Sunday, 15 July 2018

NHS privatisation plan revealed - One A&E for central Lancashire

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 Hospital

The 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.

Saturday, 14 July 2018

NHS privatisation for Chorley and Preston is here

NHS privatisation is well under way in Central Lancashire, and it's in plain sight for all to see...
Privatisation: "a process in which non-government actors become increasingly involved in the financing and/or provision of health care services.”
The above is the definition of privatisation by the World Health Organisation (WHO).

The privatisation plan for Lancashire & South Cumbria has already begun. The local area plan for Central Lancashire [Preston, Chorley, South Ribble] ineptly titled 'Our Health Our Care' is part of the process where private providers are increasingly becoming involved in provision of health services.

The image above shows just a handful of NHS hospital services awarded to private providers by Clinical Commissioning Groups (CCGs).
*The latest proposal from the Our Health Our Care program team is to have only one A&E/trauma centre for Central Lancashire. Thus replacing Preston and Chorley A&Es (although Chorley A&E is currently a 12 hour temp A&E).
As we can see from the above image, the high-turnover, low risk, lucrative services are moved out of Preston and Chorley hospitals under the Our Health Our Care program straight into the private sector.

The Our Health Our Care program calls this 'care closer to home' or 'care in the community'. In reality, it is fragmentation of NHS services primed for privatisation to line the pockets of the commercial health sector.
This decoupling of hospital services into private clinics results in fewer resources, funds and staff for the NHS: which in turn means NHS bidding power to get the contracts back into the public sector is seriously diminished.
If continued, the NHS will eventually be left with a basic rump state-funded system similar to that seen in 'Integrated Partnerships' in the USA called Accountable Care Organisations (ACOs). This ultimately is what the ex U.S. Medicare director and now head of the NHS wants.
See also: NHS CEO Simon Stevens is key player in private healthcare network

The Longer it goes on - the better chance of Privatising a public service

The NHS doesn't need to be handed over wholesale to be 'privatised'. In fact, this isn't what privateers want, as a bulk of NHS services simply aren't profitable (such as acute/A&E services).

They only want the low-risk, high-turnover, lucrative services to ensure a profit margin. This is why we are seeing more and more of these lucrative hospital services being moved out of hospitals into private-public clinics (or public surgeries hired out by the private provider).

Community services are also a prime target for the commercial sector, as are county run 'Social Services'. For this reason, the means-tested services if 'integrated' into the NHS could result in ALL NHS services becoming means tested. Similar to dentistry we have now, those who can pay will have to pay.

A prime example is that of Virgin Assura (now Virgin Care Ltd).
In 2010 Virgin had around 60 urgent and community care NHS service contracts, in 2017 however this had risen to well over FOUR-HUNDRED.

To prevent the 'rioting on the streets' scenario what the Tories have done is implemented a plan over a longer term whilst keeping the illusion that we still have a public NHS.

Although plans to dismantle the NHS have been in place for decades, the Tories themselves needed two consecutive terms of office to set in motion what would to be potentially irreversible decisions.

  1. change legislation to hand over public contracts to any private provider - done
  2. hand over the NHS budget to the private sector (CCGs)- done

1 and 2 above are the first term (5 years) the second term is to use the H&SC Act to introduce a new health insurance system.

Buying & Selling has no place in a Universal health service

GP - led Clinical Commissioning Groups (CCGs) hold the bulk of the NHS budget - denial of care is now up and running. *Note GP's are private providers operating under an NHS General Medical contract, many were familiar with 'practice-based commissioning' from the Blair Labour era.

Out of interest, if you read back over history it was a Tory leader who said "if it was us (Tories) trying to do what new Labour are doing (with the NHS) there would be 𝐫𝐢𝐨𝐭𝐢𝐧𝐠 𝐢𝐧 𝐭𝐡𝐞 𝐬𝐭𝐫𝐞𝐞𝐭𝐬.

Denial of care plays a large part in the proposed Integrated/Accountable Care partnership Organisations (ACOs). It comes under the title 'demand management'. 
Each time an NHS contract is awarded to a non-NHS (private) provider, the NHS funding, and in many cases staffing, shrinks. The NHS in that case will have less and less funds to bid on and buy back the service. 
Many hospital trusts could become bankrupt (foundation trusts are prone to this).  And over time, particularly over the 2nd term of office, the NHS will have been dismantled. The heist will then have been done.

■ 𝐍𝐨 𝐨𝐩𝐩𝐨𝐬𝐢𝐭𝐢𝐨𝐧, 𝐧𝐨 𝐜𝐨𝐧𝐬𝐮𝐥𝐭𝐚𝐭𝐢𝐨𝐧, 𝐚𝐧𝐝 𝐧𝐨 𝐫𝐢𝐨𝐭𝐢𝐧𝐠 𝐢𝐧 𝐭𝐡𝐞 𝐬𝐭𝐫𝐞𝐞𝐭𝐬.

We are now deep into the 2nd term of office.

We are now heading towards that American insurance based model of health the head of NHS England 'Simon Stevens' wants.

We either take to the streets, or watch as our NHS slips further away from our grasp....

Monday, 9 July 2018

Lancashire's Hospital Car Parking scandal revealed

In April 2017, Lancashire Teaching NHS Hospital Trust had a surplus from car parking charges of over £1 million. Yet a few months later the same hospital trust vastly increased car parking charges and also started charging disabled to park at their hospitals in Chorley and Preston.

In the same tax year, health Trusts in Lancashire and South Cumbria raked in over £5.1m in parking fees.

In the last financial year (2016/17) it was revealed NHS hospitals in England made £174m from charging patients, visitors and staff for parking.

The biggest profits in Lancashire came from the Lancashire Teaching Hospitals NHS Foundation Trust which runs Royal Preston and Chorley and South Ribble hospitals. It collected a record £2,263,000 in 2016/17. Parking fines (charges) amounted to £7,920.

Unnecessary increases  - a scandal

The Chief Executive of the Lancashire Hospitals Trust Karen Partington back in December last year claimed that car park management, maintenance and security, cost nearly £1m per year.
So if this is the case, with a surplus £1,263,000 in April 2016/17 why did her trust board agree to increase parking charges further in July 2017 - as well as starting to charge the disabled?

Not content with making £millions off the backs of the sick and poor, the Lancashire Teaching hospital trust then went ahead and vastly increased their parking charges and started charging disabled people to park in hospital grounds.

Even with an excess profit surplus from car parking charges of over £1m, the Hospital trusts new 'tariff' shows that in one case charges were actually doubled.

Subsidising the NHS budget?
Karen Partington, Chief Executive of Lancashire Teaching Hospitals NHS Foundation stated “We [hospital trust] apply charges because we do not believe the cost of providing safe and secure carparks should be funded by budgets intended for patient care and treatment. The charges fund hospital car park management, maintenance and security, which cost nearly £1m per year. Any surplus is reinvested in patient care and providing hospital services.”

So the question that needs putting to the Chief Executive of the Lancashire teaching hospital trust is: If your trust are profiting with a huge car parking surplus off the backs of the sick and poor, what's to say your trust aren't doing the same with other schemes?

Setting a precedent

Worst of all, due to the apparent greed of the Lancashire teaching hospital trust, the car parking management company have had to recommend an across the board increase to the other hospital trusts they provide facilities to.
i.e. the decision by the Lancashire teaching hospitals trust to ramp up car parking charges  has had a knock on affect across all hospitals in Lancashire.
The Department of Health issued a statement saying: "Patients and families should not have to deal with the added stress of complex and unfair parking charges. NHS organisations are locally responsible for the methods used to charge, and we want to see them coming up with flexible options that put patients and their families first."

• Blackpool Teaching Hospitals NHS Foundation Trust raised £1,662,000 in parking fees in 2016/17. East Lancashire Hospitals NHS Trust, which has a PFI (Private Finance Initiative) contracted out service, said it gained £100,021 in fees in both 2016/17 and 2015/16. In 2015/16 Lancashire Teaching Hospital Trust’s “income” from parking fees was £2,218,000, with £11,100 gathered in parking fines (charges).

Wigan Council was left with an £829,000 kitty from surplus parking revenue in a 12-month period, new figures have revealed.

Campaign group 'Protect Chorley Hospital from Cuts & Privatisation' have been lobbying the Lancashire hospital trust to rethink the disgraceful decision to charge the disabled and bring the car parking charges down or remove them altogether.

A petition is currently being circulated, for more information please visit the campaign media facebook group here.

Friday, 6 July 2018

Welcome to your new integrated Healthcare service

Dear reader. In 2005 the Health minister Jeremy Hunt co-authored a policy book calling for the NHS to be 'denationalised' [privatised] and replaced with a health insurance system. Due to rapidly increasing demands placed on the NHS, this new 'Accountable Care' system was put in place on the 4th December 2021.

This could not have been possible without the help and experience of Sir Simon Stevens, the ex vice president of the largest private health insurer in the United states, UnitedHealth. Mr Hunt appointed Mr Stevens as Chief of the NHS in 2014. Mr Stevens' experience of working on the U.S. Medicare scheme has enabled the NHS to take better rein of out of control finances and reduce hospital stays bringing more integrated partnership working into the NHS.

The letter shown below is a typical explanatory note to a fictitious Mrs Smith. It explains the co-payment system only. There are other expenses, for these see the link at the end of this page. Welcome to your new NHS......

Date: 31.03.2022

Dear Mrs Smith
Thank you for choosing Chorley & South Ribble Integrated Care Partnership as your preferred Healthcare provider. Please see below an information leaflet regarding part of your healthcare plan.

NHS Co-payments

A 'co-payment' is a fixed amount of money you pay for a certain health & social care service. The NHS pays the rest of the cost. Co-payments are worked out in percentages.

The 'Accountable Care Organisation' (ACO) currently operating in your area is C&SRP (Chorley & South Ribble Partnership). Your ACO 'Advantage' plan supplements the costs of NHS treatment and medicines (except prescriptions which are charged at the full cost, which is currently £10.80 per item).

The co-payment system is operated by your regional NHS Clinical Commissioning Group who along with your healthcare providers, are partners in the Accountable Care Organisation (ACO) for your area.

Your ACO uses co-payments for most Healthcare services. You make a co-payment of 20% for most services provided by your ACO healthcare provider system.

Here's an example of how co-payments work with your ACO 'Advantage' plan.

Note: The example shown above is from the actual Medicare webpage with $dollars converted to British £pounds.
The average Hospital charge for a total knee replacement (TKR) in the United States is $49,500. A partial knee replacement (PKR) typically costs about 10 to 20 percent less than a TKR. The main reason is that the operation requires a shorter hospital stay. For example: an average of 2.3 days, compared to 3.4 days. [23rd Feb 2015]
How do copays, coinsurance and deductibles work with Medicare plans?

Saturday, 23 June 2018

Labour U-turn on bill to reinstate public NHS

The Labour party have pulled the plug on support for the parliamentary bill that gave the NHS the only chance it had of being fully reinstated back into public ownership.

The NHS Restoration Bill, sponsored by Labour MP Elaine Smith was due to be heard on the 11th July in the house of commons.

But on Wednesday afternoon the Wolverhampton Labour MP posted a statement on her social media page saying the bill had been withdrawn and that she's "now received clarification from the Health Policy team as to where the resistance to the Bill came from".

It's unknown at this time why the Labour party have come up against resistance to the bill since a motion at a Labour conference last September fully supported the bill in its entirety.

Smith continued "In view of this [resistance] I want to reassure supporters of the Bill that the main thrust of its content will be maintained; we are going to try and work through and resolve the issues; meetings are being arranged for next week - and I expect to be invited to take part in them".

A broken commitment?

Although the NHS bill was important in itself, it's the principles behind the bill that drove Labour's NHS health policy culminating in the Labour party committing to the bill at last September's Labour party conference.

The composite 8 motion was agreed on September 25, 2017 at the Labour party conference and in part reads:
"Conference recognises that reversing this process demands more than amending the 2012 Health & Social Care Act and calls for our next manifesto to include existing Party policy to restore our fully-funded, comprehensive, universal, publicly-provided and owned NHS without user charges, as per the NHS Bill (2016-17)".
The speakers at the conference included shadow chancellor John McDonnell, shadow health secretary Jonathon Ashworth and Professor Allyson Pollock, co-author of the NHS Reinstatement Bill, which has for so long acted as a beacon for campaigners against NHS privatisation.

Support it, yes we do, wait no we don't or ...

Labour have always supported the NHS bill and approved MP's sponsor it many times since its initial reading around 2015. The second reading of the bill however attracted only 15 Labour MPs to its debate in parliament - about 94% of all Labour MPs didn't bother to turn up to support the NHS reinstatement bill.

The Campaign for the NHS Bill is provided by Public Matters, a not for profit company. Along with other groups such as Keep Our NHS Public [KONP] Public matters provided a statement on social media which caused an uproar in the NHS campaigning fraternity.

Fake News?

The public outcry must have reached Labour's HQ as after a short while Labour's Shadow health & social care secretary Jon Ashworth posted a long article saying previous reports about the NHS bill veto were 'fake news'.

If in doubt- call it 'Fake News'

The labelling of the article by public matters as fake news appears to have infuriated Public Matters who replied ...

We are extremely concerned and surprised to see Jon Ashworth, Shadow Secretary of State for Health, label the statement on the withdrawal of the NHS Bill as ‘fake news’ on his Facebook page.

We put the statement out on behalf of the reinstatement bill group. It was approved by Eleanor Smith MP who was going to present the bill.  The statement we issued did not attack either Jon Ashworth or Jeremy Corbyn on these issues. It simply expressed concern that the bill should not have been allowed to have its reading. That was specific and not fake. The issue of why that happened has not been addressed.

"We will continue to provide evidence based information on privatisation and political manoeuvres around these issues. Labour could have issued a simple apology and said they got it wrong on this occasion (or given a polite explanation of why they did not feel it was appropriate at this time).

Disappointing that they sought to cast doubt on us and the Bill Group instead.

So have Labour now detracted from their commitment to support, sponsor or promote the NHS reinstatement bill?

Nobody has actually said why the Labour health team pulled the plug on such an important bill and where the 'resistance' to the bill, which is basically Labour's own composite 8 motion, came from?

Have Labour reneged on their commitment to the NHS bill and hence their own policies?

The cross-party bill, whilst not supported by the Tories, was a huge boost for campaigners and Labour supporters alike. Supporting the bill was crucial to gaining cross-party support, as well as support from NHS campaigners who spend hundreds of hours fighting to save the NHS from further privatisation.

Who or what is resisting the bill ?

This could be the straw that broke the back of the NHS. The very party who created the NHS, may have handed it over the wolves in Blue and their corporate buddies... keep campaigning, the NHS is bigger than elusive politics....

Statement from Eleanor Smith, MP for Wolverhampton South West..

Public Matters group report shock news of NHS bill's withdrawal

Related Links

MPs have let down the public on the NHS bill [from 2016]

Labour Has Committed To Renationalise Our NHS

Labour's full composite motion pledging to support the NHS bill

Labour MPs that support the NHS Bill

Labour party conference (including videos)

Converting the draft NHS Reinstatement Bill 2015 into Law [socialist health]

Friday, 15 June 2018

Commissioning in Lincolnshire - Selling off the NHS

Dividing the NHS in two. U.S. style 'Accountable Care' models, and the link between Lincolnshire and multi-national health corporations...

The Health & Social Care [HSC] Act 2012 created GP-led Clinical Commissioning Groups (CCGs).

Section 75 3(a) of the Act imposes requirements relating to competitive tendering for the provision of NHS services to 'any qualified provider'. CCGs feel they are open to legal challenge if they do not tender NHS contracts under the HSC Act.

What are the doctors playing at?

GPs do not have the collective skills to carry out the complex procurement process of putting services out to tender. Instead, they use Commissioning Support Units such as Optum, the UK subsidiary of United Health of America, to perform this function.

United Health are the single largest private Health insurer in the United States. The head of NHS England [NHSE] Simon Stevens [shown above] was previously vice president of United Health working on Medicare and other projects such as expanding the private health care business across Europe. Stevens published his 'five year forward view' [FYFV] document just after the general election in 2015.

Sustainability & Transformation plans [STPs] based on the FYFV document were developed in 44 'footprint' areas of  England. The FYFV 'vision' brings together Steven's work as vice-president of European division of United health and introduces profit-making American style health care schemes here in England. In particular a variant of the U.S. Obamacare which is part state funded but mostly private insurance-plan based. Here's a clip from Optum's Annual review 2015/16 ..

Lincolnshire Commissioning Support Programme & United Health
Following a rigorous procurement process throughout 2015, Optum received accreditation as an approved supplier to provide Commissioning Support Services under the NHS England Lead Provider Framework (LPF).

In October 2015 Optum was successful in winning the first tender under the LPF to provide the ‘Endto-End’ Commissioning Support Services to South Lincolnshire and South West Lincolnshire CCGs (whilst also providing a subset of services to Lincolnshire East CCG) for an initial three year period
from February 1st 2016.

Following a successful handover and mobilisation period, the Optum Team is now focused on delivering the new service offerings. source: Optum Commissioning Annual Review 2015/16

To expand the health care market in Lincolnshire and beyond, Optum do not initially need to provide services, only influence and control the strategy that delivers them. This furthers the process to gradually enable them to be part of what are called Accountable Care Systems. These are the ultimate goals for Stevens, and the end game for the NHS.

Accountable Care Systems (ACS) were previously titled Accountable Care Organisations (ACOs), but NHS England thought the name had connotations  that were too close with American private health care so the name was changed to Accountable Care Systems. Ultimately they are the same entity.  If it looks like a duck, swims like a duck, and quacks like a duck, then it probably is a duck, an Accountable Care Duck. *The only substantial difference between the ACS and ACO are the number of 'partners' signed up to the accountable care scheme. To add to the confusion, other titles used are Integrated Partnerships, Accountable Care Partnerships etc.

No matter what they are called, Stevens and NHS England has said over time they are all to become ACOs (March 2017 NHSE).
An ACO is a network or 'partnership' of GP federations, hospital trusts, care trusts, social & community care and mental health care providers that share financial and medical responsibility for providing coordinated care to patients in the hope of limiting unnecessary spending. A fictitious ACO is shown below depicting a typical 10 year contract to providers who may then sub-contract out any services.

Over in the states ACOs have sprouted up as ways to reduce the national deficit, Medicare became a prime target. With baby boomers entering retirement age, the costs of caring for elderly and disabled Americans are expected to soar.

One of the main ways the ACOs seek to reduce health care costs is by encouraging doctors, hospitals and other health care providers to form ACS/ACO networks that coordinate patient care and become eligible for financial bonuses when they deliver that care more efficiently. In many cases the efficiency is sought by withholding treatment and rationing medicines, they call this demand management.
The fewer patients they treat, the more money the government save, and the more bonuses the ACO partners receive from the government. 
Providers make more money by attempting to keep their patients healthy and in particular out of a hospital setting. *This is where the market for private providers expands since this is used to justify transferring public NHS services from hospitals into communities and straight into the private sector.

ACOs are profit-oriented systems that rely heavily on two major factors: Managing demand, and capitated payments. This is where problems lay for the NHS in England.

CCGs are already managing demand by rationing medicines and treatment. But there are more perverse incentives when ACOs are actually established. Competition between ACOs rises between the private sector who will step up their share of the market to cater for more and more patients who can't or won't wait to access medical treatment and services that have been rationed or where patients have been 'denied care' by the ACO.

England is heading towards a 'two-tier' health system
Health insurance plans then become a viable option, and as with dentistry in England, we will have taken a retrograde step into a two-tier system where those who can pay will pay, and those who can't will only have access to a rump healthcare system similar to Medicare and Medicaid in the U.S.
*In the U.S. Medicaid is for under 65's, Medicare plans are for over 65's.
While ACOs are touted as a way to help fix an inefficient payment system that rewards more, not better, care, some economists warn they could lead to greater consolidation in the health care industry, which would allow some providers to charge more if they’re the only game in town. [1] 
ACOs may include private providers as 'partners'. In fact they are encouraged to do this (as it reduces competition and thus increases profits for the ACO).

Providers make more money and recieve more bonuses if they can prove to the health department they are keeping their patients healthy. The main concern is 'how' they do this since the payment system with these ACS/ACOs is based on a limited amount allocated per patient (capitated) rather than per treatment.
Capitated Payments don't account for fluctuations in populations or patients who use cross boundary services. Each ACO could end up competing with each other giving rise to the commercial sector taking on a whole ACO ten-year contract (see image above with the fictitious Kaiser Virgin Ltd).

NHS England are using the term 'integration' to sell ACOs to the public. This is a misnomer.

The term integration has its origins in the USA care pathway where paying paitients make their own decisions on which physician (e.g. dr, Nurse, specialist, surgeon or consultant) they should go to first. This led to confusion as patient records were fragmented across different providers. This is completely different to the NHS where the patient is guided by primary and secondary care professionals.

In terms of the NHS, Stevens and NHSE are using the 'integration' vernacular to justify formation of partnerships that would also incorporate the social care budget.

Sustainability & Transformation Plans changed title to Sustainability & Transformation Partnerships. Some footprint regions were trialling NHSE vanguard care models so changed their STP titles to either Integrated Care Partnerships (ICP), or Accountable Care Partnerships (ACP). They are all based on the same FYFV document are are just various prototypes of an ACO.

There is a fear that merging (integrating) social care which is means-tested, will also result in some NHS services and treatments also becoming 'means tested'. In fact, this is a major component of Universal Credit, but more on that later....



[2] Optum Commissioning Annual Review 2015/15 [PDF]

Friday, 25 May 2018

No room at the dentists inn - unless you pay

We already have a reduced A&E service at Chorley hospital. Rationing of healthcare seems to be flavour of the day, including dentistry! 

{My Story}
Today I had a look online to check the availability of NHS dentists in the local area. My spouse and I called in a local dentist & asked if we might register as  NHS patients. What happened next was shocking....

"we're not accepting any new NHS customers, only private", said the receptionist. I noted the word 'customer' then looked round noting the large waiting room was empty. So I said "but the place is empty, are you saying there are places available but only to private patients?"

The receptionist replied "yes, but there are reasonable plans available for example £55.00 for a first 45 minute consultation with any further payments made monthly".
The pre-rehearsed line about financial costs seemed to roll off the receptionists tongue as if by rote. 
I noted the receptionist shifting in the chair as if anticipating what I was about to say. Rather than debate the blatant discrimination of turning away those NHS 'customers' who can't afford to pay (twice) I simply said...

"We do pay. We pay into a collective system for dentistry called the National Health Service. It's a system where everyone supports each other in times of need. It's a system that does not discriminate or turn people away who, for whatever reason, cannot afford to pay".

"If I was to pay privately, I'd be going against the principles of a universal healthcare system I love. I'd be pushing out other NHS 'patients' resulting in this dentist treating only those who can pay privately. It would no longer be 'taking on NHS customers".

So as you can see folks, I had no means to pay as a private 'customer', and for this reason only, I was refused treatment and shown the door.

When we got home I decided to look again at the website of the dentist I'd just visited. But this time a little closer, and one sentence stood out highlighting the hypocracy of my experience. The sentence was...

"our practice caters for all"

Ironically, the dentist is called {My Dentist} on Dole Lane, Chorley.

The  {My Dentist} website then shows a list of NHS treatments and costs, with a band 3 crown costing the NHS 'customer' £256.50.

Our NHS is the best, safest and most affordable healthcare system in the advanced world. Yet slowly but surely it is being eroded and converted into a private payment system where those who can pay will, and those who can't are either shown the door, asked to setup a payment plan, or go without.

Related Links

Half of NHS dental practices are not accepting new adult NHS patients