Ever decreasing NHS budget held together by service cuts

We don't want to say it but we will “We told you so!” 

The Health and Care Act of 2018 broke up the NHS in England into 42 separate regional health authorities and introduced private firms into the central direction of the regional NHS management, through, what is called a “Provider Forum” of the local, Greater Manchester Integrated Care Structure (GM ICS). 

We, in Keep Our NHS Public (KONP) Greater Manchester warned the 11 local Councils in Greater Manchester who welcomed the new “integrated” care structure, that they were not acting in their constituents' best interests. The new system was undemocratic, with no local control of the Integrated Care Board (with only one elected representative on it); and by accepting a Tory budget that went along with the new structure, they would be forced to make Tory budget cuts for them – doing the Tories' dirty work for them.

"Five years later, all 42 regional Integrated Care Boards (ICBs) in England are in deficit - in total, by about £1000 million". 

But Greater Manchester ICS (and North East London) are the most heavily overdrawn. From April to the end of August 2023, the GM Integrated Care Board thought they would be £20 million overspent. In fact they were in deficit for £125million.

So Greater Manchester ICB brought in some so-called “turn around” directors - and is desperately negotiating with their financial masters in NHS England and The Treasury. But as a spokesperson for Greater Manchester ICB said ”...with multiple pressures.... we need to put measures in place to ensure we save money...” that is, their only way forward is to cut more NHS services and bring more distress to Greater Manchester service users.

From April to the end of August 2023, the GM Integrated Care Board thought they would be £20 million overspent. In fact they were in deficit for £125million.

Every independent NHS management association and think tank, besides us NHS campaigners and NHS trade unions, recognise that the Tory budgets are totally inadequate to provide a humane, decent health service. 

But you won't hear anything like that from the public consultations or websites of the Greater Manchester Combined Authority. 

We say “Come clean, GM ICB!” Don't hide what the real situation is in the NHS, with glossy brochures and “public consultations” which lack any financial information in them. Declare to the millions of NHS supporters in Greater Manchester, that you are trying to manage an unsustainable, faltering, crisis - ridden NHS – deliberately engineered by a Tory government. 

Join with NHS campaigners in your area, sympathetic political parties and trade unions to lobby for a decent, public, free NHS that the people of England deserve (and that UK can afford).

The NHS is now just a 'Logo'

'NHS' is Now Just a Logo

by Dr Bob Gill

The NHS has already been privatised in law.

The Health and Care act 2022 completed the legislative transition from a publicly provided service to a tax funded, privately controlled and run service resembling American 'managed care'.

The NHS has been reduced to a logo and a funding stream from which profit can be extracted through staff wage suppression, down-skilling and task shifting clinical work (employing the cheapest least qualified staff to provide care outside of their competence).

Most dangerously, profits are to be made through the denial of care to the sick.

Managed care allows money not spent on patients to be kept by private corporations as profit, thus creating a perverse incentive to let the sick suffer or die. This has been the well documented experience in America.

The NHS now resembles Medicare and Medicaid, both public funded but privately delivered healthcare for most of those excluded by the US private insurance industry.

The Labour party and the health unions have colluded with this process.

From 1997 to 2010 Blair/Brown governments saddled the NHS with toxic PFI debt and began outsourcing medical services. In 2006 the health unions were co-opted by signing up to the Social Partnership Forum (SPF) agreeing not to oppose privatisation. [Health unions signed an updated SPF agreement in 2019 to support the Conservative rollout of a 10 year NHS privatisation plan].

Streeting and Starmer, both in reciept of funding from wealthy donors with financial interest in private health, have loudly signalled their intention to keep lining the pockets of private healthcare with a commitment to public-private partnerships, while remaining silent on the catastrophic impact, happening now, of shrinking capacity, dismantling public health and driving staff out of the NHS.

Labour leader Keir Starmer has committed to almost all the Tories’ policies on NHS privatisation and general austerity. His health spokesman, Wes Streeting, took £15,000 from a hedge fund manager connected to vulture healthcare privatising. source here click link

42 new legal entities called Integrated Care Systems are public-private partnerships [PPP], handing control of NHS budgets to private corporations to decide on who gets care and what care is provided. NHS England call these 42 split NHS business areas 'footprints'.

The intentional collapse of NHS service provision - in particular emergency care, rising waiting lists and struggling GP surgeries is contributing to record excess deaths and preventable harm.

This avoidable inhumanity is the catalyst for a public shift into paying out of pocket for private treatment or for top-up private insurance in an attempt to insulate themselves from future risk of sickness.

We need to call for renationalisation. Health unions must abandon their current complicit stance and embark on industrial action in good faith. Memberships of all unions should demand that their leaders fund mass public awareness campaigns and co-ordinate strikes. Only grassroots awareness and action stands any chance of there being a renationalisation.

If not reversed, healthcare in England will exclude many, worsen health outcomes further, cost more than double, exploit psychologically damaged staff and continue to waste £Billions in bureaucracy, dysfunction, fraud, enriching shareholders and CEOs.

Dr. Bob Gill

New Lancashire Wide health system starts with "truly massive deficit"

CHORLEY, PRESTON, SOUTH RIBBLE NHS ICS STARTS OFF WITH "TRULY MASSIVE DEFICIT"

NHS Campaigners  have been warning about the disaster that awaits when the new American style Integrated Care System (ICS) is introduced into the NHS in England in 2022. 

Contrary to their manifesto, the Conservatives are forcing a top-down reorganisation of the NHS which aims to mimic profit-seeking American health maintenance organisations (HMO) and make it more profitable for NHS contract shareholders known as Integrated Care Providers (partners in an Integrated Care System).

The recent parliamentary approval of the governments 2022 Health & Care Bill means the new ICS system, which splits the NHS in England into 42 areas and changes the method of funding, now has statutory approval to go ahead.

However, many of these 42 areas have been putting the ICS framework in place with other partners (including councils and private healthcare providers) since early 2019 using shadow boards and directors, even to the extent of drawing up their own ICS "constitutions" in anticipation of getting the green light to go ahead to form the ICS. All this was done without scrutiny and without agreement from local council/county authorities.

Lancashire & South Cumbria ICS includes the area of Central Lancashire consisting of Chorley, South Ribble, and Greater Preston.

The shadow ICS Board for Lancashire & South Cumbria (L&SC)  has been warning since the end of 2020 of the threat of a truly massive deficit, with the Feb 2021 forecast concluding* : 

“all in all the implication of the guidance is that L&SC could be in deficit somewhere within a range of £240m to £340m”.

This is of grave concern for everyone considering the current situation. Starting off with such a massive deficit can only lead to cuts and rationing of health services and treatment, something NHS campaigners in Chorley have been warning about for years. 

NHS Campaigners are however just as concerned that private health companies, now partners in the ICS, could step in and provide  private investment to make up any shortfall, thus tying the NHS into a private irreversible long-term contract similar to previous Pfi (Private finance initiatives).

This will effectively end the NHS as a universal, comprehensive, public service freely available for everyone and convert it into the profit seeking American health system which the Prime Minister Boris Johnson has already stated he prefers.

 

*source (PDF) Integrated Care System (ICS) Board Agenda 3 February 2021: https://www.healthierlsc.co.uk/application/files/3816/1192/9693/Formal_ICS_Board_-_One_Pack_Papers_-_3_February_2021.pdf

https://lowdownnhs.info/news/north-west/?fbclid=IwAR1ubMAvAAke4ezNYTMJBna_IGGW4QXkn149SPPp8YiINE9nGRfl8ZeQiBk

Dozens of NHS services handed over to private sector

Richard Branson has sold Virgin Care to US private equity company Twenty20 Capital. Its new name is HCRG Care Group. The US outfit will be responsible for around £2bn of NHS contracts.

HCRG Care group are now one of the UK’s leading private providers of community health and care services. 

Basically it's our NHS being handed to the private health sector on a platter...

HCRG Services ....

■ adult and children community health services, 

■primary care services including urgent care, 

■ sexual health, dermatology and MSK services,

■ adult social care and wellbeing services.

Twenty20 Capital Ltd, the current owner of HCRG Care Group, is a private equity investment company. The company aims to make as much profit for shareholders in as short a time as possible. Such companies often buy businesses that are either non-profitable or failing and use strategies, such as asset selling, redundancies, and mergers, to create shareholder value.

Links to the new NHS U.S. Integrated Care System (ICS)

In May 2021, Virgin Care representatives were reported to be on the board of the fledgling ICS in the Bath and North East Somerset, Swindon and Wiltshire region. A report in The Lowdown noted that Virgin Care’s local managing director Julia Clarke is already listed as a member of the Integrated Care Partnership Board, the unitary Board which currently runs the ICS covering Bath and North East Somerset, Swindon and Wiltshire (BSW).

source: NHSforsale.info

New Hospital's Plan said to be "unachievable"

 

New Hospital's Plan "unachievable"?

A government infrastructure watchdog has raised serious concerns about the lack of progress made to build “40 new hospitals” by 2030, HSJ has learned.

Boris Johnson's election promise of "40 New Hospitals" has now been declared unachievable by the Infrastructure and Projects Authority.

The plans to downgrade both Epsom and St Helier Hospitals and replace the acute services they provide -with a much much smaller,  more distant alternative, co located with the Marsden in Belmont- have been declared as unachievable, along with all  the other 39 such plans.

Many of the so called "40 new hospitals" involve cuts, downgrades and closures sometimes with smaller replacements and often involving NHS land sales, just like the Epsom and St Helier model.

"According to sources, the New Hospitals Programme – which was created to deliver the key manifesto pledge – has been downgraded to a “red” rating by the Infrastructure and Projects Authority following a review of the programme and its leadership."

"....a “red” rating means it “appears to be unachievable”.

The “red” rating also means there are “major issues with project definition, schedule, budget, quality and/or benefits delivery, which at this stage do not appear to be manageable or resolvable”.

We wait to see what this might mean for Chorley, Preston & Lancaster.

Health & Care bill could destroy the NHS with a PACS model

Could the English Health & Care bill destroy the NHS with a PACS model?

The newly proposed integrated care system (ICS) includes several 'new' ways of working - these are called new 'models of care'.

Here, we look at the PACS business model of care which is included in the governments Health & Care Bill before parliament mid-Nov (2021). 

Observations here are from the Salford Together trial program report; and summarises the key findings, learning and recommendations from the end of programme evaluation of Salford Together’s Adults Integrated Care Programme (ICP).

Integrated Primary and Acute Care Systems (PACS)

Vanguard (kaiser beacon pilot program): Salford Together

The PACS model is to be applied to all footprint regions across England.

The PACS model is a population-based new care model based on the American  Accountable Care model (pg 5 pacs framework NHSE).

It appears rollout will be done regardless of whether the Salford Together vanguard program is successful or not (surprise surprise).

Since the program is running in parallel with existing services, it does not and cannot, truly be presented as an 'evidence-based' model. 

Rolled out on a larger scale the PACS model could be a disaster due to existing services being closed before any meaningful results are recorded.

The evaluation report ran up to the pandemic (up to June 2020).

When reading through the report it's important to look closely at the figures - however, it was soon discovered existing figures (eg A&E attendances) were either omitted altogether or presented as percentages. 

Further, when part of a program or pathway wasn't working they changed it. But fail to say what these changes were.

Also, in an integrated combined system that must work together, "pockets of success" equates to "failure of the rest of the system. 

The summary from stakeholders described the PACS program as:

"an aspirational aim, which had not been fully achieved"

The report (link below to PDF) then proceeds to the "what have we learned and recommendations" (page 7)

Some high-risk problems encountered on the scheme include:

1. Problems accessing data [catastrophic in an integrated system], 
2. quality and complexity; [high risk on any risk assessment]
3. challenges of accurate demand forecasting due to limited data available; lack of clarity among stakeholders about new roles, [nobody truly knows who's responsible for what]
4. responsibilities and governance; [crucial for any ICS to function]
5. stakeholder engagement challenges; staff recruitment and retention;
   limited estates accommodation to enable co-location of teams; and 
6. IT systems interoperability impeding implementation.

Notes: The limited estates accommodation needed to re-locate hospital services into has been the main reason for failure of most STP. The original idea was to partner with local councils and have the council provide empty spaces/buildings for the clinics. 

The lack of available and suitable accommodation may result in an ICS refusing to proceed.

If a non-evidence based PACS does proceed, it is likely local hospital services transferred into community clinics will fail, with the hospital or most of its assets sold.

If there is a lack of staff at the vanguard stage then any attempt at a larger system footprint -wide rollout could end in disaster. 

According to the results: there would be a shortage of staff to look after and treat patients, and with no estates available, there would be nowhere to treat them. There would also be no IT network in place and little if any access to patient data.

Related Links

More flaws exposed in ‘integrated care’

The two-year Salford PACS evaluation report can be read in this PDF

Southport and Ormskirk hospital trust likely to cut a dozen services

 

Southport and Ormskirk hospital trust "unlikely" to be able to continue providing at least a dozen services.

The hospital trust recently merged with neighbouring St Helens and Knowsley Teaching Hospitals NHS trust in a bid to make savings under a business plan that could see at least twelve services cut to save money.

The chair of the Southport & Ormskirk trust board Neil Masom claimed the hospitals had "a dozen or so ‘fragile’ clinical services"  which the trust were unlikely to be able to continue. Mr. Masom apportioned this to weaknesses in the Trust’s finances and the inability to recruit and retain staff.

The so-called 'partnership' between the two hospital trusts is inline with NHS cuts right across the board under the regions Shaping Care Together program.

- ends -

related links

Southport and Ormskirk Hospitals Trust has responded to claims the hospitals are at risk of closure or downsizing.