“The unhappy and growing tendency to regard healthcare as a commodity is not serving the people of the UK well.”— President of the Royal College of Paediatrics and Child Health
The House of Commons’ Health and Social Care Committee has published its report ‘Integrated care: Organisations, partnerships and systems’. It’s a curate’s egg (good in part) but overall, it’s disappointing and a bit of a fudge.
It recognises that Accountable Care Organisations are illegal under current law, and believes that, if introduced, they should be established by primary legislation.
However, they also seem to suggest that ACOs’ illegal status can be ‘worked around” through passing secondary legislation (thus avoiding Parliamentary scrutiny). The Committee refuses to accept that ACOs facilitate privatisation, but does recommend that they should be public bodies (because of the risk that companies holding long-term, large-scale ACO contracts will collapse).
See Keep Our NHS Public‘s response for more details.
A report by the National Audit Office (NAO) has identified failings on the part of NHSE when it awarded a £330 million, seven-year contract to outsourcing giant Capita to supply primary care support services. Subsequently, Capita made aggressive cuts to the numbers of support staff from 1,314 to 314, so reducing costs by 69% but also loosing important local expertise.
The NAO found that NHSE was over-ambitious and had not understood the complexity and variation of primary care support services well enough to set achievable service specifications or performance standards. It misjudged the risks involved. Capita’s failings included creating shortages of medical and other supplies, delayed payments and loss of earnings for many GPs, dentists, opticians and pharmacists and serious problems with patient record transfers: patients were put at significant risk. The British Medical Association (BMA) has called for NHSE to bring primary care support services back in-house.
The campaign group JR4NHS is challenging the legality of NHS England’s plan to introduce Accountable Care Organisations without primary legislation and proper public consultation. There will be a full hearing at the Royal Courts of Justice, London on 24 and 25 May 2018.
You can show your support by joining other NHS defenders outside the Royal Courts of Justice in the Strand on 24th and 25th May from 9 am onwards.
For more information on different judicial reviews that seek to challenge the ongoing privatisation and fragmentation of the NHS, and how to support these campaigns, see our page “What can I do”
The Royal College of General Practitioners says that patient choice and the GP-patient relationship are at risk because of referral management centres, which may challenge GP referrals and are designed to cut costs instead of caring for patients.
The College asks you to write to your Clinical Commissioning Group to object. See this website details on how to do this: https://rcgp.eaction.org.uk/lobby/helpenid?dm_i=4LXX,8NEN,264HW2,XWEW,1.
The parliamentary commissioner for standards has received a complaint about the Minister for Health and Social Care, after Mr Hunt did not comply with money-laundering legislation and failed to register a new property company with Companies House. Mr Hunt’s company owns seven flats in a development led by the Nicolas James Group, a company (according to the Guardian 14.4.18) that’s owned by a substantial donor to Mr Hunt’s constituency. The Minster for Health and Social Care is one of nine current cabinet ministers with interests in property.
Meanwhile, following the Naylor Review, NHS Trusts are under pressure from the government to cope with underfunding by selling land and buildings to property developers.
GP at Hand promises a service that allows people working or living in a broad area of London to get a digital consultation with an NHS GP within a couple of hours of their request. They just need to quit their existing GP practice and register as an out-of-area patient.
However, GP at Hand say their service is not appropriate for those with complex physical or mental health problems, pregnant women, or people with learning difficulties, drug dependence, those who are frail, have social needs, or dementia, need end of life care, or have a safeguarding need. So by and large, they focus on healthy young people – who happen to be the most profitable patients!
Most GP practices get the same amount of money per year, per patient, irrespective of their patients’ needs. About 80% of patients will be reasonably well and because they need less care, their funding helps to pay for the 20% who are sick. But when a GP practice focuses on those who are well, they increase their own income while taking patients – and therefore NHS funding – from GP surgeries that continue to take care of those who are sick or have complex needs, and may now have a disproportionate number of these patients.
GP at Hand can provide some face to face consultations at 6 sites across London. But all patients register with a particular practice in north west London. As a result, their GP list size has increased from 2,500 in April 2017 to 24,652 by 1st March 2018. 75% of these new patients live outside the area. The local Clinical Commissioning Group (CCG) does not get any extra funding for this out of area population and calculates that it could be facing extra costs of £10.6 million by the end of the current financial year, pushing it into deficit.
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An increasing number of cash-strapped NHS Trusts are setting up private companies to employ their non-clinical staff. This is to save money by avoiding VAT (private companies working for the NHS can claim back VAT charged from the government). These companies can also employ new staff on lower pay and worse conditions than if they worked for the NHS.
Theresa May has refused to rule out the possibility that US corporations will have access to NHS contracts as part of a future trade deal with the USA.
NHS England has a number of contracts with Carillion, the giant outsourcing corporation that has just gone into compulsory liquidation. 14 NHS Trusts receive services from Carillion. For 13 of these, Carillion plc was subcontracted by a PFI provider to operate some hard (such as building maintenance) or soft (such as catering, cleaning or portering) facilities management services.
Three trusts also directly contracted with Carillion to provide services (two for hard facilities management services, one for soft facilities management services and one for car parking management). In addition, there are a number of smaller primary and community care properties with services sub-contracted to Carillion. The corporation is also involved in two sites for health facilities under construction.
It’s expected that the Official Receiver will prioritise the continuity of vital public services. A fast-track investigation is to be launched look at the conduct of directors – both previous and those in charge at the time of company’s insolvency.
For more information about out-sourcing and the NHS, see Turning the NHS into a market