Wednesday, 28 November 2018
The acute services review for central Lancashire is a large part of the reconfiguration of
services under the our health our care program which stems from a regional
document titled the 'sustainability & transformation' plan (STP). The
region is Lancashire & South Cumbria.
The objective is to get people to start looking after themselves better
(prevention) and vastly increase the commercial market in the NHS so the state
can save money and pass on profits to private providers.
This was the remit of Simon Stevens [pictured], who in 2014 was made CEO of NHS England. Stevens was previously the ex vice president of commercial operations (European division) for the American private health insurer UnitedHealth. The aim of each STP in 44 regions of England only, is to make the NHS financially 'sustainable' by 'transforming' it into a fully fledged commercial healthcare market open to any qualified [private] provider as incorporated into legislation in the 2012 Health & Social Care Act.
This was the remit of Simon Stevens [pictured], who in 2014 was made CEO of NHS England. Stevens was previously the ex vice president of commercial operations (European division) for the American private health insurer UnitedHealth. The aim of each STP in 44 regions of England only, is to make the NHS financially 'sustainable' by 'transforming' it into a fully fledged commercial healthcare market open to any qualified [private] provider as incorporated into legislation in the 2012 Health & Social Care Act.
The
downgrade of Chorley A&E to an urgent care centre (UCC) was an option under
debate as far back as 2014 as stated by the hospital trust medical director in
the Lancashire Evening Post in August2016 when plans for a super hospital came to light in the same news
article.
The closure of Chorley A&E is no accident, the long term plan was to ultimately replace it with a UCC as per the instructions from NHS England in it's 'five year forward view' document - the document all STPs are based on.
The closure of Chorley A&E is no accident, the long term plan was to ultimately replace it with a UCC as per the instructions from NHS England in it's 'five year forward view' document - the document all STPs are based on.
The case
for change touted by CCGs is based on financial shortfalls and deficits, not
patient outcomes. This is evidenced in CCG clinical policies where each month,
to save money. the CCGs remove more
treatment or medicines available on the NHS, meaning the NHS no longer has a
full comprehensive list of treatment available to all, many now have to pay for
these treatments or medicines.
The 'our
health our care' program for central Lancashire
is incomplete. It has not engaged/notified the public about the proposed new
method of contractual payments which places providers at risk. Providers also
must meet stringent criteria based on an annual 'fixed block payment' (and very
restrictive/limited) capitated (per person) budget.
Currently,
if there is an increase in demand for example at hospital, the trust adds this
via there Payment by Results (PbR) 'tariff' then invoices the CCG who account
for the increase. In the new payment system contract called the Integrated Care Provider (ICP) Contract,
the hospital must estimate how much they will need for the year ahead then negotiate
the amount needed in the contract as a 'block payment'.
The trust now has to manage that budget so it doesn't go above spending targets. Under the ICP contract, the trust accept huge risks. If there is an increase in demand and it goes above budget then the trust cannot invoice the CCG for more money. Instead, the trust will need to demand manage the budget by making further efficiency savings which could be more service closures, denial of care (agreed mainly by the CCGs) or worse the hospital trust could be placed in special measures or go bankrupt. Though this is unlikely as under the program most of the hospital services are to be shifted out of hospital into a private-public partnership (PPP) provided in community clinics, again run under an ICP provider contract. ICP contracts are currently under judicial review as to their legality.
The trust now has to manage that budget so it doesn't go above spending targets. Under the ICP contract, the trust accept huge risks. If there is an increase in demand and it goes above budget then the trust cannot invoice the CCG for more money. Instead, the trust will need to demand manage the budget by making further efficiency savings which could be more service closures, denial of care (agreed mainly by the CCGs) or worse the hospital trust could be placed in special measures or go bankrupt. Though this is unlikely as under the program most of the hospital services are to be shifted out of hospital into a private-public partnership (PPP) provided in community clinics, again run under an ICP provider contract. ICP contracts are currently under judicial review as to their legality.
The incentive therefore in any ICP contract is to provide as little care as possible to ensure profits are passed back to shareholders.
Ultimately,
NHS England are looking to convert the ICP contract later and form American Accountable Care Organisations (ACOs). These
ACO's have a longer-term contract which could be held solely by a private
provider such as Virgin care ltd who then provides all services or
sub-contracts some out. The NHS would
then cease to exist in all but Logo as it cannot run financially with losses to
the private sector and at that stage or even sooner, taking out health insurance plans
will be mandatory for all but the poor who will access only basic care
as currently provided in the American medicaid health aid insurance system. And
even then co-payments may need to be made towards health costs.
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