Don’t wait for the DUP

Being rather old-fashioned we had so far refrained from commenting on the Conservative Election Manifesto extract recently posted. We thought we ought to wait to see what came out of negotiations with the DUP and appeared in the Queen’s Speech.

It seems that no such constraints are being applied by the Department of Health and NHS England. They are using the current political limbo to push ahead with some of the most highly controversial plans they have been cooking up in recent years.

As with all party political manifestos it is often necessary to ‘read between the lines’ to understand the real message. Just as one example under the heading ‘Holding NHS leaders to account’ the Manifesto says:

“If the current legislative landscape is either slowing implementation or preventing clear national or local accountability, we will consult and make the necessary legislative changes. This includes the NHS’s own internal market, which can fail to act in the interests of patients and creates costly bureaucracy. So we will review the operation of the internal market and, in time for the start of the 2018 financial year, we will make non-legislative changes to remove barriers to the integration of care.”

We take this to be an oblique reference to the proposal to move to buying local NHS healthcare and local social care through new ‘Accountable Care Partnerships’ (ACP) and ‘Multi-Speciality Care Provider’ (MCP) contracts. In other words there is an intention to by-pass the 2012 Health and Social Care Act statutory framework for commissioning NHS healthcare through the local GP led Clinical Commissioning Groups by administrative rulings without legislative authority. It is putting it mildly to say that we are uneasy about the problems that may result form this departure: both as to the cost of duplicating the structures, conflicts of interest, and as to foreseeable expensive litigation from challenges by healthcare providers.

Regrettably we must now report that there is no need to read between the lines.

The Health Service Journal reported on 15 June, just one week after the election:

  • “Simon Stevens announces first eight accountable care systems
  • Potential for £450m tranformation funding in exchange for them taking on “accountability” for population health

Speaking at NHS Confederation conference today, the NHS England chief executive said: “We are now embarked on the biggest national move to integrating care of any major western country.” He pledged to end “the fragmented system that passes people from pillar to post”.

The ACSs will bring together providers and commissioners to help break down barriers between primary, secondary and social care, NHS England said.”

Of course it sounds terrific. Why haven’t we done this before?

The reality is that the contracts to deliver ACSs will give rise to huge conflicts of interest, be massively complex way beyond the understanding of the busy GPs who will sign them and will have no statutory backing. In addition none of the pilots (“Vanguards”) have been independently evaluated. BPV believes that it will all end in tears and make lawyers richer.

While so far London is being spared from this risky mechanism, radical and very detailed plans for selling off land at Charing Cross hospital and reducing the acute clinical services to a shadow of their present selves have been published in The Guardian online at : https://www.theguardian.com/society/2017/jun/16/most-of-central-london-hospital-to-be-sold-off-secret-plans-reveal?CMP=Share_iOSApp_Other .

We should also mention that we have written to NW London and Brent CCGs and hospital Trusts to ask if they are considering a range of options for achieving extra savings by reducing services to patients as set out in a paper obtained by the Health Service Journal during the election campaign. Details of a letter about applying these policies to North Central London appear in The Guardian today, 21st June. The Trusts appear to be protesting.

Robin Sharp

Chair Brent Patient Voice

 

 

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