Thursday, 15 November 2018

Primary urgent care privatisation in full swing in Lincolnshire



NHS England have just paved the way for the private health sector to run the front end of every major hospital in Lincolnshire. 

Simon Stevens, the boss of NHS England and ex vice president of UnitedHealth, the largest private health insurer in the united states, announced his plan to convert the public NHS in England into his American counterpart called an 'accountable care system'.

He did this in what NHS England call the five year forward view, the blueprint document all regional Sustainability & Transformation Plans [STPs] are based on.

Decoupling hospital services such as outpatients and diagnostics and moving them into private-public community clinics is a crucial part of the STPs and privatisation process.

As is closing A&E departments and replacing them with urgent care centres, also ultimately with the facility to be run by the private healthcare sector.

The NHS England plan, that so far has received no public consultation, is to introduce Urgent Treatment/Care centres (UCCs) at 5 hospital sites across Lincolnshire in an attempt to reduce attendances at A&Es.

It's also been revealed there are 150 Urgent Care Centres planned for England by December 2019. It's anticipated the 150 urgent care centres will be located at various places throughout the community and could result in over one-third of A&Es in England either closing or being downgraded.

On a smaller scale this is what NHS England did over at Chorley & South Ribble hospital in Lancashire in 2015 with health bosses claiming the Urgent Care Centre was there to supplement the A&E and to reduce admissions to A&E. The reality is the ultimate plan revealed later in 2015 as the 'STP' was to downgrade the Chorley A&E and replace it with the extended UCC & and to send patients from the Chorley area over to the trusts other hospital A&E at Preston.

It's not necessary to build an urgent care centre adjacent to the A&E unless the UCC is to be privatised and to replace the A&E. With perhaps the exception of 1 or 2 A&Es in Lincolnshire, so is a trial to see if an A&E can still manage demand with reduced numbers redirected to the Urgent Care Centre before eventually replacing the A&E. *Urgent care review.
NHS England claim the walk-in urgent treatment centres will be open at least 12 hours a day and can also be booked via a GP or through NHS 111. They also claim attendances at urgent treatment centres will count towards the four hour access and waiting times standard.
Each hospital trust need stats across 4 quarters (1 year) to get the numbers (across 4 seasons) and to satisfy NHSE criteria for a downgrade.

Reports claim a walk-in centre at one hospital in Lincolnshire is to be replaced with a UCC which begs the questions as to how are they to be funded and were the plans scrutinised by the health committees long before the decision being made.

General Practice also stand to gain from further deals established in the five year forward view and a related document called the General Practice  forward view (GPFV).  The General Practice forward view expands the role of the dwindling GP practices by integrating them into a network partnership similar to that used by USA health maintenance firm 'Kaiser Permanente'. The GPFV provides an opportunity for private practices to invest in new ways of providing primary care.

And of course remember, the Clinical Commissioning Groups (CCGs) are those GPs and civil servants making the changes in the STPs and reaping any investments. Conflict of interests appear to have gone out the window with CCG co-commissioning. Delegated co-commissioning is illegal in local authorities due to the obvious conflicts of interest.

NHS England claim a urgent treatment centre is a type 3 or type 4 A&E.
The urgent care centres not adjacent to an A&E are nothing like an A&E department and the tag of 'type 3 A&E or 4 A&E' is assigned to appease the public that the 4 hour A&E target to be seen as in a type 1 A&E still applies.

The titles are irrelevant, they are just the same as a walk-in or a  minor injuries unit. Same services: lucrative/profitable, high-turnover, low risk, just right for the private sector.

NHS England have just paved the way for the private health sector to run the front end of every hospital in Lincolnshire.

LINKS


NHS England announce 150 urgent treatment centres
https://www.england.nhs.uk/urgent-emergency-care/urgent-treatment-centres/

NHSE Guidance telling local areas need hurry up and to get started on setting up the new urgent treatment clinics..
https://www.england.nhs.uk/publication/urgent-treatment-centres-principles-and-standards/

Lincolnshire health bosses identify five urgent treatment centre sites for county
https://www.sleafordstandard.co.uk/news/health/lincolnshire-health-bosses-identify-five-urgent-treatment-centre-sites-for-county-1-8703107

Monday, 29 October 2018

Chorley urgent care and the missing Hospital directors


In May this year, the local papers reported that four top directors were leaving the Lancashire Teaching Hospital NHS foundation trust. This sparked suspicion as to why such top executive figures had made the decision to leave?

The trust had a deficit of £42m and were rated as 'requires improvement' by the care quality commission - and has recently again been rated the same.

Gone...

  • operations director
  • divisional director for surgery
  • divisional director for medicine
  • divisional director for support services

At the time, our very own dedicated campaigner Steve Turner predicted that the departures of so many directors would mean "that audits by the Care Quality Commission will pick up on increasing failures at operational levels this puts our hospitals at risk.”

The prediction was accurate, and a few months later in October 2018 the CQC awarded the hospital trust another rating of 'requires improvement'.

Suspiciously, the trust chief executive  Karen Partington stated all directors who had left the Hospital trust had confirmed they'd got other jobs, and Ms Partington wished them every success. A strange congratulation considering they'd left Ms Partington and the rest of the board to collect the unfortunate accolade that would lead to requires improvement from the CQC.

The real reason of course is the ship has been putting plasters over its leaks for years; hoping someone won't notice - fortunately campaigners and health scrutiny found out the ship was heading towards the rocks and stepped in.

In 2017 the trust board were castigated in an independent review about Chorley A&E closure for refusing to ask health boards for advice and assistance. They were also criticised for not recruiting staff earlier.

The independent review panel looked at the arrangements at the time at both Preston and Chorley hospitals, to see if our A&E department at Chorley could reopen, within the current medical staffing available. And it was re-opened albeit part-time, but it was re-opened and apparently could have been reopened sooner.

Finally, there is one paragraph in the external review that I believe indicates the true intentions of closing Chorley A&E permanently under the local STP plan called Our Health Our Care.. here it is....
"Having the emergency department reopened at the same time as the opening of the new 24-hour urgent care centre, integrating the two services, will provide additional resilience. This is an opportunity to enable the service to reopen without compromising patient safety".
All along they've wanted to ensure a part-time A&E could likely run alongside a 24 hour Urgent care centre. This is the precursor for a permanent closure of the A&E as a simple expansion elsewhere (eg Preston hospital) could take up the slack leading to the permanent closure of Chorley A&E.

I stand by what I've always said: The urgent care centre was not built to supplement Chorley A&E but to eventually replace it. Now the urgent care centre is privatised, the CCGs, who hold the purse strings and no doubt pull them, intend moving other services out of hospital and doing the same to them.

There is of course another reason. 

In October the same year [2016], NHS England chief executive and ex vice president of Americas largest private health insurer 'Simon Stevens' had previously singled out the Lancashire Hospital chief executive Karen Partington for praise in an interview with HSJ, for making the “right decision about what was needed in Lancashire”. He said it was an example of how he would support and create a “safe harbour” for local leaders who would take brave decisions and who were “going to drive” change in the health service.



Well not while we're around you're NOT!

It's Our NHS, and we're not letting you give it away or to play dangerous game with!

Join our campaign to save Hospital A&E and other services in Lancashire.

Join our Facebook Group for more info...





Daft or Dangerous? What’s the reality of STPs?


Excerpt from Draft, Daft or Dangerous? What’s the reality of STPs?
By Dr John Lister, coordinator Health Campaigns Together
www.healthcampaignstogether.com

STPs won’t do what they say on the tin: they are not sustainable, there’s no
capital to finance any serious transformation, and many of them plainly don’t
add up: but they are seen as the future of England’s NHS.


..all STPs have one thing in common: just weeks before they are scheduled
to begin implementation, none of them has been subject to any serious public
engagement or consultation.

Indeed some plans were only published by irritated council leaders, allegedly
‘partners’ in the STP process, who lost patience with the secretive process
decreed by NHS England.

Most of the later drafts have some approval from NHS England, but it’s not
clear why some of the vaguest and least convincing plans have got through.
However one element among many unidentified “savings” plans is “Specialist
Commissioning” – controlled by NHS England. In NW London alone the gap on
this is £189m.

Campaigners and the local public have been understandably suspicious and
hostile.

Local councillors, as perhaps potentially the most politically vulnerable to
public anger over cutbacks, have emerged in some areas as unexpected vocal
challengers to the latest controversial plans – after decades of council
abstention or gullible connivance on NHS policy and resource issues (for which
they are not formally accountable, and have little knowledge). Councils have
largely failed for decades to use the powers they still potentially retain on
health.

Delayed reaction...

But some reactions have been delayed and muted by confusion over the
contradictory content of STPs, which manage to talk abstractly about some
positive objectives, and getting commissioners and providers collaborating
together, even while developing more concrete and questionable plans to save
money.

An aspirational window-dressing of positive ideas camouflages the unpleasant
content of STPs like a sophisticated air-freshener masking the real scent of
sewage.

The 'sweeteners'

Every STP, following the new orthodoxy of Simon Stevens’ Five Year Forward
View, uses words for which nobody would consciously choose the opposite:
better “integration” of the under-funded, fragmented and largely privatised
‘social care’ system outside hospital with under-funded, fragmented and in
some cases arbitrarily privatised NHS hospital, community and primary care
services, for example.

Who doesn’t want more effective preventive and public health measures to
keep people from needing the NHS in the first place? Who rejects action to
address the “social determinants” driving ill-health?

Who would say no to fresh new resources to support and enhance primary
care, easier access to GPs – and the option wherever possible of care nearby or
even in your own home rather than trekking miles to overstretched,
overwhelmed “centralised” hospital services?
"But these sections, in each STP, are a smokescreen for unpopular changes, and ignore facts on the ground".
Public health programmes are being actually cut back across the country after
government funding cuts. There is no money for worthy projects on social
determinants – which in any case would take years to show any measurable
reduction in pressure on the NHS.

What about the staff?

Primary care is floundering, not flourishing: with many busy [GP] practices unable to cope with ever-increased pressure, many GPs are leaving and increasingly hard to replace, and Jeremy Hunt’s promises to recruit 5,000 more GPs are simply bogus. Many STPs merely seek to paper over the cracks, with other – yet to be recruited – less qualified staff, to take over some roles from GPs.

As for community health services, some rural STPs are looking to close
community hospitals, expecting patients to travel up to 50 miles on hazardous
roads when they need a hospital. None of them address travel issues for the
elderly, less mobile and single parents.

In town and country alike there is little plausible hope of developing properly resourced systems capable of delivering complex care in individual homes, with no funding, no staff, no plan – and no public acceptance.

Even where community and home-based health or care services can be shown to be effective in enhancing patient care, they don’t save money, but cost more. This contradicts STPs which have to save money, and close a total gap in excess of £22 billion by 2020.

Managing 'demand'

Where the fancy plans don’t deliver savings, old-fashioned cuts and measures
will be wheeled back out. At least half of STPs’ planned savings in most areas
are already expected to be squeezed out of the hospital sector, through
relentless, enormous “efficiency savings”, ruthless reductions in “back office”
support staff and staffing levels, and unpopular closures of beds, services and
whole hospitals.

A recipe for disaster?

With no alternatives and no capital available to build new or extend existing
hospitals, this is a recipe for a chronically under-resourced, chaotic and
scandal-prone NHS. The “transformation” might even see services declining to
the levels that triggered the major alarm in Mid Staffordshire Hospitals a
decade ago.

When the time comes to implement the STPs and there are howls of public
rage and protest, rocking local politicians, NHS England has nobody to blame
but themselves – for a secretive process forcing rapid adoption of often flawed
plans with no consensus.

STPs may seem easier than to speak truth to power and warn Mrs May that if
the cash freeze begun in 2010 is extended to 2020 many services will be
reduced to a state of collapse.

But STPs cannot solve this problem. Ministers must fund the NHS – or take full
political responsibility for triggering its collapse.


Friday, 26 October 2018

Tories at County Hall vote to exclude public from 'two A&Es' debate

Conservative councillors at County Hall voted this week not to include the option at a public consultation of having an A&E at both Preston and Chorley. 

County councillors earlier this week clashed over the future of our Accident and Emergency department in Chorley at a meeting of the the full council.

A motion was proposed calling for the Lancashire authority to state its “strong opposition” to plans for a single A&E unit to serve the whole of Central Lancashire.

As I read through an article on the issue, I noted an amendment had been added to the motion by Conservatives calling instead for "the public consultation process to be allowed to come to a conclusion".
It's hardly 'public consultation' if the potential for two A&Es are not being consulted on now is it? 
The regional hospital trust 'Lancashire Teaching Hospitals NHS foundation Trust' runs 2 acute hospitals in Central Lancashire.

One at Preston and the other at Chorley.

Chorley A&E is currently only open part-time so no doubt would be the initial target for closure if a choice between the two had to be made.

The Tory 'amendment' excludes debate at the public consultation around whether or not two A&E departments should be considered and debated on by the people who use the services, the public.

Tories exclude the public - let them get on with privatisation plans

By refusing to support the motion, the public won't be in a position to query why a single A&E option was selected and why indeed it was proposed in the first place considering the demand for two A&Es across central Lancashire had increased over the last few years.

Supporting the amendment, Conservative councillor Shaun Turner then said "It’s a clinically-led consultation and we should have an open mind,” County Cllr Shaun Turner said. [So] for that reason, I’m proposing we let the consultation run in full...and see what it finds.”

One thing Cllr Turner seemed to omit was that the consultation on service provision on both sites, although called by clinicians, is actually a public consultation, not a clinician consultation.

Leaving the proposals as they are without public scrutiny throughout the consultation is simply playing into the hands of those wishing to have a single A&E for central Lancashire. It's a done deal, not an 'option'.

One thing the concillors didn't debate, was the A&E closure is being used as a distraction to the real intentions of the 'NHS transformation plan' to cut services and hand them over to the private sector wholesale as per the Health & Social Care Act 2012.

The Conservative amendment was carried, with Tory Councillor Eddie Pope claiming a victory for common sense. Ironically, it was Cllr Pope who the week previous opposed scrutinising two A&E's when the same issue arose at the health scrutiny committee he also sits on.

The Conservative governments view, and no doubt that supported by Conserviative councillors across many councils, is that the NHS needs to change to a more market-based system that includes much more involvement from the private health sector.

A profit driven NHS where competition is meant to drive up standards.

In reailty, the NHS doesn't work that way, but nevertheless the general concensus as stated in a Conservative 2005 policy paper is to 'break down the barriers between public and private provision, effectively denationalising [privatising] the NHS".

To emphasise just how serious the Tories are about privatising most of the NHS, this week they awarded a £104m children 0 - 19 yr old contract to private company Virgin Care Ltd.

LINKS

LEP news article report on council clash this week

Tories at Lancashire county hall sell off £104m NHS contract to Virgin Care

NHS for Sale - Virgin Care

Tuesday, 23 October 2018

Health & Social Care legislation, an Act of cruelty

Your NHS - they're taking it all away... 

The 2012 Health & Social Care act removed the duty for the secretary of state to 'provide' health services to citizens of England. This was replaced with a duty only to 'promote'.

The provision was handed down to newly formed Clinical Commissioning Groups (CCGs) in April 2013. These CCGs are now rationing and banning certain medicines and procedures, some say readying to place them on a health insurance list for people to pay for when NHS reforms take hold in late 2019/20. 

Legal basis for CCGs arranging fewer government funded health services

Under the H&SC act, CCGs are allowed to arrange fewer statutory services than provided previously by their predecessors Primary Care Trusts PCTs.

Previously, the “functions regulations,” were that PCTs must provide or secure the following services on behalf of everyone in a specified geographical area:

  • Accident and emergency services and ambulance services
  • Services provided at walk-in centres
  • Facilities and services for testing for, and preventing the spread of, genitourinary infections and diseases and for diseases
  • Medical inspection and treatment of pupils
  • Services relating to contraception 
  • Health promotion services • Services in connection with drug and alcohol misuse 
  • Any other services that the secretary of state may direct. 

These regulations were repealed, and the act does not require CCGs to secure the above services. They have to arrange only ambulance services and “emergency care” for everyone living in the area defined in their constitutions.

The H&SC act therefore established a legal basis for CCGs to secure fewer government funded health services. The act also transferred from the secretary of state to CCGs the power to determine what is “appropriate as part of the health service” for certain individuals.

The services concerned are care of pregnant and breastfeeding women, care of young children, prevention of illness, care of people with illnesses, and aftercare of people who have been ill. In this way CCGs may decide what is appropriate for government funding.

Moreover, decisions about what is appropriate can be delegated to commercial companies and, under rules set out in schedule 2 of the act, need not be made by general practitioners, other clinicians, or NHS staff.

All the above was predicted in an article from 2011 by the BMJ, and it is now all coming to fruition.

Sunday, 30 September 2018

The less care the STP provides, the more money they make

It matters not a jot what they are called: STP, ICP, ICO, ICS, ACP, ACO...

The less government money and resources they spend on patients, the more they save the government. As a result: the incentive to ration increases and demand management leads to more denial of treatment.
You'll have to go without, you'll have to self-care...
Each rationed treatment is placed on your future health insurance plan. The 'means test' will apply to the NHS as it does dentistry, and if you can afford to pay for it then you must. 

Then you will find that the capitated payments appear to reduce each year and  don't stretch for the population they are supposed to serve, mainly due to the increased demand the ACO created with the rationing, denial of care, patients crossing boundaries for care, and lawsuits arising between ACO partners and the overall contract holder...


Whatever happened to the STPs?

One of the early decisions made by the STP was that it would continue to pay providers on the existing “payment by results” system, maintaining the purchaser-provider split, rather than behave like an ACO, where a single capitation-based block budget is agreed by the providers, who then accept the financial risk of costs exceeding the budget:

“Providers will be paid for the activity they undertake, against an agreed activity trajectory, and commissioners will be responsible for taking decisions about what services can be provided affordably …. Due to the lack of incentive to do more activity, even where it would be desirable as it would reduce overall system costs, block contracts should be avoided for all services.”

That was November 2017. Just six months later, in an update to the NWAFT Board on the implementation of the STP, we find this decision has been reversed:

“The STP is refreshing its plans and the way it works. A notable change for this financial year is a move to Guaranteed Income [block] Contracts for the two acute providers. A Guaranteed Income Contract is alternatively known as a Block Contract, rather than the payment by results or activity that has been in place in the NHS for many years.

“As a result the Trust has accepted a risk in relation to activity growth above that agreed, in return for no fines and a benefit if the activity was below plan”. (Chief Executive’s report to May 30 Board).

In other words, with the capitated payments block contract system, the less activity they provide below plan, the more money they save. Which in turn gives a greater incentive to ration more and more services and medicines.
Get the idea? It's a private insurance-health model where denials of care are often found - something which should NEVER appear in the NHS.

In the USA Health insurance companies use capitated payments to control health care costs. Capitation payments control use of health care resources by putting the doctor (physician) at financial risk for patient services. At the same time, in order to ensure that patients do not receive suboptimal care by underusing health care services, insurance companies measure the rate of how patients are using the services over/under utilising services in doctors surgeries or clinics. These reports are publicly available and can be linked to financial rewards, such as bonuses.
Hence, the capitated payment system is a profit-driven system which gives clinicians incentives to either over diagnose or reduce/withhold treatment for financial gain. It's the system due to be used in the NHS.
With capitation, the ACO gets paid whether the patient uses the system or not.

It matters not a jot what they are called: STP, ICP, ICO, ICS, ACP, ACO...
The less government money and resources they spend, the greater is the incentive to save by cutting more and more services and placing these on your insurance-plan list. Partners in the organisations are accountable to each other to ensure they save money - i.e. make a surplus profit.


and it's getting worse...

full article on "whatever happened to the STPs"? can be found on page 7 in the June 2018 report commissioned by UNISON Eastern Region to give members and representatives a realistic analysis of the situation in each STP area.


See PDF download below...
https://www.healthcampaignstogether.com/pdf/Whatever-happened-to-the-STPs-3-web.pdf
.




Thursday, 27 September 2018

Conservative scrutiny councillors refuse vote to discuss option of two A&E's for Central Lancashire

Conservative councillor Pope says no to 2 A&E option
Conservative Health scrutiny councillors at Preston county hall have refused a vote to further debate an option of having two A&E's for Central Lancashire under a health change program.

Over the last two years a local health change program titled 'Our Health Our Care' [OHOC] run by local commissioning groups has been gathering feedback from public engagement events in venues across Chorley, South Ribble and Preston.

In response to government NHS underfunding and staff shortages, the public engagement events were established to build a picture of what people wanted for future healthcare and more importantly what they would tolerate in terms of reconfiguration of services.

Removing Chorley & South Ribble hospital A&E was not dicsussed throughout the events and in March 2017 the program suddenly ceased. Then in July 2018 the 'Our health Our Care' program suddenly started up again.

This time there came a shock announcement from the OHOC team that they were looking at a proposal for having only one single A&E for the whole of Central Lancashire which covers Chorley, South Ribble and Preston.

The program team didn't say which A&E (Chorley or Preston) was being kept open but the idea of a super-hospital touted earlier in the local press wasn't on the program agenda.

Outraged at the proposal, the local Labour councillors on the health scrutiny committee at Lancashire county hall submitted a recommendation that the option of having an A&E at Chorley AND Preston be included in the public consultation starting after next years elections.

Bizarrely, the recommendation - which would have at least put the option of both A&E's on the table - was voted out by Conservative councillors, with no valid reason given. Here's what happened. The recommendation came via Cllr S. Holgate [Lab].

recommendation as read out: the HSC believe the OHOC document needs to be revised prior to consultation to include the option of there being 24/7 A&E provision on both the Preston and Chorley sites.

P. Britcliffe [Con]: Chair "I don't intend to have a protracted discussion on this so I will bring in county councillor Pope [Con] and then I'm going to take the vote".

Cllr pope... "I don't agree it's a good option....the trust & ccg are going through consultation and further consultation when they come up with the full ideas of the way forward,, and I wouldn't want their hands to be tied in any way in looking at that [two A&E's option] and the various options er going forward. therefore I would not support that recommendation".

It's unsure why Cllr Pope thought the CCGs hands would have been tied since it is the health scrutiny committee who should be scrutinising on BOTH options and debating which site may be preferred,. By voting down the recommendation the scrutiny councillors were refusing their constituents a debate on who gets which A&E service. A disgraceful state of affairs since it means the Chorley A&E may now no longer be an option during the consultation.

After councillor pope had shunned the recommendation, the chairman, cllr P. Britcliffe, then asks "what is the procedure for a recorded vote"?

The vote was then taken 6 against [Con], 3 For [Lab], and 1 Abstention [Green party]

All options on the table?
Ludicrously, Conservative county councillor Charlie Edwards then proceeded to thank and commend those who spoke to us today and that 'all options are on the table"....

Clearly not all options were on the table, as Cllr Edwards' Conservative party colleagues had just removed the option of debating and scrutinising the reasons why there can't be two A&E's to serve central Lancashire.

I'm sure the Conservative councillors constituents will have something to say about that....

Thanks to the Labour scrutiny councillors for proposing and supporting the recommendation to fight for a 24 hour A&E at both Preston and  Chorley Hospitals.

The webcast of the health scrutiny meeting can be viewed on the councils website: