Health Campaigners in Chorley, South Ribble and Preston now have a much better idea of the disaster that's about to hit local NHS services.
In this article we look at how foundation hospitals are in effect private businesses and how the plans for Central Lancashire will lead to large swathes of private companies running the NHS...
Initially, the use of the private sector facilities was to provide NHS Hospital trusts with additional theatre and bed capacity to ensure patients receive timely treatment, particularly when hospitals ran at over 100% capacity (nowhere to discharge patients to = bed blocking).
After the intro of the 2012 Health & Social Care Act and consequently CCGs, NHS hospitals have been dealing with private firms to buy and sell patient care and treatment services. In 2015 these were worth more than £1bn, creating a marketplace for commercial healthcare companies in the English health service.
Many NHS managers and commissioners at the health melas and 'Our Health Our Care STP events we've attended would say the NHS has been forced down this road.
Managers have to deal with waiting lists and a narrowing in the range of operations provided by the state and end up falling back on private operators. This is compounded by the biggest shakeup in decades at a time when the government is attempting to cut £20bn from the NHS budget.
Many hospital foundation trusts are gearing up to lure private patients from home and abroad as health budgets are squeezed – a move made possible after the Con-Lib coalition's 2012 H&SC Act which allowed the proportion of income hospitals can earn from paying patients to rise by 5% a year to a maximum of 49% of patient income.
Four senior hospital directors resigned from the Lancashire Teaching Hospital NHS foundation trust [LTHT] a few months back, deserting the sinking ship currently in a £43m deficit. And what do we have in return?
More executives hired from the private sector importing a new culture into the NHS. More executive managers from the non healthcare commercial sector costing thousands for pie in the sky charts of ambitious 'solutions'. Only they're not solutions, they're just..... well, pie charts.
So what of Preston and Chorley hospitals?The current plan is to:
- gradually move services out of the hospitals into private/public clinics (called Hubs). This process has already begun. See also PACS and MCP clinics
- Replace A&E with urgent care clinics [already done at CDH] with more smaller community Urgent Care Clinics to come...
- close one or BOTH A&Es at Preston and Chorley hospitals and have one specialist A&E/Trauma unit replacing them.
- Use other funding sources to 'Transform' the NHS into a sustainable 'two-tier' insurance system: these would be such as Sustainability & Transformation Funding, Local Government Authority grant, PFi2, and sale of public assets (land and buildings as in the Naylor Review). *LGA grant already approved for a Clinic in Preston (see LEP last week).
- Establish an 'Integrated' care partnership organisation with other health bodies including social care, acute trusts, CCGs, private sector, mental health trust, GP federations,voluntary sector etc..
- Introduce personal health budgets Phb. *If a patient spends up their Phb they will have to pay a top-up to extend the Phb.
- Introduce demand managed care (american model of rationing)
- Introduce restrictive capitated (per patient) payment system [currently it's pay per treatment]. *A fixed start of year budget. The budget is based on GP population (patient list sizes), that's why GP federations of between 20,000 and 50,000 are needed (to make up the capitated business model)
The above isn't an exhaustive list and illustrates how each partnership and its contractual obligations depend on the number of partners and thus types of services they can provide.
A true ACO with all partners in the organisation is shown below.
*using fictitious names ..
But generally the plan is to form the American model of health care provision called 'Accountable Care Organisations' or ACOs for short.
GPs, many of who also sit on CCG commissioning groups, and who have made substantial losses in the past stand to profit.
They stand to gain with the uptake of specialised teams running community services and the private sector will partner up to help everything along.
The GPs and GP federation are also entitled to keep any savings they make from the partnership deal which is an incentive to constantly save money using demand management (rationing) rather than concentrating on providing comprehensive universal healthcare.
Many trusts are referring to their STP plans and have admitted that in future hospitals are likely to have fewer beds, as services move into community settings, demand management initiatives reduce the number of patients accessing acute services, and there is more competition for less complex elective services.Less beds, less money, less patients, poorer care, fewer cars at hospitals...
Don't build the multi-storey Car Park at Preston HospitalThe re-directing of NHS services into private community clinics is the reason why in 2015-16 the LTHT pulled the plug on a plan to build a multi-storey car park at its hospital in Preston. Knowing there would be fewer services and hence fewer spaces needed it didn't make economic sense to spend on the car park building project.
With the public sector in chaos, the private sector remains buoyant.
Ramsay health ltd, one of the biggest private healthcare firms, with 22 UK hospitals (one in the Chorley area), reported in its 2012 accounts that "in particular, in the UK, NHS admissions were up 11.3% last financial year and now comprise more than 65% of the total Ramsay UK admissions.
And Public Consultation?Complete sham. On Thursday at the Our Health Our Care public event people were told public consultation would come around March 2019.
Yet as mentioned above, the CCG along with the hospital trust and other partners don't need to consult on most of the work; since moving a service out of hospital to another provider doesn't require public consultation.
There are some major reconfigurations that do require statutory public consultation. These relate to the Emergency and other services proposed to undergo a major change.
These A&Es are the heart of our hospitals, the private sector don't want them as they aren't profitable.
Yet once they are gone, live's will be lost, and there will be no turning back.Simon Stevens, the man who used to run the Medicare division of Americas largest private health insurer 'United Health', will have played his part in the 'transformation' of a truly social healthcare system.
An ethical and efficient system that provides for everyone no matter what their means, will have been transformed into a mirror image of the profit-making' Accountable care scheme in the USA.