The less care the STP provides, the more money they make

It matters not a jot what they are called: STP, ICP, ICO, ICS, ACP, ACO...

The less government money and resources they spend on patients, the more they save the government. As a result: the incentive to ration increases and demand management leads to more denial of treatment.

You'll have to go without, you'll have to self-care...

Each rationed treatment is placed on your future health insurance plan. The 'means test' will apply to the NHS as it does dentistry, and if you can afford to pay for it then you must. 

Then you will find that the capitated payments appear to reduce each year and  don't stretch for the population they are supposed to serve, mainly due to the increased demand the ACO created with the rationing, denial of care, patients crossing boundaries for care, and lawsuits arising between ACO partners and the overall contract holder...

Whatever happened to the STPs?

One of the early decisions made by the STP was that it would continue to pay providers on the existing “payment by results” system, maintaining the purchaser-provider split, rather than behave like an ACO, where a single capitation-based block budget is agreed by the providers, who then accept the financial risk of costs exceeding the budget:

“Providers will be paid for the activity they undertake, against an agreed activity trajectory, and commissioners will be responsible for taking decisions about what services can be provided affordably …. Due to the lack of incentive to do more activity, even where it would be desirable as it would reduce overall system costs, block contracts should be avoided for all services.”

That was November 2017. Just six months later, in an update to the NWAFT Board on the implementation of the STP, we find this decision has been reversed:

“The STP is refreshing its plans and the way it works. A notable change for this financial year is a move to Guaranteed Income [block] Contracts for the two acute providers. A Guaranteed Income Contract is alternatively known as a Block Contract, rather than the payment by results or activity that has been in place in the NHS for many years.

“As a result the Trust has accepted a risk in relation to activity growth above that agreed, in return for no fines and a benefit if the activity was below plan”. (Chief Executive’s report to May 30 Board).

In other words, with the capitated payments block contract system, the less activity they provide below plan, the more money they save. Which in turn gives a greater incentive to ration more and more services and medicines.
Get the idea? It's a private insurance-health model where denials of care are often found - something which should NEVER appear in the NHS.

In the USA Health insurance companies use capitated payments to control health care costs. Capitation payments control use of health care resources by putting the doctor (physician) at financial risk for patient services. At the same time, in order to ensure that patients do not receive suboptimal care by underusing health care services, insurance companies measure the rate of how patients are using the services over/under utilising services in doctors surgeries or clinics. These reports are publicly available and can be linked to financial rewards, such as bonuses.

Hence, the capitated payment system is a profit-driven system which gives clinicians incentives to either over diagnose or reduce/withhold treatment for financial gain. It's the system due to be used in the NHS.

With capitation, the ACO gets paid whether the patient uses the system or not.

It matters not a jot what they are called: STP, ICP, ICO, ICS, ACP, ACO...
The less government money and resources they spend, the greater is the incentive to save by cutting more and more services and placing these on your insurance-plan list. Partners in the organisations are accountable to each other to ensure they save money - i.e. make a surplus profit.


and it's getting worse...

full article on "whatever happened to the STPs"? can be found on page 7 in the June 2018 report commissioned by UNISON Eastern Region to give members and representatives a realistic analysis of the situation in each STP area.


See PDF download below...
https://www.healthcampaignstogether.com/pdf/Whatever-happened-to-the-STPs-3-web.pdf
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Conservative scrutiny councillors refuse vote to discuss option of two A&E's for Central Lancashire

Conservative councillor Pope says no to 2 A&E option

Conservative Health scrutiny councillors at Preston county hall have refused a vote to further debate an option of having two A&E's for Central Lancashire under a health change program.

Over the last two years a local health change program titled 'Our Health Our Care' [OHOC] run by local commissioning groups has been gathering feedback from public engagement events in venues across Chorley, South Ribble and Preston.

In response to government NHS underfunding and staff shortages, the public engagement events were established to build a picture of what people wanted for future healthcare and more importantly what they would tolerate in terms of reconfiguration of services.

Removing Chorley & South Ribble hospital A&E was not dicsussed throughout the events and in March 2017 the program suddenly ceased. Then in July 2018 the 'Our health Our Care' program suddenly started up again.

This time there came a shock announcement from the OHOC team that they were looking at a proposal for having only one single A&E for the whole of Central Lancashire which covers Chorley, South Ribble and Preston.

The program team didn't say which A&E (Chorley or Preston) was being kept open but the idea of a super-hospital touted earlier in the local press wasn't on the program agenda.

Outraged at the proposal, the local Labour councillors on the health scrutiny committee at Lancashire county hall submitted a recommendation that the option of having an A&E at Chorley AND Preston be included in the public consultation starting after next years elections.

Bizarrely, the recommendation - which would have at least put the option of both A&E's on the table - was voted out by Conservative councillors, with no valid reason given. Here's what happened. The recommendation came via Cllr S. Holgate [Lab].

recommendation as read out: the HSC believe the OHOC document needs to be revised prior to consultation to include the option of there being 24/7 A&E provision on both the Preston and Chorley sites.

P. Britcliffe [Con]: Chair "I don't intend to have a protracted discussion on this so I will bring in county councillor Pope [Con] and then I'm going to take the vote".

Cllr pope... "I don't agree it's a good option....the trust & ccg are going through consultation and further consultation when they come up with the full ideas of the way forward,, and I wouldn't want their hands to be tied in any way in looking at that [two A&E's option] and the various options er going forward. therefore I would not support that recommendation".

It's unsure why Cllr Pope thought the CCGs hands would have been tied since it is the health scrutiny committee who should be scrutinising on BOTH options and debating which site may be preferred,. By voting down the recommendation the scrutiny councillors were refusing their constituents a debate on who gets which A&E service. A disgraceful state of affairs since it means the Chorley A&E may now no longer be an option during the consultation.

After councillor pope had shunned the recommendation, the chairman, cllr P. Britcliffe, then asks "what is the procedure for a recorded vote"?

The vote was then taken 6 against [Con], 3 For [Lab], and 1 Abstention [Green party]

All options on the table?
Ludicrously, Conservative county councillor Charlie Edwards then proceeded to thank and commend those who spoke to us today and that 'all options are on the table"....

Clearly not all options were on the table, as Cllr Edwards' Conservative party colleagues had just removed the option of debating and scrutinising the reasons why there can't be two A&E's to serve central Lancashire.

I'm sure the Conservative councillors constituents will have something to say about that....

Thanks to the Labour scrutiny councillors for proposing and supporting the recommendation to fight for a 24 hour A&E at both Preston and  Chorley Hospitals.

The webcast of the health scrutiny meeting can be viewed on the councils website: