Underfunding - the key to privatising public services

Whats going on tomorrow at Lancashire County Council?
There should be fireworks, but in the current climate it's likely to be more of of a damp fizzle.

In terms of our NHS there are 'TWO' important items on tomorrow's Agenda (Thursday 23rd Feb):

Agenda Item 4. Review of the Councils Business & Operating Model
Last April county council cabinet members agreed to commission a consultancy called Price Waterhouse Cooper (PwC) to look at how LCC could streamline (i.e. cut) services to save money. The budget allocated from central government to local governments such as LCC has been severely reduced over the years resulting in LCC having to make cut-backs such as closing libraries and bus-routes etc. To make up the shortfall, LCC are even considering raising council tax. Allegedly, LCC paid between £3m and £6m for PwC to do the survey and report.

Out with the begging bowl

The report shows it's so bad we're now having to beg the Tories (the council call it lobbying) for assistance with a £95m shortfall in resources for Adult Social Care forecast for 2020/21.

Underfunding public services - the Tories key weapon in privatisation

The government should be adequately funding LCC to enable them to manage, subsidise, and run local services such as care homes and district nursing, so increasing the council tax only means the public are paying twice for the same services. *Council tax is based on the value of a property.

But there's more to it; the report recommends devolving health budgets from central government down to local government (Lancashire). and thus absolving more of Jeremy Hunt's responsibility to provide healthcare to the masses. Integration means fragmentation........

The NHS isn't means-tested, but social care is. So integrating NHS services with social care services opens up the market to means-testing NHS services. Hence, patients will then have to pay for services which were previously free at the point of need.

Social care is involved so the report also recommends LCC agree to go along with the STP plans for their area. They call it 'Health and wellbeing integration', I call it privatisation. Its a very contentious report since NHS partners have not been involved in it. There's anger that LCC are to publish a detailed report, commissioned by the Council, which implies major NHS reorganisation without the report having any input from NHS partners (sound familiar?). link below..

Agenda Item 11. LCCs Health Scrutiny reporting back to full committee.
The health bit is in annex 2. This is simply what the scrutiny have been told by NHS England about the STP in their fancy slideshows. There isn't even a recommendation. Considering the importance of STPs, the report to LCC full committee from Health scrutiny really is the worst scrutiny analysis I've ever seen. It's as though health scrutiny have no objection - in fact, there is no objection. Take a look... link below

It's obvious even to a blind pig that the overall objectives of both agenda items is for central government to underfund public services to enable them to pursue their own privatisation agenda.

And with the Tories in their second term of office, they are now pushing the boat out.

It's our job to sink it


Links

Item 4. Review of councils business services & operating model

Appendix to Item 4 (PDF) - PwC's Lancashire Public Service Delivery Model - An STP for public services?

Health Scrutiny Report on STP to full council

Research indicates STPs have a high risk of Failure

Research from the King's Fund indicates STPs have a high risk of Failure. Despite the introduction of the Sustainability and Transformation Fund, the financial reset and the use of a new financial `special measures’ regime, financial performance in providers continues to slide. 

As a result, reducing the net provider deficit to £250 million from the forecast £644 million at quarter one looks increasingly unlikely and indeed, there are greater risks it will rise rather than fall. This is despite a quarter of all trusts now reporting delays or cancellations of capital spending in order to support their finances.

Staff redundancies included in efficiency savings

The latest Quarterly Monitoring Report from the King's Fund think-tank shows that increasing numbers of health trusts in England are also looking to reduce their clinical workforce, with 29 per cent now planning to reduce their headcount.

Mental Health staff cuts targeted most

While relatively few acute hospitals plan to reduce the number of staff, more than half of mental health and community health service providers are now planning to cut staff numbers. This threatens the aspirations to raise the quality of care set out in the Five year forward view for mental health as well as long-term goals to improve services in community settings.
Alongside cuts to capital spending by trusts, more than half of CCGs are delaying or cancelling spending plans. This underlines the risks that the drive to cut deficits is having on the long-term transformation agenda for the NHS.

Unachievable savings

Looking forward to 2020/21, the STP process has not led to any greater optimism about the prospects for achieving the £22 billion in efficiency savings needed to deliver the STP/Forward View. While some 79 per cent of trust finance directors think there is a high or very high risk of failure, now 90 per cent of CCG finance directors say the same, sharply more pessimistic than in July before STP plans were submitted or the planning guidance issued.

STP funding withheld

With many organisations still expecting to end this year in deficit, no additional transformation funding available, and minimal real-terms growth in 2017/18 and 2018/19, NHS finance directors have found little to be optimistic about.


Source(s)
http://qmr.kingsfund.org.uk/2016/21/overview

The NHS is not unaffordable, it's being starved

In this post we blow apart the MYTH that the NHS is 'unaffordable' noting the real reason for the current NHS crisis is under-funding to allow privatisation...


Last September [2016], the Office for Budget Responsibility [OBR] stated the NHS is easily affordable up to and beyond 2030.

Current Spending to fall under Tory Government

----- The NHS is not unaffordable, it's being starved ------

■ MYTH: We need to change since we can't afford the NHS in its present form.

■ FACT: the fallacy of the NHS being unaffordable has been debunked by all major health think tanks such as Nuffield trust & King's Fund along with the Office for Budget Responsibility (OBR) and other economists. A recent report from the OBR shows the NHS is easily affordable up to and beyond 2030.

The OBR figures show that the UK currently spends 7.4% of its GDP on healthcare, which is set to fall to 6.9% by 2020 under the current Tory government funding settlement. The health select committee have already shown that the £10b funding set aside to aid roll-out of Hunts NHS reforms (STPs) is less than half of what is needed to properly fund the NHS; indicating the real intention is to starve the NHS to meet privatisation requirements set up with Andrew  Lansley's Health & Social Care Act 2012 (the privatisation act).

The OBR figures show that this amount could easily increase to 8.8% by 2030 - evidently without an increase in general taxation. Appleby stated the 8.8% increase in spending is actually lower than the long-term growth in NHS spending. Average spend since 1954 is 4% a year, whereas an increase to 8.8% by 2030 would represent a growth of less than 0.1% a year.

So the irony is, even if we're at an 8.8% spend in 2030, the UK will still be at the same spending levels France, the Netherlands, Denmark, Sweden, Germany and Japan were  back in 2015 !

Prof. Appleby said “The real debate the UK needs to have is over how much more we want to spend on the NHS, not whether we need to change the way the health service is funded.”

The wish to move to a radically different model of health care is purely political ideology - what many now know as denationalisation of the NHS as Jeremy Hunt espoused in his co-authored booklet titled 'Direct Democracy'.

Finally, we're all aware that the Sustainability & Transformation Plans (STPs) are being rolled-out by the ex vice president of the U.S. private insurance firm UnitedHealth, and the models of care being proposed for England, such as 'Accountable Care Organisations' are based on the U.S. private insurance models.

So to conclude, I've included a health spend comparison table below showing that even though the UK spends less than the other countries shown, it comes out on top for efficiency, affordability (equity), access to care and outcomes. The USA on the other hand comes an abysmal bottom with the greatest spend and the worst outcomes.

Yet this Tory government want England to move to the failed U.S. model that most American citizens can't afford. And all for their Tory egotistical ideology and historical wishes of denationalising the NHS.  If that doesn't put the fight back in you, then reality hasn't hit home yet of what's happening to our NHS. This is a wake up call, a call to arms to save the NHS before it's too late.

References & related links

Nuffield Trust: New OBS figures show NHS ‘is still affordable’ [26.9.2016]

As GP numbers fall, patients are more likely to pay to see them

 The reason the Tories want fewer GPs as per their STP plan is to narrow down the market ensuring the public will have to pay for GP services in future.

NHS England’s Sustainability and Transformation Plans (STP) see England divided into 44 “footprints” – which must achieve financial balance by next year.

The philosophy of health insurance is inline with the American model of health care where 'physicians' or GPs as we know them, charge patients per visit.  And who would be better than 'Simon Stevens', the boss of NHS England to introduce these 'U.S. models of care. 

Stevens, who worked for 10 years as vice-president of the American private insurance based company 
UnitedHealth, was appointed in 2014 as CEO of NHS England by the tory health secretary Jeremy Hunt. That's right; the same Hunt who imposed an unfair and unsafe contract on NHS Junior Doctors early last year.

Many Junior Doctors were so incensed by the 'imposing' nature of Hunts actions they pledged to leave the NHS in droves. And this does seem to be the case. Does Hunt care? not at all, it was all planned along while ago...

The frightening thing about both Hunt and Stevens is they both wish to see the American models of care(less) introduced in England. Remember, the U.S.A. does not have a universal healthcare system as here in the U.K. so is fully dependent on private insurers covering only those who can pay to see a doctor or visit hospital.

 

I've just explained to my GP about the plot to dismantle the NHS and in particular force GPs into federated practices operating on private-public partnerships. 

My GP mentioned if they were forced to join a GP federation they would quit the profession. But the real plot is just that, to demoralise GPs thus forcing a system that's understaffed ensuring patients in future pay for GP primary care services.

In a recent news article (below) the Clinical Commissioning Group chairperson clearly states that GP services will be more patient-centered. And that means only one thing: population - based care which is centred around insurance-plans and 'personal health budgets'.

In other words, many patients, knowing they will have to pay to see a GP, won't make a GP appointment. Result, fewer GPs needed as indicated in the news article.

Tory philosophy - "pay or stay away"

The NHS principle of free at the point of need is disregarded in this Tory bastardry. 

Why they are still in government is matter of tolerance, but tolerated by how many, and for how long?

  
News article: Secretive NHS STP plans could see GP numbers in Hackney fall by a third

Lancs STP leader says STP plans are 'meaningless' to public

Lancs & South Cumbria STP leader accepts her new NHS reform plans are almost 'meaningless' to the public. Lead planner says STP is 'not a plan'.

Speaking as part of a roundtable discussion earlier this month next to two prominent STP leads, Amanda Doyle and David Pearson, Mathew Swindells (National Director of Operations and Information NHS England) added that it’s “really up to local leaders” in the meantime to manage how they engage with their communities with respect to ongoing plans – but said NHS England would “discourage” people from publishing plans they’re still working on.

Commissioner chair claims Lancs & South Cumbria STP is "not a plan"

Adding to this, Doyle, who is the CCO at Blackpool CCG and Sustainability & Transformation Plan (STP) lead for Lancashire and South Cumbria, clarified that what her footprint has so far is “not a plan", a complete narrative that describes everything we’re going to do and what healthcare will look like in five years’ time”. Instead, it is a series of templates, government information and finance templates, most of which would be “almost meaningless” to the wider public.

Is the STP 'ask' really really difficult? Or impossible?

Doyle, who is also the co-chair of NHSCC*, argued that the STP ask is “really, really, difficult”, but necessary: “We’re not making any bones about that, and the message back to Matthew, Simon [Stevens] and Jim [Mackey] is that this is really hard to do in the time we’ve got. *NHS Clinical Commissioners is the membership organisation of clinical commissioning groups.

Lack of detail due to lack of public involvement?

“But we have got unlimited time to sort this out. We are not sustainable as we are. We do not have the luxury of two years to nail down every detail of everything. We have to get on and deliver, we have to improve health, we have to improve outcomes, and we have to be able to afford what we’re doing.”

Swindells agreed, adding that every day NHS leaders “decide to have another committee meeting” rather than “getting on and making a hard decision”, the system is “not delivering the optimum NHS and social care with the money that’s available”.

What do we know so far?

Well, the STP for Lancashire & South Cumbria is supposed to contain decisions that are part-fed from feedback from public events on Central Lancashire's 'Our Health Our Care' plan , the local delivery plan (i.e. the Central Lancashire submission towards the overall Lancs & South Cumbria STP.

Public had no input into their local plan or STP

THREE public 'listening events' were organised by local CCGs and their partners for November and December (2016), and March 2017. But NHS England brought forward the submission date for two year operational pans (for 2017/18) and the STP was published BEFORE the first public event.

Two of the events went ahead, but since the plans had already been submitted, program leaders attempted to deceive the public by talking around the options in the plan and instead concentrated on the lesser contentious issue of social care.

Doyle claims "We do not have the luxury of two years to nail down every detail of everything".

Yet her STP nails down absolutely no details whatsoever and isn't worth the paper its written on. A tweeter and well known author on NHS health policy recently tweeted Doyle's STP was 'rubbish'.

I'm inclined to agree, after reading the empty statements in the Lancashire STP I was left wondering if the public had been involved more detail could have been included.

But the fact is the public and local authorities haven't been included in the STP (draft or otherwise) leaving the whole 'transparency' issue in question.

Any plan rolled out in secret should be doomed to fail.

It looks like Doyle and her cronies wish to roll-out their ill-thought out STP and 'nail down' the details as they progress, with or without public involvement.

Not as long as we are here to fight against it they're not!

Campaign group "Protect Chorley Hospital from Cuts and Privatisation" are awaiting a reply from the local STP leaders on why the public have not been involved in the 2 year plans and STP local delivery plan.

Links & Sources

NHS Expo Dec 2016. Dr Doyle declares STP 'not a plan at all'.

Our Health, Who Cares?

I decided to leave the 2nd 'Our Health Our Care' [ohoc] event since it was getting farcical.
You really couldn't get any further from the truth about a new healthcare system.

I sat in at the afternoon event where the program slideshow presenter (clinical director LTH trust) said urgent care centre aside an A&E was a new model of care + he said privatisation wasn't on the agenda.

Fortunately he sat next to me, and luckily the CCG chief officer also sat at our table. I put him right about the UCC model being over 30 years old (it's an import from Denmark) + privatisation is a large part of the STP (as the health secretary said in his book about denationalising the NHS titled 'direct democracy').

Ironically, the presenter changed his tune at the evening presentation when he said privatisation in the NHS does exist and the UCC model is not new!

The story gets farcical. I also attended the evening event only to find the CCG couldn't get more people to promote their trash plan so they'd hired some non-de-plume to do their bidding. I asked the lady, who was sporting a badge titled 'OHOC', was she employed by the CCG or the hospital trust or other healthcare organisation and she said no. Nor, as far as I gathered, had she read the LDP (OHOC) submission as part of the STP for lancs & south cumbria. 

We can't afford the NHS but the CCG can splash out on an unknown to promote something they likely know little or nothing about? Farce.

After the slideshow the public were asked to devise a new healthcare system or come up with a solution to overcrowding at the A&E. I said well if Nuffield trust and King's fund can't solve it I can't help here.

There were no new options or models of care pathways proposed at the meetings, except questions such as just what do you think of bringing together (integrating) pharmacies, clinics and GPs?

Erm, they already exist, all you're talking about is getting them to federate with the GP practices.

It was clear at that point they were avoiding the more controversial issues of the OHOC LDP program and instead 'gauging the feeling' of how apathtic the public were.

There are over 313,000 people in Central Lancashire.
135 people replied to the OHOC program over 8 events, and apparently this is good?

There was NOTHING mentioned at the meeting about the true contents of the OHOC LDP 67 page document which was submitted to NHS England in November. Nothing about the MCP clinics or service closures, nothing about personal health budgets or hospital re-configurations, nothing!

Are we being deceived?

If you thought the STP was rushed through in secret then it's going to be an explosive time when the 'public consultation' for the STP does start.

I can tell ya one thing, I'll be there when it does start, and this time watch out London 2017, cause I'm heading your way too....

Suggested council tax increase to pay for Social care?

You can shove that idea you bunch of pansies! The problem of NHS underfunding, including social care can be wiped out with a 1p increase in National Insurance contributions. Yet once again the Tories want to pass the buck to local councils to throttle their citizens even more...

Suggested council tax increase to pay for Social care

On the news earlier, ask yourself why didn't the CCG suggest this in their contribution to the STP?

Instead, the CCGs rushed ahead claiming they would find a way but completely failed to say HOW they would solve the problem of pensioners stuck in hospital with no alternative out-of-hospital care on discharge.

Here's what the Chorley & South Ribble CCG want to do, even though they have no idea how to do it....from their Local Devlivery Plan (LDP) i.e. their contribution to the STP...

Outcome 3: Reducing the amount of time people spend avoidably in hospital through better and more integrated care in the community, outside of hospital – this means ensuring that alternative care is available so that fewer people have to go into hospital
Outcome 4: Increasing the proportion of older people living independently at home following discharge from hospital – this means ensuring that alternative care is available to support older people so that they can leave hospital sooner

NO ALTERNATIVE

So how do they 'ensure' alternative care is available if social care is already in crisis?
Integrated care has been a mantra for years yet like other areas its never had enough funding, and it certainly won't solve hospital overcrowding.

Indeed, the hospital trust board have already agreed to new care models, as long as it gets then out of deficit they don't seem to give 2 hoots... from page 9 of CCG Local Delivery Plan (LDP)...

"We [CCG] anticipate that once the models of care have been agreed and sized, and after any required consultation, that Lancashire Teaching Hospital will then start a process of modernising its hospital estate to ensure that it is efficient and fit for the future".

"By 2020/21 we plan to have moved away from a reactive hospital based-system of unplanned care, to preventative, anticipatory, whole person approach to care."

By its very nature a hospital is a reactive based system since it's never possible to predict accidents or when an emergency arises. To move to preventative whole-person simply means moving to an insurance-based system for patients with chronic conditions. The payment plan will initially be 'free' under what's called a 'personal health budget' (PHB). But as more services are lost from the NHS these will need to be obtained via a 'top-up' fee on the PHB.

So briefly....page 18

"The health economy is agreed that this Acute model of care will look different to its current and that it may well reduce in size from its current form. We are committed to shifting resources towards interventions that prevent ill health and reduce demand for hospital and residential care services."

Instead of expanding to accomodate the increase in population, the CCGs are actually proposing reducing the amount of secondary acute space available to children, adults and pensioners in desperate need!

Yes, it will reduce in size to a small acute/trauma hospital on the outskirts of Lostock. The other hospitals in Chorley and Preston will be sold-off for their estate value to pay for the smaller community 'Hub' clinics called 'multispecialty community provider' (MCP) clinics, run in the future by VirginCare or other private venture (there is no other way due to underfunding of the NHS).

Page 19 map = no hospital for Chorley
Page 20 map = no hospital for Preston
Page 21 map = only 20 GP practices on 3 sites/polyclinics for South Ribble

One of the most worrying features of the CCGs 'STP' delivery plan is that in its opening paragraph on page 24 it concludes the [STP] process with a pre-consultation business case.

It's nothing to do with clinical outcomes only financial stability, and as usual the patient has the last say...

So why has the Tory government decided to make up losses in Social care by proposing to increase Council Tax?

For a start, we've already been paying for social care through an increase in council tax, and it's been going disastrously wrong.

Wealthier areas with a higher council tax base raise as much as three times more than poorer areas where the need for social care is much higher. It's not hard to see how this increases 'inequality'

Despite the growing numbers of older people, council funding for social care has been slashed by £5bn since 2010. Many organisations that provide care are struggling to stay afloat and are handing contracts back to councils.  Click for More...

 

Download the CCG Local Delivery Plan, the CCGs STP submission..