health England, the Care Quality Commission and NHS England itself. The “5 year Forward View” reads like a wish-list for further privatisation of the NHS. It may ‘pack a punch‘ for the BBC – which has throttled mainstream media discussion of NHS privatisation. But talk of ‘accountable care organisations’, as developed in Spain and the United States, and the emphasis on preventive health packages so keenly sold by multinational corporates, are paradigmatic of a privatisation plan. The document is a naked shill, intended to carry on the ‘case for change’ made exhaustively by think tanks such as the King’s Fund. Such organisations were instrumental in giving the catastrophic policy of market competition in the National Health Service some legs in the first place. Take, for example, the seemingly-modest proposal of “integrated care commissioning”. In the full glare of sunlight, the policy of personal budgets looks incredibly anaemic. A big unanswered question is how a universal health system is going to be successfully merged with a means-tested social care system. NHS England tried, unsuccessfully to head this issue off at the pass as far back as 2012. Personal health budgets, which Simon Stevens is busy quietly rolling out, are the perfect vehicle for merging the two systems in a way that introduces ‘top ups’ and ‘co-payments’, threatening the fundamental principle of universal, free-at-the-point-of-need. Our NHS
How the NHS and Government are “managing” Public Consultation
The following is the summary of a paper written by Ursula Pearce in October 2014 on the way in which public consultation is currently being ‘managed’ by the NHS. A link to the full article can be found at the bottom of the piece.
The type of public engagement preferred by NHS organisations and the Cabinet Office is the involvement of individual patients or individual members of the public – in marginal decision making and on management terms. A more democratic approach seemed possible in 2013 when NHS England published guidance stating people should be directly involved in decisions about who should provide services. However, that guidance was soon altered. It now refers to patient representation on panels and their need for support and training, not consultation with the general public. Individual participants, as discussed, have no means of redress when their views are ignored. So engagement with them allows managers to operate unhindered while, paying lip service to public accountability and consultation. The NHS Constitution, meanwhile, gives individual patients or members of the public the right to claim judicial review if they are personally affected by an illegal or discriminatory decision. But recent moves by the government to limit the number of judicial reviews make it increasingly difficult for them to do so.
Opposing policies such as the above, where statutory rights are given by one hand and removed or weakened by the other, are now widespread. Local authorities or OSCs, the last remnants of democracy in the NHS, have the right to require NHS Foundation trusts, private sector providers and CCGs to provide them with information but they have no enforcement powers, outside the formal consultation process, or visiting rights to enable them to seek information for themselves. They have the right to be consulted on proposals for substantial changes but it is becoming more onerous for them to refer objections to the Secretary of State. Moreover, the duty on NHS organisations to consult with OSCs is shrinking. There is no formal requirement for commissioners to involve LAs/OSCs in deciding whether to classify services as commissioner requested services or not. Changes to or closures of services deemed ‘non-commissioner requested’ or ‘non–essential’, by definition, would not trigger a requirement for consultation even though such services may be valued or needed by patients. OSCs do not have a right to be consulted on Foundation Trust plans to increase private patient income or make significant transactions or mergers, acquisitions and separations or to form joint businesses with the private sector, all of which could pose a significant risk to local services. Foundation Trust governors, alone have the power to approve them. Yet OSCs are far better placed than FT governors to assess the implications of such decisions for the wider health economy. The duty to consult LAs or OSCs does not apply when Trusts go bankrupt and are taken into special administration. The amendment to clause 118 of the Care Bill was rightly viewed as a triumph by campaigners. It requires administrators to consult with every CCG likely to be affected by their recommendations, not just the CCGs attached to the failing trust, and provides some scope for public consultation. However, the amendment leaves a basic loophole intact, namely, when administrators and CCGs cannot agree, NHS England, not the CCGs or public opinion, has the final say.
Local Healthwatch organisations – the official ‘consumer champions’ – are constrained similarly. Healthwatch members have the sole right to visit and inspect health service premises on behalf of local residents. They can report their findings to Healthwatch England and NHS organisations but are forbidden by law to use the information to oppose government policies or engage in policy work. They may campaign if they have enough evidence but only if it is kept as a minor activity. Equally odd, is the Secretary of State’s refusal to provide Healthwatch members with the right to information or the right to attend CCG board meetings as observers. Healthwatch members have a duty to provide the public with information and help patients exercise choice. Yet they may have to use the Freedom of Information Act to obtain official information for themselves. Another key role for Healthwatch organisations is to gather the views and experiences of patients and feed these back to Healthwatch England, the Local Authority, OSCs and NHS organisations. Yet Healthwatch members cannot make use of their own knowledge in public consultations as they do not have a statutory right to be consulted. Instead, Healthwatch committees have been subsumed into the planning process by virtue of their single seat on Health and Wellbeing Boards. In practice, far from being ‘consumer champions’, Healthwatch organisations are the equivalent of a government smoke screen, engaging the public in a minor way, while fundamental changes to the NHS, including privatisation and its consequences, remain hidden from view.
A prerequisite for accountability to operate is a free flow of information to ensure citizens have the knowledge to scrutinise and challenge the decisions and acts of those in power (Ref 4). However, under the Freedom of Information Act, information can be withheld on the grounds of commercial confidentiality. Contracts between NHS bodies and commercial firms are shrouded in secrecy. As a result, consultation documents are bereft of essential information, so that consultees cannot make an informed response even if they wish to.
Moreover, contracts with private firms leave patients with less information to choose where to be treated. This irony and the fact many patients may be too ill to choose fosters not only spurious competition but health inequalities, as shown in the recent Labour Party Parliamentary health committee review. An absurdity at the heart of government policy is the ideological belief that privatisation and competition promote choice, improve services and reduce health inequalities.
Ominously, profit hungry commissioning support firms are coming together in groups to bid for lucrative NHS contracts. One shadowy commissioning support group, chaired by United Health, the giant US health insurer, is currently lobbying NHS England strongly for a contract worth £1 billion, even to the extent of taking NHS officials on a fact finding trip to the US. When so much tax payers money is at stake, it is, perhaps, not surprising that CCGs are taking major decisions in closed sessions and disengaging from local accountability mechanisms, as reported by Healthwatch organisations. The decision of the Secretary of State to refuse Healthwatch representatives an observer seat on CCG committees reinforces the view that deals with private firms are being struck in secret. The prescient words of historian Charles Webster spring to mind “local communities and their representatives are likely to count for little when it comes to appeasing corporate interests” (Guardian May 8th 2002).
There may still be time to save the NHS and restore democractic accountability. People of all political persuasions, in England, as well as Scotland, support the health service and do not want it handed over to profit driven private firms. And irrespective of how hard the government works behind the scenes to curtail statutory rights, it cannot remove the power of the public to vote politicians out of office at the ballot box. That power, above all, explains the politicians fear of exposure, their drive to hide information and to privatise by stealth. Thanks to the persistence and direct action of campaigners, however, news of NHS privatisation is getting out, hopefully in time to influence public opinion and galvanise grassroots support before the general election in 2015. Effective grassroots campaigners have shown they have the power to jolt and influence politicians out of their complacency. The survival of the NHS rests in their hands.
Save Our NHS
est Briton Newspaper – Truro
From “Keep our NHS Public Cornwall”
C/O, Press Secretary, Chris Dayus, 7 Lychgate Drive, Truro, TR1 3UE.
Title – End NHS Privatisation.
Since the coalition government passed the Health & Social Care Bill, there has been an explosion of privatisation across the NHS.
In Cornwall we have direct experience of the Private sector. Running car parking at RCHT, making profit from those who have no choice but to pay extortionate prices to park at the hospitals. Serco, running the G.P. “Out of hours” service. During the life of the contract they have generated a catalogue of problems and incidents, clearly evidencing poor quality of services to patients. The Patient Treatment Centre in Bodmin, badged as an NHS treatment centre is actually run by Ramsay Healthcare. Community Health Services across Cornwall are provided by Peninsula Community Health, a social Enterprise.
Most recently we have seen the transfer of ambulance patient transport services to NSL and Hotel Services to Mitie a private equity company. Both NSL and Mitie have recently featured in the news as providing poor service to patients and even worse, reportedly compromising patient safety.
This is evidence that the private sector do not improve services for patients, their objective is to provide profits for shareholders.
On the 21 November MP’s are being given the chance to support a private members bill. If passed it would end many of the damaging aspects of the “top down” reorganisation of the NHS. It would remove the requirement to put services out to competition and promote integration to provide improved patient care.
We urge readers to support this move to save the NHS, and end private profits. Please lobby your MP to support the Bill and the NHS they claim to value.
Also sign the online petition being run by the TUC at www.unionstogether.org which also has further information and details of events being organised on the 15 November in support of the Bill.