Monday, 23 October 2017

NHS Privatisation, where's the scrutiny?

Lancashire's Health scrutiny committee need to stop being hoodwinked and properly scrutinise STPs before it's too late. It's time to start asking questions, no decision about us without us.

At the previous Lancashire Health scrutiny committee on the 19th September, councillors were given a presentation by the 'Healthier Lancashire and South Cumbria - STP Team*' on 'progress' made since the Next Steps on the NHS Five Year Forward View published in March 2017 including the Sustainability Transformation Partnership (STP) for Lancashire and South Cumbria.

Councillors were informed that a 'board' called "the STP Board" had been established but this board was not a statutory body but merely consisted of several organisations such as the hospital trust, GP federation, mental healthcare trust, social services, clinical commissioning groups voluntary and private sector.

All these existing organisations are to be merged into a single partnership organisation. The merged healthcare bodies form an organisation imported from the U.S.A called an 'Accountable Care System' (aka Accountable Care Organisation or 'ACO' in the United states).

Ironically, the boss of NHS England 'Simon Stevens' is ex vice-president of UnitedHealth Group, the largest private healthcare insurer in the United States. Steven's now wants to bring the U.S. multinational private healthcare market to the U.K. with UnitedHealth group taking a slice of the NHS cake...

Among the companies taking on NHS work were privately owned businesses such as VirginCare and Care UK as well as stock market listed multinationals including UnitedHealth Group, Acadia Healthcare, Circle, Capita and Interserve.

Councillors at the health scrutiny meeting on the 19th were told these organisations on the STP board had no statutory mandate but that each organisation had signed up to it and volunteered to agree to work together to forward the NHS England STP plans. The STP board deals with the STP target finances and approves the transformation plans (its own plans). Yet the STP board has no accountability and is merely 'acting out' roles that are neither democratic, lawful, nor representative of the people who pay for the services they provide as individual organisations.
The STP board is in effect a QUANGO set up by NHS England in an attempt to bypass local democracy and enforce a private-public accountable care system (ACS) upon the peoples without their consent.
Those who've followed the disgraceful overruling by this government of the county objections to fracking know only too well the strategy here.

The 2012 Health & Social Care Act handed most of the NHS budget over to private GP practice commissioning groups (CCGs) handsomely rewarding those GPs with business acumen to start the NHS privatisation process in motion. Since its inception in April 2013, CCGs have tendered over a third of NHS services to the private sector, and are rationing more medicines and hospital surgery treatment every week.

Forming 'Accountable Care Systems' will only legitimise and expand on the existing rationing of healthcare treatment and services (what an ACS calls 'demand management' ) and fragment what's left of our public healthcare system into a two-tier private-public partnership accountable only to it's shareholders - the collection of healthcare organisations mentioned above.

Health Insurers & Accountable Care Systems (ACS)

In effect, CCGs will act as micro-insurers in the ACS with the prime incentive for the whole organisation to ensure an end-of-year surplus (profit) is made. To do this it uses a fixed capitated budget and 'demand management' to ration and withhold medicines and treatment.

Or as puts it...

ACOs/STPs don’t explain that this mean-spirited restriction of treatments and patient numbers is based on an American health insurance system variously called  managed care, health maintenance organisations or accountable care organisations. An Accountable Care Organisation (or System now also called in 2017) is accountable to the health insurance company that holds the budgets for treatments available to the population that is covered by the ACO . This is usually around 50K people - compare this with the 2k-6K population that is usually registered with a UK GP surgery. Don't be fooled by the word 'accountable' in this contect. It means counting money not BEING accountable to the public.

The health insurance company specifies what treatments are available (managed care) and which patients can access them (the ones who are cheapest to treat and who offer the best chance of financial recovery), as well as setting the overall annual population budget that the ACO has to stick to.

If the ACO comes in under budget it can keep what it hasn’t spent so there is incentive there to restrict treatment in order to maximise profit. The spin from NHS England is that this incentivises efficiency. The reality is it leads to cherry picking patients and restrictions and denial of care.  This is called ‘demand management.’ STPs and ACOs are ALL ABOUT 'Demand Management'.

By imposing managed care pathways - ie telling doctors what treatments they can provide and how to provide them -  Accountable Care Organisations de-professionalise doctors and other health workers and destroy the individual patient- health worker relationship.This is clearly not the NHS as a publicly owned, funded and run comprehensive health service, or as an empathetic, person-centred health service... is correct, here in Chorley & South Ribble we're already seeing CCGs telling doctors which medicines and treatments they should or shouldn't provide. Only last week Clinical Commissioning groups in Chorley and Preston introduced draconian policies that stopped certain surgical surgery such as some hernia operations leaving many to suffer.

All Councillors need to be aware, this is what STP leaders and other 'boards' who meet in secret haven't told you. It's happening in front of your very eyes, with very few councillors and members of the public aware of the sheer scale of NHS healthcare privatisation that's coming.

Let this be a warning. One by one you will see larger private clinics (called Hubs) being built/established in Preston and Chorley/South Ribble to house services that have been moved from hospitals. Gradually, the likes of Virgin care who already have the Musculo-Skeletal (MSK) contract, will takeover more of the lucrative NHS services thus destabalising the remaining NHS services.

For Chorley, South Ribble, and Preston, the STP solution designs team have already stated they wish to see almost ALL outpatient hospital services CLOSED and moved into a community setting - thus paving the way for more private contractors to take over NHS services.

Emergency care cannot survive without these services and Chorley District Hospital will become nothing more than a shadow of its former self; re-labelled as a 'community hospital' (private providers already have a specially built building at the hospital and hold a 7 year urgent care contract in the bargain).

The threat of the closure of both Preston and Chorley hospitals is still hanging over us, that's why week in and week out we stand outside Chorley & South Ribble hospital. Shortage of mid-grade staff or not, questions need to be asked about what these unelected 'STP boards' are really up to.

There is no money to roll-out these plans, there is a serious lack of staff, and there is no evidence that the plans will work in practice. So what are we waiting for? If STPs were planning applications they'd be thrown out of county hall.

I suggest the same treatment is given to STPs, or we'll be heading back to the dark ages where only those who can afford to pay get treated. Think on, be prepared, ask the questions. I guarantee you will not get any straight honest answers. Stop the STPs before it's too late....

Next Health Scrutiny Committee
Tuesday, 31st October, 2017 10.30 am
Venue: Cabinet Room 'C' - The Duke of Lancaster Room, County Hall, Preston

Agenda page here:


*Healthier Lancashire and South Cumbria (STP Team):  Dr Amanda Doyle OBE, GP and STP Lead; Neil Greaves, Communications and Engagement Manager Gary Raphael, Finance Director; and From Morecambe Bay CCG:  Andrew Bennett, Chief Officer