Friday, 16 February 2018

CCG rationing policies are forerunner to private partnerships

Don't be fooled by Chorley & South Ribble CCGs policies on stopping medications. It's a forerunner to NHS privatisation for when they become partners in an STP private-partnership...

Let's clarify one or two things since there still appears to be some misconception about what's happening with Clinical Commissioning Groups (CCGs) and rationing of medicines and procedures.

Consider this: No GP writes out a prescription for 37p worth of paracetamol.
The mild pain killers are usually prescribed in bulk boxes of 100 and included with other items for patients with long-term conditions such as COPD, MS. fibromyalgia etc.

Also, when boxes of paracetamol are written on prescription they do not cost the NHS £8.60 (a box of 100 is around £1.67 and the practice claims back the difference). Patients who pay for paracetamol are unlikely to be written a prescription and the number of GPs who prescribe paracetamol is very small, with the exception as in bulk for chronic long term conditions where paracetamol is preferable to a stronger prescription only pain killer such as Tramadol.


Let's not get sidelined here, the real reason for CCGs cutting back on medicines and services is to preserve their budget and enable them to make gains in other areas. Areas they deem more important such as perhaps paying their chairman an annual salary of over £130,000 [1]

It's penny pinching, and the reason behind the rationing of medicines and treatment is to 'familiarise' patients with 'paying for treatment and drugs'.
This is part of the overall strategy for Lancashire & South Cumbria 'Sustainability & Transformation Partnership' (STP) where all healthcare providers have been told to make 'efficiency savings' (i.e. make cuts).

This is so healthcare providers can access 'transformation funding' to enable the roll-out of American Style private public partnerships called 'Accountable Care Systems' (ACS).[2] .*Also known as Accountable Care Organisations (ACO).

Accountable Care Systems - Care managed by accountants
An Accountable Care System (ACS) relies heavily on reducing 'patient demand' on services such as hospital admissions and GP attendances along with rationing procedures such as hip and knee operations* and cutting back on entitlements for medication and treatment.
*Rationing paracetamol is only the start. For example, in January, three clinical commissioning groups (CCGs) in the West Midlands proposed reducing the number of people who qualify for hip replacements by 12%, and knee replacements by 19%. To qualify under the proposed rules, patients would need to have such severe levels of pain that they could not sleep or carry out daily tasks.
In the United States the health insurance industry call this 'demand management'. The NHS currently has a fixed tariff payment per treatment (payment by results) but with an Accountable Care System this changes to a fixed budget payment per person (capitated payment).

The incentive then becomes more financial and partners in the ACS will start to 'cherry pick' the most lucrative high-turnover procedures/treatment and introduce a more demanding rationing system.
Whilst people are arguing over who pays for a packet of paracetamol, the CCGs are working on policies to actually STOP you accessing NHS services in a timely manner and prioritising those who can pay for those services, i.e. the profitable element comes first

Those affected the most are the poor

Many poorer in society will go to the back of the queue and be classed as low priority by the ACS (they undertake a risk assessment and categorise all patient records registered with a GP Practice). In the U.S.A the scheme is called Medicaid and is a 'two-tier' system where those who can't afford healthcare are only entitled to certain services, and only then if they setup a healthcare plan with their providers [an ACS might call this a 'Personal Health Budget'].

Now factor in the 'welfare' element and the gradual reduction of benefits to the disabled and families on low income and we have a situation where many people become dependant on household incomes that are on the poverty line.

This means they may have to choose between paracetamol and a meal, just as we have now with foodbanks.
Mark my words, if the ACS systems are rolled out here in England you won't be arguing over a packet of paracetamol, you'll be fighting for access to life-saving treatment that was once free at the point of need on the NHS.
It's time to stop this madness before it goes any further.

Sustainability and Transformation Plans are now STP Partnerships and are turning into Accountable Care Systems. Local Authority Health Scrutiny Committees are nodding them through without any objections. Councillors don't seem to know what  Accountable Care Systems are or realise how they will dismantle our NHS.

Speak to your councillor, write to your MP, join your local NHS campaign group. We must do everything we can to prevent our NHS becoming a thing of the past... Read more here from STOP THE STPS

[1] Annual Report CCG 2016/17
[2] Lancashire & South Cumbria STP page 9

Chorley & South Ribble CCG plan to REMOVE THIRTY THREE more medicines and treatments in bid to save on spending...

Saturday, 10 February 2018

The truth about the King's Fund think tank

The King's Fund are an independant health 'think-tank' who today provide advice to healthcare providers and government departments. The King's fund was orginally formed in 1897 to help the poor access healthcare in London. Today however they are a different beast advising private health companies on how to cut NHS services and take money from the poor, not give it.... read on....


In 2012 the way the NHS operates was re-written by a Conservative led government via the Health & Social Care (H&SC) bill. The bill received royal assent and became an 'act' which came into effect in April 2013.

The act guaranteed the King's Fund further research funding.


The King's Fund rely heavily on lobbying private companies and government to fund their future pet think-tank projects. They soon set to work on the H&SC Act and 10 months later released an 86-page report recommending everyone pay more for NHS services through a range of additional fees. So much for their 'charitable' status and humble beginnings helping the poor...

In 2014 the King's Fund published its Interim Report on the "Future of Health and Social Care in England" - 86 pages setting out what its ‘Independent Commission’ think must happen to save the NHS from becoming 'unaffordable' and 'unsustainable'.

The author, Kate Barker CBE, a business economist, has suggested a range of 'options' to increase income for the NHS. By and large these mean those who use it having to pay more.

The Kings Fund’s ideas include:

Over 60s (except those on pension credit) to pay for prescriptions - £1.5bn

  • Increase the qualifying age to 65
  • Raise the prescription charge to £10
  • Or remove all prescription exemptions and charge £2.45 to all
  • Charge to visit the GP from £5-25
  • Charging to attend A&E £10
  • Charge £10 for outpatient attendance
  • Charge £10 for each day in hospital
  • Charge £50 for each hospital 'procedure' - £900

Yet funding the NHS is about choices not affordability. If we invested a similar proportion of our national wealth as Germany and France do (both around 11.5%) the NHS would have about £25billion more than it does now.

Affordability is the wrong question. The right question is what do we prioritise? We could invest in the NHS and make it the best healthcare service in the world.


In 2018 the Conservative led government agreed to accept the advice from the 'Naylor Review' which is an NHS asset stripping document commissioned by the DoH. Once again a few months later, in response to the Naylor review of NHS estate, the King's Fund published its report commissioned by the Department of Health in support of the Naylor Review.

Twelve months earlier the King's Fund came out to support new U.S. style care models proposed by the head of NHS England Simon Stevens, a previous director of strategy at United Health, Americas largest private healthcare insurer.

Healthcare and profit are a bad combination. Ask any of the 47 million non-elderly Americans that were uninsured in 2012.

Source(s) + related links

Kings Fund suggests NHS fees - but is it really 'independent'?

The revolving door between healthcare companies, lobbyists, think tanks, special advisers and government

human guinea pig trial U.S. accountable care systems

NHS England boss selling U.S. healthcare as 'solution' to NHS crisis
If you live in the Morecambe Bay area or on the Fylde Coast then pay heed...All healthcare providers and commissioners in your area have agreed on a Memorandum of Understanding to set up a U.S. style Accountable Care System. 

Contentious NHS reforms: The outcomes of human 'guinea pig' trial U.S. accountable care systems are still unknown, yet they are still going ahead...

Memorandum of Understanding (MoU) Morecambe Bay Area 

Accountable Care System (ACS) - sample area Bay Health (Shadow ACS until April 2018)

Objectives: bring together (integrate) ALL health and care providers under a single partnership. Pool resources and demand manage [ration] health & care services and medicines.

■ Reducing cost per capita for our 365,000 population (£ spent per person)

3.2.1 Estates management and capital investment
 Conduct an  audit of all land, buildings and equipment "owned" by the ACS;

Above estates and buildings owned by each partner will now become responsibility of the ACS and ALL estate and buldings will be opened up for sale to further the ACS

The Bay ACS will either “make or buy” (provide directly or commission) health and care services for the Bay population – a hybrid of commissioning and provider functions. With a focus on prevention [preventing patients accessing services] with increasing focus on community and getting people to take responsibility for their own health and wellbeing.

Budget type: Capitation
■ Demand management restricts patients’ choice.
■ providers cherry pick types of procedures choosing most lucrative high-turnover
■ ACS historically have incentives to only take healthier (i.e. more lucrative and less time-consuming) patients.
■ difficult to evaluate performance between providers/clinicians
■ Capitation can encourage a doctor or practice to take on too many patients, more than they can ideally care for.
■ incentive is to make financial surplus to pass back to ACS shareholders
■ Over-treating: Capitated payments encourage doctors/practices to take on too many patients, more than they can ideally care for.
■ over-prescribing and unecessary referrals to specialists instead of general clinicians
■ ACSs are trialling schemes and playing with patients lives. they have No safety net for patients if budget is exceeded, capitation requires increasing, or under-funded or even if prevention schemes fail

Taking the 'Social' out of 'Social Care'
Social care is currently means tested: when local authority care services are transferred to an ACS/ACO the means tests could then apply to both the 'care' and 'health' services elements. That is, patients could end up taking a means-test, and if their income is above a certain limit they'll have to pay for health services that were previously included as free on the NHS.

Accountable Care - provided by accountants who care about finance
Historical List (not exhaustive) E&OE....

  • ACS Scheme taken from U.S. Health Maintenance Organisations (HMO) and failed Obamacare model.
  • ACS Scheme being rolled out by NHS England's CEO Simon Stevens ex president of United Health - Americas largest private health insurer.
  • scheme has full support and backing of health secretary Jeremy Hunt who in 2008 co-authored party policy pamphlet calling for NHS to be denationalised [privatised].
  • 2012 Health & Social (H&SC) Care bill introduced by the then health minister, Conservative minister Andrew Lansley opens up NHS market to any private [qualified] provider paving way for NHS privatisation.
  • 2013 H&SC Act comes into effect replacing 152 primary care trusts with 222 GP-led Clinical Commissioning Groups (CCGs) in England
  • CCGs set to work liasing with quangos NHS England and 22 Commissioning Support Units (CSUs) 
  • 2015 election - NHS England's five year forward view [FYFV] document for U.S. style healthcare shelved. 
  • 2015 - Conservatives win election, five year forward view document for U.S. style healthcare dusted off and distributed 
  • England divided into 44 'footprint' areas with providers and commissioners in each footprint told to draw up a 'sustainability & transformation plan (STP) in line with five year forward view document.
  • Providers and commissioners underfunded, unfair contract imposed on junior doctors; BMA mount weak opposition.
  • CCGs begin rationing of healthcare services and medicines (earliest signs of 'denial of care' seen mainly in U.S. health insurance policy claims
  • 2015/16 - five models of care from FYFV document start trials across 50 vanguard sites in England. these are the test beds for ACSs
  • Protests begin around secrecy of STP documents. Con/Lib Coalition government refuse to reveal contents of STPs after call by shadow health for transparency
  • 2016 - name changed by NHS England from ST Plan to ST Partnership indicating arrival of U.S. Accountable Care Organisation (ACO) type model. Legal challenges begin as to how ACS/ACO could remove purchaser/provider split without change in legislation
  • 2016 - CEO of NHS England invites U.S. Medicare director over to England to re-affirm position to Health sec. on benefits of demand management in elderly care
  • 2017 - Mass demonstrations against STPs throughout England and in London
  • 2017 [June] - Eight shadow Accountable Care System areas established with two more added 
  • 2017 - NHS England confirmed the first wave of accountable care systems (including two health devolution deal areas)
  • Judicial reviews start on legality of forming ACSs/ACOs
  • 2018 [Feb] - NHS campaigners rally in London against austerity cuts
  • 2018 - NHS England pause ACS rollout for 12 week listening exercise due to public not understanding what ACSs involved
  • 2018 - NHS England, during its pause period, tell providers to go full speed ahead with ACS plans...

15 Jun 2017 - HEALTH bosses across the Fylde coast say they are 'delighted' to have been chosen as one of only a few areas in the country to receive support to progress towards being an accountable care system.
Fylde coast healthcare leading the way – Your Care Our Priority

Sunday, 28 January 2018

A healthy nation yields a healthy economy

If STPs for Lancashire want folk to adopt preventive medicine then they can ruddy well pay for it!  TORIES scrapped free swimming at Chorley leisure centre and Brinscall in 2010 reducing the activity levels of those using the free facilities. T

Technically it wasn't free, it was government subsidised by New Labour in 2009 but the Tories scrapped the funding in 2010 as soon as they got to power.

Austerity is an excuse to kill 

The announcement to remove the funding in 2010 formed part of the Conservative government’s future spending plans, which aimed to reduce the national deficit. What they actually did was to add to the increase in hospital and GP attendances.

Now, in 2018 the same Tory government are pushing for people to 'self care' and use 'prevention' to avoid future illnesses and reduce hospital admissions and  attendances at the doctors.

But they can't have it both ways; removing free access to healthy leisure facilities increases chances of more GP and hospital attendances.
So if they are serious about preventative medicine they'll need to fund it. Historically, there's little chance of a Conservative government funding free access or vastly reduced concessions to leisure for the unemployed, disabled or unwaged.

This year, in 2018, I'm going too push for free/concessionary access to leisure for EVERYONE who can't afford the ridiculous fees currently charged at local leisure centres.

Councils that subsidise local leisure centres could save the health service money in the longer term by helping people stay fit.

At present, Chorley council claim to be partnered with local leisure centres yet concessionary admission fees at these centres for the disabled or unemployed are still expensive and unaffordable to many.

In a recent news article, the Health & Wellbeing commissioner for Wales Sophie Howe said public bodies, such as councils and the NHS, were now required by law to think in an "integrated way" about the impact of their decisions.

She also said a "national conversation" was needed on whether tax increases were needed for health and social care.

Prevention is better than cure. "For too long we've put health in the category of the health service [and] hospital spending and that's at the acute end, that's where things have actually already gone wrong."

Wales has the 'Future Generations Act' which requires all those public bodies coming together under something called a public services board - to be having exactly those sorts of conversations. So if, because of budget pressures, the local authority is thinking about closing leisure centres they should be having that discussion with other partners [and saying] 'who can help us?

The health of a community depends largely on keeping people fit thus preventing further problems down the line. In England the issue has been overlooked for too long and many people are excluded from physiotherapy and physical activity at their local leisure centres due to high admission costs or annual membership fees. If we are to take preventive medicine seriously this needs to change.

In July 2010 free swimming at Chorley leisure centre and Brinscall was axed.
At the time the Leader of Chorley Council Councillor Peter Goldsworthy said: “Although free swimming was popular in Chorley, all the evidence suggests it had been taken up by people who were already swimming and it wasn’t attracting lots of people to take up the sport".

Ironically, Cllr Goldsworthy then went on to say to encourage these people to continue swimming and keeping themselves fit and healthy at our leisure centres they'll now have to pay.
Surely if people aren't using the free swimming scheme it won't cost anything so why not keep free access open in the event people do? The answer of course is leisure centres need money as a business so they axed the free swimming and introduced charges - and the charges didn't stop at swimming fees either...
Free swimming, which was launched nationally in 2009 and funded by the Government, was aimed at getting more people taking part in exercise. Yet as soon as the Tories came to government in 2010 the funding was axed. As mentioned above the announcement to remove the funding formed part of the Tory government’s future spending plans, which aimed to reduce the national deficit.

So on the one hand the Tories in 2010 scrapped a scheme that was helping towards keeping the nation fit and healthy. In 2015 the Tories set out reforms that heavily involve keeping the nation fit using preventative medicines.
They can't have it both ways. 
The unwaged, disabled, unemployed are all too often forgotten about when it comes to social care and preventive medicine. A healthy nation yields a healthy economy. But the funding must be released to enable this to happen.

Let's all press for the funding - and at the same time kick STP NHS privatisation plans into the long grass where they belong...

Free swimming at Chorley axed [July 2010]

Wednesday, 24 January 2018

Lancashire Hospital Chief exec to self-certify delays

Poor results of Delayed Transfers of Care (DToC) at the hospitals in Lancashire is causing backlogs, long A&E waits, and even Ambulances being redirected to other hospitals.

So when a local Health & Wellbeing board identified Lancashire Teaching hospital NHS Trust as having the worst patient transfer delays in England you'd think an independent body would monitor and report back on the issue?

Bizarrely, Lancashire County Council's health & wellbeing board have asked the hospitals chief executive and commissioning group to self-certify that all is well or otherwise. 

Lancashire Health and Wellbeing Board
Minutes of the Meeting held on Tuesday, 14th November, 2017
Hospital Delayed Transfers of Care (DToC) from hospital to home/care

This area has been recognised as the top priority for joint working by NHS and Social Care. There is significant national scrutiny that has placed Lancashire in the worse performing quartile resulting in an impending review of the use of the iBCF monies in improving DToC performance.

There was discussion about DToC performance and it was agreed that there would be a Check and Challenge Group that would meet in between Board meetings that will feed back into this group. The membership of this group was agreed as follows:

  • Louise Taylor - Corporate Director Operations and Delivery (LCC)
  • Karen Partington  - Chief Executive Lancashire Teaching hospitals foundation Trust
  • Jayne Mellor - Head of Planning and Delivery Chorley & South Ribble CCG and Greater Preston CCG
Louise Taylor agreed to lead this group and convene the meetings.
source LCC Health & Wellbeing board minutes of meeting Nov 2017

The Lancashire Evening Post reported mid-January that hundreds of patients a week were stuck in Lancashire hospitals – even though they are well enough to be discharged – at a time when bosses are having to put on extra beds to cope with huge demand.

The Lancashire trust run two hospitals in Preston and Chorley.
Chorley hospital had its A&E closed in April 2016 causing a larger number of patients to attend the only full-time A&E in Preston adding to the capacity and patient transfer delay problems. 

Although the A&E supporting Chorley & South Ribble was re-opened part-time in January last year the problems at the neighbouring hospital in Preston persist. 

Campaigners are calling for a full-time round the clock A&E at Chorley which would alleviate the problems at Preston Hospital.


The next Lancashire Health & Wellbeing board is Thursday , 25th January, 2018 10.00 am Committee Room 'C' - The Duke of Lancaster Room, County Hall, Preston. The above issue is on the agenda - come along and speak up!


The transformation of NHS hospitals into businesses was accelerated with the introduction in 2003 of a funding mechanism known as ‘payment by results’, whereby hospitals were paid per each individual who completed treatment, rather than with a lump sum for a given number of cases.

Income now became closely tied to performance, which was measured by ‘throughput’, and payments were based on a national tariff of fixed prices, adjusted for the seriousness of each case category, not on how well patients did after they were treated.

‘Payment by results’ was actually a misleading name for the arrangement – it should have been ‘payment by throughput’. It was another piece of policy bought wholesale from the USA.

excerpt above kindly reproduced from NHS SOS: How The Nhs Was Betrayed – And How We Can Save It (by R.Tallis)

And the result of implementing 'Payment by Results'?
Hospitals act like 'conveyor belts' for dying patients

Sunday, 14 January 2018

Jeremy Hunt, Social Care, and means tests

What d'ya mean 'means-tested'?

"No society can legitimately call itself civilized if a sick person is denied medical aid because of lack of means". Aneurin Bevan
Let's expand on the term 'means tests' and how this relates to the health secretary's new responsibility for social care.

Currently social care is 'means tested' , so if you’re looking at getting some social care, such as help at home, home adaptations or a care home place, and you exceed a certain income or have savings above a certain threshold then you must pay for it.

Integrating social care into the NHS runs the risk that eligibility to NHS medicines and treatment, as with social care, would become 'means-tested'. Hunt, knowing this, intends to do just that and pool his NHS budget to cover social care then roll it out under the American style accountable care organisations (after all - he appointed Simon Stevens, ex vice-president of the largest private health insurer in the USA to head NHS England to further the cause).

The proposed STP reforms intend creating a two-tier system to do just that - split the NHS into a private-public partnership as with medicare in the U.S.A. It will look at your income, savings and property (if you need to move into a  permanent care home) to calculate how much you need to contribute towards the cost of your care and support.

Those who can afford certain treatments or procedures on their insurers (CCGs) list* will be seen prompt and jump the queue. Those who can't will have to wait and put up with a very bare healthcare system which will dwindle as years go by.

*It's anticipated commissioning will be done wholly by CSUs (Commissioning Support Units) and CCGs will continue to further ration healthcare under their existing policies (but this depends on how each Accountable Care System evolves).

It's already started - insurers call it 'Denial of Service'

Clinical Commissioning Groups, underfunded by NHS England are resorting to clinical policies that restrict or deny patients certain treatments (as with HMO private insurers in the states). It starts with the small items, then moves onto cateracts, hip replacements, full or partial knee ops etc. Patients who are now referred by their GP for certain procedures in the CCGs expanding restricted list must now go cap-in-hand and apply for an "Individual funding request".

Patients will eventually be encouraged to make 'co-payments' towards their procedure or take out insurance in case something goes wrong with you or your loved ones.

It's all contrary to providing comprehensive healthcare to all, no matter what means to pay. And behind it all is Simon Stevens and Jeremy Hunt (spelling error) who's next step is to force a failed U.S system on us from the country with the worst healthcare rating in the advanced world. Knowledge is key, read on....

The Americanisation of the NHS, happening right here, right now