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.

The NHS as a national service is about to come to an end

The NHS as a national service is about to come to an end. It will be fragmented and replaced with 42 footprint regions run by private-public "Integrated Care Boards" operating as a financial profit-driven system.

■ The once publicly owned and run "NHS" is hanging by a thread..... It will be fragmented and replaced with 42 private-public "Integrated Care Boards" operating as a financial profit-driven system. These areas, known as 'footprints' will be overseen by American corporations from commissioning support units and driven by American subsidiaries via NHS England's "Approved provider" framework.

some footprint regions

■ Integrated Care Systems aim to CLOSE most hospital outpatient services and move them into community clinics run under a Private public partnership. These multi-specialty provider (MCP) clinics bring together (integrate) the private and public sector, thus redirecting funding away from the NHS.

■ Since 2010, over 60 towns and cities across England have had vital hospital services either closed down or downgraded.

■ American healthcare systems are some of the worst in the world for access & costs. The government are insisting England adopts a health care system similar to Medicaid & Medicare in America as the U.S. health schemes make 'greater savings' and are thus more 'profitable' for shareholders in private healthcare.

■ The government's 2021 health & care bill will ensure the NHS is opened up to large multinational companies who will sit on "integrated care boards" steering services towards private ventures for profit extraction.

Our once publicly owned and run "NHS" is hanging by a thread....

Only the people can save the NHS in England from a transformation of a state-owned asset to a corporate profit-driven health service as seen in the United States.

Links

About Integrated Care Systems from Patients 4 NHS

Private health firms without adequate diagnostic equipment are still being awarded NHS contracts

 TREATMENT DENIED

Lancashire & South Cumbria NHS foundation trust appear to have been sub-contracting out some of their MSK work to private health 'Partners' Ascenti physio who in turn seem to be doing their utmost to keep NHS patients referred to them out of hospital.

This is very dangerous for patients since NHS hospitals provide the more expensive diagnostics equipment needed for MSK such as MRI and CT scanners, which Ascentii don't have.

Without these diagnostic and access to more experienced consultants the patient is being denied their right to a universal NHS coupled with a higher risk of mis-diagnoses.

Since the advent of Clinical Commissioning Groups (CCG) in 2013, almost FIFTY NHS treatments have been removed from the list of treatments available on the NHS.

Contract regulations now apply conditions when a clinician refers a patient for a certain procedure/operation, including "is it financially viable". This 'funding request' is then either accepted in part payment, referred back for a 2nd opinion, or denied.

The clinician/GP now has to go cap-in-hand to the CCG, begging for funding to treat their patients.

The NHS is now being operated as a health insurer by denying treatment on the grounds that management believe it to be ineffective or unaffordable.

RELATED LINKS In this article, a treatment that what was previously provided on the NHS was awarded to private physio firm Ascenti instead. But Ascenti Ltd admitted it didn't have the sophisticated diagnostics equipment to help the patient.

Instead of resolving the patients obvious postcode lottery problem, a spokesman for the local Clinical Commissioning Group - who awarded Ascenti the contract - refused to do anything. Instead they glossed over the problem by reciting such issues as how to self-refer.

Chorley woman who has been living with pain in her foot for 6 months hits out at ‘medical postcode lottery’

The Lowdown June 2021, health, news, analysis

 

The Lowdown - health news, analysis  Evidence-based journalism and research on the NHS to create change. 29th June 2021 Matt Hancock may have resigned but his fingerprints remain all over the new reorganisation of the NHS that will likely be put before Parliament soon. The proposals seen so far are controversial amongst Tories and opposed by Labour. There is an opportunity for public pressure to make important changes, and here at the Lowdown we have been working to raise awareness about this and the huge challenges facing the NHS. Thank you for your support, please share our articles where you can to help raise awareness and to get people involved. Here is this week's Lowdown and PDF  Calls for Javid to stop NHS shakeup Tory splits on Health Bill Don’t expect a return to normal service any time soon NHS Reorganisation – a never-ending story Awkward questions linger over Leicester plan NICE: Deciding what the NHS provides and how in case you missed it... What will be in the Health and Care Bill? Inequality – from words to action? Urgent calls to fix “incoherent” health and social care staffing  And you can mail your MP with the evidence of the action needed on staffing and resources here.

Priming the NHS for privatisation

NHS hospitals don't belong to virgin care or Richard Branson. Not yet anyways.....

NHS hospitals, particularly foundation trusts are however, semi-autonomous companies, each with a company secretary with financial targets to meet. They are also allowed to undertake up to 50% of patients using their private insurance cover. *Watch this BLOG for more on this later..... 

This means NHS patients could now be seen either as  a burden, or a profit. Not convinced? look what happened at Mid Staffordshire hospital scandal where the race for hospital boards to become a part-private company led to years of patient neglect and hundreds of deaths.

Your NHS has already been part-privatised by stealth, the rest is coming soon....

The GP - led commissioning groups however did award some contracts for some urgent care treatment centres to virgin healthcare and are still awarding them. The fact that pre-2010 Lord Ari Darzi advised New Labour 'split' emergency triage into urgent and emergent is where the covert hospital primary care triage 'sell off' scheme started. 

Urgent care alongside A&E is a Danish model of triage and only works well if BOTH are run by the same non-profit seeking organisation and BOTH are run on the same hospital site.

Think about it, urgent care is triage done by Drs who generally work out of private practice (some are wholly employed by virgin or other company such as GoToDoc).

So to ensure a profit, the politicians knew they had to split emergency care up into serious cases and not so serious - and that caused confusion for patients and doctors alike. When to attend, self-diagnoses, which hospital to attend etc..

Blair had similar to what is being proposed currently as Multi-specialty Community Provider (MCP) clinics, he called them independent [private] sector treatment centres . In 2006 Blair welcomed 11 private healthcare providers into the 'NHS ... the first wave of independent sector treatment centres (ISTCs).

The STPs/long term NHS plan pushed thru' by the Tories is merely an extension of Blair's (and Simon Stevens) 2006 white paper titled our health our care our say.

The separation of Urgent care 'away' from the A&E (eg about 12 miles as with Burnley hospital), was a test bed to see how the public reacted. This is why NHS campaigners have a problem, it is sometimes difficult to distinguish between the 2 political parties on outsourcing NHS services and the benefits. There are no benefits for the NHS, only the private frontdoor triaging firms.

But as soon as Tory MP Andrew Lansley's 2012 H&SC act came into effect, the  Clinical Commissioning Groups (CCGs) in England set up under the act began selling off contracts for hospital urgent care to private providers. So the money (via payment by results/Pbr) no longer circulated in the NHS but went to the private provider and some Hospital A&E's as a consequence began to downgrade or close.

Many hospitals were straddled with debt from Blair's Private finance initiatives (Pfi) where private companies (instead of government) were allowed to build the hospital for infrastructure, leading to huge increases in payback interest over the contract term. Hospital boards were falling over themselves to get new hospitals and equipment using Pfi, as for patients?

Some U.S health insurance firms are similar frontdoor providers, but their profit comes from tax relief schemes and referrals. This is why the American system has a 2-tier pathway, one for the poor with VERY basic access, and another for insurance payers.

The Conservatives, particular Boris Johnson, has openly stated they prefer the payer system. And that's what people have voted for in England, whether they were aware, or not...

If we are to use the results of the latest by-election at Hartlepool, the American system in 44 footprint areas of England could be in place very soon. All the more discretely done due to the ongoing pandemic.......