The NHS is being Americanised, and we're all about to pay the price

image courtesy of Vox health

Demand management, capped budgets, restricted care, rationed operations, drug price hikes... American style health care is now almost certain to change the face of the NHS.

Well, with the December 2019 general election now over and the results favouring the Conservatives, the chances of the NHS in England going the 'American way' are now very high.

I'm hoping at this stage you're all aware of what myself and other NHS campaigners have been saying for some time, and what you are about to lose.
So here's a recap....

The man running the English NHS 'Simon Stevens' is the ex health boss of Americas largest health insurer, United Health. Ex Labour councillor and adviser to New Labour's 'Tony Blair' his CV as a privatiser should be of interest to NHS campaigners...

• Stevens was UnitedHealth Group Vice-President and President and/or Chief Executive Officer of UnitedHealth group companies 2004 – 2014;
• Since 2014, Head of NHS England Stevens has been in charge of implementing the five-year plan for “integrated care”, in other words completion of the takeover of the NHS by UnitedHealth Group;
• His duties at UnitedHealth included lobbying for the NHS and other European national health services to be included in the Transatlantic Trade and Investment Partnership (TTIP); An even Higher risk after a no-deal BREXIT.
• His 'plan' is to utilise the NHS budget to run the profit-driven American 'Accountable Care Organisations (ACO).
• ACOs change how the NHS is funded, removes accountability, and introduces two disastrous processes 'demand management' and 'capitated payments'. In other words, a fixed amount of money per capita (per patient)- and when its gone there is no more, and managing which patient gets access to which service. As with the ACO in America, the less care an ACO provides, the more money it makes (i.e. the more it saves). This is then passed on to the shareholders - called 'providers'. 
• With an ACO the budget (contract) is long-term and can be held by private companies who then sub-contract work out to other 'providers'.
• There is a HIGH RISK that the NHS is split into those who can pay for certain treatments, and a state funded element for those than can't. *See below co-payments made via an ACO.

[PDF] The rest of Simon Stevens' historical CV can be downloaded here...

An Integrated Care System (ICS) is based on the American model of care called an Accountable Care Organisation (ACO). An ICS holds a single long-term budget which is allocated to its partners called Integrated Care Providers (ICP).

As with an ACO, an ICS is profit-based operating on the principle of treating fewer people to make savings [profits]. The profits are then passed back into the system to shareholders.

This restriction of care and services is accomplished in several ways, the main method is to allocate an up front annual per person (capitated) budget to each 'registered' patient in the area then 'manage the demand' of services using health maintenance techniques.

These include but are not limited to: guiding patients to other areas provided by volunteers, treating patients at home, allocating some patients a personal health budget, promoting prevention, and allowing hospital foundation trusts [as partner providers] to undertake 'paid for' procedures previously provided free on the NHS but restricted under the new ACO regime. *See Warrington hospital.

Two months ago the chief officer of Central Lancashire's two CCGs for Preston and Chorley with south Ribble implied.....we’ve got senior people doing long-term strategic planning [aiming to] save money and configure only the type of really important services for each level [each care pathway].


It appears that in future, patients may only be able to access the 'really important' services with other services going the same way as those currently being rationed and placed on a 'self-pay' basis. Either that or go private, take out an ACO plan as in the states, and make co-payments towards the cost. It is a REALITY folks.
Here's an example..

However, there is currently no legislation which permits either the ICS or its ICPs to exist as formal entities - that's why they are described as operating in “shadow form”.

NHS England are trying to dodge and 'work-around' avoiding changes in legislation..."for now the powers of the two [CCG] groups are only as strong as the statutory bodies from which they are comprised, indicating a merger of two or more CCGs would provide for a single joint committee holding more sway along with standardising rationing policies for the represented areas for certain treatments, increasing some treatments in some areas and decreasing others in other areas [as they call it rounding up or down] or to you and I 'a postcode lottery'.

The aim is not to come in on budget, but to limit overspending - to no more than £112m across the region.[1]

In Lancashire and South Cumbria, the collective deficit is derived exclusively from the region’s hospital trusts and stands at seven percent of their combined annual budget of £1.6bn i.e around £112m. The area’s CCGs, however, are aiming for financial balance.

Gary Raphael, executive director of finance for the region’s Integrated Care System (ICS) said that ringfencing for primary and community care £4.5bn out of the additional £20.5bn which has been pledged to the English NHS by 2023, will cause “a big problem” for acute Hospital trusts.

However, Raphael fails to mention just what the regions hospital 'big problems' are or how they might be tackled.

Affordability will be a “key issue” for the Lancashire-wide plan for the NHS over the next five years which is currently being drawn up.

To limit the overspend, savings must be made via cuts to services along with changes to the way services are provided, who provides them, and where they are provided. It's understood that the underlying deficit for Lancashire and South Cumbria is higher than £112m, when one-off savings are excluded.

The Heist - aka the bribe

If the control total is met, the region [L&SC] will receive an extra £76m in funding as a reward.

This target is shared by all the organisations involved so each are accountable to each other. In the USA, this has resulted in some organisations in the ACO cutting corners by cherry picking the more profitable patients and services along with corruption and many legal challenges between organisations that are supposed to be collaberating and working together.

https://www.lep.co.uk/health/can-partnership-plan-for-lancashire-s-nhs-improve-care-and-bridge-funding-gap-1-9908020