Thursday, 17 November 2016

NHS rationing, personal health budgets, and the death of A&Es

Patients in Chorley & South Ribble are about to receive letters from private companies who wish to control their lifestyles. Your GP practice could be be distributing your personal medical records without your knowledge.

No Public Consultation Required

Personal or 'self-centred' care encompasses many areas, including the STP 'Prevention' program and the 'personal heathcare budget' (PHB).

There have been some very important changes over the last few months that although included in the STP plans do not necessarily require public consultation to roll out. At least that's what NHS England believe.

A few of these non-consultation changes include rationing some drugs & treatments, contracting private companies to undertake personal health checks and advise on how patients with chronic conditions might manage their medications, weight and so on or provide advice on how to lead an active healthy lifestyle. Personal Health Budgets (PHB) have now also been extended by CCGs to people with long-term conditions.

Many GP practices in Chorley & South Ribble have already sent forms to companies such as the Bolton based ABL Ltd without the patient asking for the service or even knowing about the referral. ABL claim to "support people to be ‘active participants’ in the healthcare system and build imaginative and responsive services around their needs". And they're claiming a large chunk of the NHS budget to do it!

All this activity is the beginning of a patient 'familiarisation' of an insurance-based health system and in the U.S. is the mainstay of Health Maintenance Organisations (HMO). The boss of NHS England 'Simon Stevens' wishes to introduce the American private insurance-based healthcare system over here in England. That is no secret (google 'five year forward view') * See also Accountable Care Organisations (ACO) as currently being trialled in Morecambe bay.

It's important to remember that the objective of the STP is to separate routine procedures from emergency procedures so that the routines can be undertaken by the private sector 'in communities closer to home' in dedicated clinics that 'integrate' (bring together) different skills (specialties) and practitioners. Hence the term 'MultiSpeciality Community Provider clinics' (MCPs) as defined in local STPs. *Initially these clinics will be a Public-Private Partnership (PPP) with GP confederations eventually becoming employees of the private companies (e.g. see VirginCare).

The problem is the money generated form these routine procedures goes towards supporting the A&E procedures and without that money A&Es simply cannot survive. Ultimately, and again as with the U.S. based system, the A&E activity will become pay per visit and only very basic life saving treatment provided (as with the U.S. Medicaid which is a government insurance program for people of all ages whose income and resources are insufficient to pay for health care).

Private sectors want nothing to do with Emergency treatments since they are high-risk and expensive making little or no profit. For example, Lancashire Teaching Hospitals NHS Trust constantly state in their board reports that the A&E activity is "driving all their deficits". ALL of their losses come from the A&E department which is why they are so adamant their Urgent Care model works and people choose wisely about which treatment centre they attend.

For LTH trust the STP is an opportunity to reset their finances and bring in additional income, but this comes at a very high price, especially for patients.

But that hasn't deterred the Lancashire trust board from teaming up with the local CCGs to roll-out the STP plans. The care models, which haven't been released in the STP yet, are an ideal way for the LTH trust to offload their debts and reduce overcrowding in their hospitals.
Yet the hospital trust can't begin to roll-out their part of the STP until they meet the 'financial reset' forced upon them by NHS England. *Each trust is given money from the Sustainability & Transformation Fund (STF) to roll-out its part of the STP. The trust only gets the STF funding if it brings down its deficit significantly.

This month the trust missed out on £4.4m of STF funding, no wonder they kowtow to the CCGs.

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