Tuesday, 12 September 2017

Chorley Hospital could lose 80% of it's outpatient services under STPs

ACOs, an issue nobody wants to talk about, but I'm going to anyway...
Well, I've just got back from the STP public debate organised by Healthwatch Lancashire in Leyland. Healthwatch invited clinical leaders working on the STP to the event so the 'leaders' could explain what the Sustainability & Transformation Partnerships (STPs) were all about and what the STP plans involved and how they 'might' work.

I asked why the name was changed from ST 'Plans' to ST 'Partnerships' since when the public were taking part in the engagment events they commented on plans, not partnerships. The answer was the plans are now partnerships and all healthcare providers now intend working together. Not really a justification is it? Ah, so this is the Accountable Care Organisation (ACO) Partnerships I offered.

So we all sat patiently waiting for how these ACO partnerships were going to work, how they would be funded, where staff would come from, and see some evidence of an ACO being beneficial to patients. It never came.

In fact, around 70 minutes into the 2 hour session I had to ask the STP lead doing most of the talking 'Dr Amanda Doyle' why she or her team hadn't mentioned the ACOs (which is what all STPs are to become), and only then got a brief mumble about working together etc,, no mention that ACOs work on capitated budgets and 'demand management' (restricting demand to treatment and medicines by limiting access to healthcare).

But what really plagued my mind was what Dr Doyle said in response to a question from a member of the public about the NHS being privatised. She came out with the old chestnut that the NHS already has private practice GPs and have done so for many years. No problem with that since the GPs work for the NHS indirectly via their contracts. But on closer thought consider this......
Here we have the lead organisor of the Lancashire STP (also Blackpool CCG) Dr Amanda Doyle, a PRIVATE practice GP. Rolling out plans that were put together by the boss of NHS England 'Simon Stevens' the ex vice-president of the largest PRIVATE healthcare company in the U.S. (UnitedHealth), who in turn was appointed by the Health Secretary 'Jeremy Hunt' who openly stated in a policy pamphlet the NHS was an arcahaic institution and called for it to be 'denationailised' (privatised).

The in-depth issue of ACOs and how they work were seemingly avoided by the panel at all costs. But I think you get the picture, and of course one of the reasons the Tories wanted private practice GPs to sit on Clinical Commissioning Groups (CCGs) and be put in charge of the biggest chunk of the NHS budget.

There has been no asessment on the impact the 'challenging' changes will have on patient care, only talk of improvements in services and care closer to home. Again no answers to where the funding is coming from, where the staff are coming from, or where the evidence is that care pathways such as 'preventive/self care' will reduce the financial burden. Although Dr Doyle claimed IF it did work it would reduce the NHS budget by a big chunk. It's been tried before and never worked, and no evidence was provided tonight. But one thing is for sure....


They are willing to role the ACOs out on a 'trial basis' (suck it and see), STP leads and clinicians have been told it's OK to fail but "we must get on and do something" and to be less risk averse [take risks] and not [be] afraid to try something new [1].

The risks in such partnership plans are very high, and many patients will suffer if anything goes wrong, yet those implementing the STPs have been told to go ahead and do it anyway.

What they plan to do..

The Solution Design Event Team in July 2017 made some proposals based on feedback from 3 public engagement events (called 'Our Health Our Care) to meet the out of hospital strategy (effectively denying hospital care to patients).

  • Transfer services into communities (this is what I call 'Primary priming' ready for the privatisation or the take-over of primary and community services).
  • CLOSE at least 80% of Hospital outpatient services and move them into clinics (this is decoupling of services from the hospital ready for take-over by the likes of Virgin care - this will be a PPP 'Private-Public Partnership to start with).

If the GPs don't agree to be part of the GP federation (i.e. one of the ACO partners), then the ST Plan could fail. Same with other proposed 'partners' such as social care (Better Care Fund). And if any one of the partners refused to join the ST Partnership ACO? or what if a partner decides to leave? or Who's running the show (governance structure?).. Again, no answers to these questions from the panel at the public meeting in Leyland.

When faced with the reality of what could happen (what if scenarios).
When faced with questions they couldn't answer, the questions were seemingly avoided and a reply of how lovely it would be IF it all did work.

So there are no answers. ACOs are a spin-off from Obamacare and are simply an extension of Health Maintenance Organisations that are demand led, capitated (restricted) budgets, and have never been trialled in a system where taxpayers money would be thrown at it (the U.S.A. medicaid ensures customers make co-payments if they exceed a certain treatment cost).

There are always two sides to a debate but unfortunately, when the reality of what could happen is ignored the inevitable happens. It's time to wake up everyone about what's happening, before it's too late....

[1] 'Solution Design Events' July 2017 proposals

Related Links

STP Lead Dr Amanda Doyle claims STPs are meaningless to public

Sunday, 3 September 2017

Americanisation of the NHS in England

Americanisation - multi-national corporations have been eyeing up the NHS for many years. All they need is an inroad, and that's just what the health secretary Jeremy Hunt has given them. Video above - Jeremy Hunt moving forward to kaiser permanente...

In the USA, "United Health" deliver healthcare through Accountable Care Organisations (ACO). Simon Stevens the current CEO of NHS England worked there for 10 years and they are one of NHS England’s preferred contractors for supplying support services to clinical commissioning groups.

and the £1bn contract that went to Capita in June?

In June, Capita Ltd won a £1bn contract to supply administrative support to the NHS as England’s state-funded healthcare service increasingly seeks to use the private sector in its pursuit of savings. The seven-to-10 year contract will see Capita provide NHS primary care providers such as GPs, opticians, pharmacists and dentists with a range of back office services, including payments administration and the management of clinical records

Capturing back office positions is key to the ongoing Americanisation of the NHS. It is about promoting the US model - one of the most costly and inefficient health systems in the world.

Monday, 28 August 2017

Cover ups, increased waiting times, and NHS contract sell-offs

During the general election campaign Healthwatch bodies were told they could not publish factual financial information that showed the true scale of NHS deficits, indicating another “cover up” to deny the public the true picture of the NHS. [1]

The head of the NHS and previous vice president of the largest private healthcare insurer in the U.S. 'Simon Stevens' was accused of abandoning waiting times targets after he said some patients would have to wait longer for treatment.
  • 3.78 million patients are now waiting longer for NHS treatment - a rise of more than 50 per cent since 2012.
  •  1,573 patients are now waiting more than a YEAR for planned operations, compared with 886 just a year ago - a rise of 78 per cent.
  • 382,000 patients are now waiting longer than 18 weeks for routine surgery, the largest since September 2008
  • Over the past three years, the number of patients waiting more than 26 weeks for treatment has increased from 60,402 in April 2014 to 136,030 in April 2017 [2].
  • Touchscreen advertising within NHS GP practices are now offering patients facing waits of almost a month a same-day appointment for £39. Evidence that the NHS is moving towards a “two-tier” system, where only those who can pay upfront could get the care needed.
  • Senior NHS managers have been told to “think the unthinkable” as part of a national programme to cap costs. This 'capped expenditure process' could be seen to be forcing many trusts to bypass public consultation and implement draconian cuts, downgrades, and service contract handovers to the private healthcare sector.
Closing wards and surgical theatres, cutting back on staff, and systematically lengthening waiting times for operations are among the moves being discussed between NHS England, health trusts. and some management consultancy firms such as McKinsey and Deloitte.

Fourteen areas are under particular pressure to make swingeing cuts because they are on course to miss agreed “overdraft limits” so have been told to follow the capped expenditure process (CEP) [3]. This includes 'Morecambe Bay' which is in the same STP footprint as Chorley & South Ribble.

CCGs to sell off more NHS services affecting Chorley & South Ribble

■ Midlands and Lancashire Commissioning Support Unit (CSU) are working on behalf of Chorley & South Ribble and Greater Preston CCGs and in December 2016 put four more NHS services out to tender to the estimated value of £12,751,970.00 per year. These are: Musculoskeletal [MSK], Physiotherapy, Pain Management and Rheumatology Services.[4]

Considering the Lancashire Teaching hospital trusts current deficit the above four services are likely to go to the private sector but as yet the tender is still open. The MSK contract is currently held by Virgin Care so it's unknown if the CCGs are renewing this or holding out for split bids (Lots) along with the other services (Physiotherapy, Pain Management and Rheumatology) .


[1] http://www.telegraph.co.uk/news/2017/06/05/nhs-told-think-unthinkable-cuts-closures/
[3] http://www.telegraph.co.uk/news/2017/06/05/nhs-told-think-unthinkable-cuts-closures/

Saturday, 26 August 2017

Lancashire County Council could be forced to integrate into STP Private Partnership

Lancashire County council could be forced to join with private healthcare sector & thousands of lives put at risk if underfunding continues.

We're told that the voluntary or third sector play a large part in the STPs with many health and social care services relying on these.

But reading again through the Lancashire & South Cumbria (L&SC) STP I noticed another anomaly that really should ring alarm bells about just how Lancashire County Council will manage if they continue to be strangled by insufficient funding from central government. Here's a snippet from page 6 of the L&SC STP...
Impact - "However the picture and the outlook is not all rosy. Third sector funding investment is falling year on year however demand for service is increasing. As an example reablement and supported living funding has been dramatically reduced by Lancashire County Council as part of necessary cost savings however many organistions have chosen to continue providing the services transferring the cost onto their own resources. Essentially at a time were prevention is creeping up the [STP] agenda, the actual resources to achieve prevention (public health as an example) are being cut to the bone".
it continues.. "The Third sector has become the safety net (food banks and shelters are prime examples) and the economic impact of the lack of funding for those and other services will be further ill-health, increased long term conditions and the requirement for more acute services. The third sector is very aware that it plays a crucial role at both end[s] of [the] scale".
Here we are, at a time of high patient demand fighting for more acute services in Chorley and around the country yet the government won't give us back enough money to help us prevent ill-health. The revolution is coming.

In fact, the end result of a top-down NHS reorganisation coupled with further austerity cuts to local government will result in many local people being unable to prevent ill-health and symptoms worsening or even leading to death.
Yes, the situation is so dire, the STP is actually WARNING the reader that what's to come could result in many many people suffering.
Demand for community services has always been increasing but the reserves are decreasing leaving volunteers to fill the gap if possible. But the outlook is bleak for us denizens here in Lancashire if LCC revert to providing statutory service only, notably:

■ LCC called in Price Waterhouse Cooper (PwC) last year and a review into the authority's finances predicted its reserves will be gone by April 2019 with a deficit [debt] of almost £400m by 2021. [1]

■ ALL STP's are in time to become Accountable Care Organisations (ACOs).

These health management models of care are based around the U.S. model of accountable care organisations (ACO) that are infamous for 'managing demand' and further RATIONING treatments and services. Due to its projected deficits, LCC will have no opportunity but to opt into the ACO with other partners bringing about the Private Public Partnership (PPP), and the downfall of a single-tier NHS.

*When the LCC merge into the ACO, means-tested care plans (currently under LCCs social care banner) will merge into general health care provision resulting in co-payments and insurance plans as options for standard NHS patients.

We now have 'two' options, we can all start looking at where our nearest foodbank is, or we can start to fightback and let those crippling our services know we won't stand for it any longer.

The people of Lancashire can only take so much. There is now only one option...



[1] http://www.bbc.co.uk/news/uk-england-lancashire-37486724

By April 2018 the council will not have sufficient financial resources to meet its statutory obligations; even if we don't deliver any of the non-statutory services.

Download Lancashire & South Cumbria STP

Thursday, 24 August 2017

Kaiser Hunt visits Preston with plans to cull NHS

The health secretary Jeremy Hunt's visit to Preston Hospital on Tuesday was to promote his version of an English 'Kaiser Permanente' which he believes will solve all financial and clinical problems in the regions.

And technically it will, since his and Simon Stevens' Transformation Plans drive all profitable services towards the private sector thus dismantling the NHS and killing off thousands of patients in the process.

A few of our campaign team were there on Tuesday outside Preston hospital to remind Hunt that our NHS is not for Sale and that we continue to fight for a 'publicly provided' and 'publicly owned' Universal Healthcare System available to everyone, free at the point of need.

We've always paid into a publicly provided healthcare system and we will NOT TOLERATE any more interference from politicians who's sole purpose is to transform our health services into profitable ventures just to their suit their own political ends.

Healthwatch Update

PAGE 6 of Yesterday's Chorley Guardian highlights the hypocrisy of what's supposed to be a body representing patient's views. Healthwatch Lancashire are supposed to scrutinise and question existing and proposed changes to healthcare in our region.

Instead, in response to excessive attendances at Lancashire's hospitals the chairman of Healthwatch Lancashire Mike Wedgeworth claims the 'NHS' is looking to establish new 'urgent treatment centres' open 12 hours a day 7 days a week staffed by GPs with simple diagnostic tests and accessed using the 111 phone line.

These 'urgent treatment centres' referred to are private/public partnership clinics run by the likes of Serco and VirginCare and are referenced in all STPs as 'Multi-specialty Community Provider clinics (MCP).

Remember -  we are already short of hospital staff, GPs, and funding, one reason for more patients attending urgent care/A&E. But... Ironically, the Healthwatch chair then contradicts himself saying..
"it's an ambitious plan, and to be successful it depends on the right staff being available at the right place and at the right time. The fear must be that the increasing shortage of GPs and nurses will frustrate the big hope".
So what is this 'big hope' the chairman of Healthwatch Lancashire speaks of?

Do Healthwatch Lancashire have an agenda of their own? Why aren't they scrutinising the plans to transform healthcare in Lancashire?
  • Where's the money coming from to pay for these clinics on every street corner?
  • Where's the staff coming from to fill all the vacancies?
  • Where's the evidence that these changes will result in better patient care and better outcomes for ALL patients?
  • What effect will this have on destabilising existing hospital and GP services?
  • Will the new models of care be implemented before we see any evidence that they are financially and clinically sustainable?
Why are these plans 'ambitious'?
Why isn't Healthwatch Lancashire scrutinising these STP plans and reporting back to the public on the feasibility of the plans with any potential risks to patients and to financial stability in the NHS?

Because it's likely,  just like everyone else, Healthwatch have been kept in the dark about Jeremy Hunt's covert STP plans to dismantle the NHS. Yet the worst thing a Healthwatch body can do is to forge ahead and promote plans that have no evidence-base and jeapordise a publicly run healthcare service putting the quality of patient care at risk.

All these questions, and I have yet to see a single valid answer from Healthwatch Lancashire.

Proper scrutiny is needed..... Healthwatch can do much better, and must start by using a common sense approach to analysing plans that have no evidence-base whatsoever and are based on a model of care from a country that's just been ranked LAST in terms of healthcare provision, efficiency, effectiveness, and availability to all...


Tuesday, 22 August 2017

Boss of NHS England says get used to longer delays

Take a good look at this man.His name is Simon Stevens, ex policy advisor to Tony Blair. He is responsible for betraying the NHS and is currently the Tories head of NHS England, put there by the disgraced Health Secretary Jeremy Hunt.

Stevens is ex vice president of strategy at United Health, the largest private healthcare insurer in the Unites states, where he oversaw 'Medicare', a program that rations healthcare plans to those in receipt of welfare.

The U.S. were recently rated LAST out of all modernised countries in areas of healthcare such as efficiency, cost-effectiveness, and access for all to healthcare. Yet Stevens has brought his U.S. private health experience with him from across the Atlantic and wants to implement them over here in England.

He calls these plans his 'five year forward view', yet they represent nothing more than a transformation of the NHS into the same disastrous healthcare system as that in the U.S.A.
Yesterday, Stevens admitted his ruinous plans had resulted in long delays for hospital treatment and that patients should get used to even longer days in the years to come. Stevens was referring to a recent report that claimed thousands of patients were 'highly likely' to have suffered clinical harm after Portsmouth Hospital failed to push for check-ups.
Yes, Simon Stevens is Mr STP himself. An ex councillor and hospital porter, this man, along with others such as Jeremy Hunt, are hell bent on privatising the most profitable services in the NHS, destabilising what's left, leaving the NHS with nothing more than a tow-tier poor mans system of healthcare.


Is Simon Stevens really the right person to run the NHS?

Mr Stevens, a senior executive at controversial US firm United HealthCare, was picked out as one of  the ‘aggressive new generation of leaders’

Friday, 18 August 2017

STPs lack any legal status or powers

Hackney shows the weakness of STPs: time to follow suit

City & Hackney Clinical Commissioning Group has finally been the one to state openly that the STP emperor has no clothes – by insisting, with the support of legal advice that STPs lack any legal status or powers to compel CCGs or other “partners” to comply with majority decisions.

This potentially throws a spanner in the works of all 44 STPs consolidating themselves as bodies to drive controversial cuts, reconfiguration and service changes.

As some campaigners and analysts have argued from the beginning, they have no right to tell any organisation to do anything. And as bodies which function in secret with no transparency or publication of minutes, the STPs lack any legitimacy or public acceptance.

Conservative manifesto promises of plans to change the law to allow STPs to take control have had to be scrapped after Theresa May failed to secure a majority. Now the weakness that remains has been powerfully exposed in Hackney, and the door is wide open for campaigners to demand other CCGs and councils take up a similar stance.

The CCG has stood out against the plan to merge all 7 NE London CCGs under just one “Accountable Officer” thus minimising – and effectively dodging – any accountability to local people any of the seven NE London boroughs.

Hackney council’s Oversight & Scrutiny Committee has endorsed this with a powerful letter insisting on the need to retain the statutory levels of accountability that has remained after the disastrous 2012 Health & Social Care Act scrapped previous bodies and established CCGs.

The Health Service Journal publicising the CCG’s stand, the legal advice sent to the CCG and the letter endorsing the CCG’s position and restating clearly the case against local bodies being compelled into collective decisions and losing accountability are all available here.

See also the guidance from experienced NHS law firm Hempsons – on the centre pages of #7 of Health Campaigns Together Newspaper, and, on CCGs, at http://www.hempsons.co.uk/ccg-governance-lessons-learned/

Hackney KONP’s Carol Ackroyd has sent this letter to the local Hackney Gazette:

‘Dear Hackney Gazette,

‘NHS England (NHSE) are determined to roll out country-wide plans for 44 Sustainability and Transformation Partnerships, which will cut £22bn from the NHS budget by 2021 and create Accountable Care Systems (ACSs) which make the NHS more susceptible to takeover by healthcare corporations.

The new East London Health & Care Partnership (ELHCP) covers 7 East London Boroughs, including Hackney, and its Sustainability and Transformation Plan will involve massive reductions in NHS services in the face of a projected 18% rise in population by 2025

NHSE have made it clear that they expect Clinical Commissioning Groups (CCGs) to co-operate with these frightening aims. However City & Hackney CCG are reluctant to hand over responsibility for local decisions about NHS organisation and funding to the ELHCP, based on advice from their lawyers as to the legality of ELHCP’s proposed arrangements. We applaud the fact that Hackney Council is opposing this loss of control over local NHS resources.

However NHSE have reacted to this by expressing ‘concern about decision-making processes’ in the CCG, and have hired consultancy firm Deloitte (no doubt at considerable expense) to ‘investigate further’.

City & Hackney CCG is one of the most successful CCGs in the country. We are extremely concerned that it is being pressured in this way and that Hackney Council’s right to control local NHS resources is being undermined.

We hope that the Hackney Gazette, its readers and local people will give every support to the Council and CCG by emailing their local councillors and/or Mayor Philip Glanville, to confirm they want the CCG and Hackney Council to retain their lawful control over local NHS resources.

Yours sincerely
Carol Ackroyd
On behalf of Hackney Keep Our NHS Public