“Let American firms run hospitals, urges free trade group”

“Ministers should allow American healthcare companies to compete with the NHS to run hospitals as part of a free-trade pact after Brexit, a think tank recommends.

The Initiative for Free Trade (IFT) said that Britain should also end its ban on imports of products such as chlorinated chicken and accept American environmental and food safety regulations as equivalent to those in the UK.

The moves, it claimed, would help clear the way for a UK-US trade deal that would “rewrite the rules” of global commerce and allow Britain to take advantage of trade freedoms offered by Brexit. The IFT has received backing from Liam Fox, the international trade secretary, and Boris Johnson.

The report, edited by Daniel Hannan, a Tory MEP, was partly written by the trade lawyer Shanker Singham who has been consulted on free trade by Dr Fox, David Davis, Steve Baker and other ministers since the referendum.

Its conclusions will fuel suspicions that the think tank is being used as an “outrider” to align Britain with America on standards to secure a trade deal that would not be possible if the government signs a Chequers-style agreement with the EU.

The report, which was published simultaneously in London and Washington, was a collaboration between the IFT and the libertarian US think tank the Cato Institute.

It calls for Britain and the US to negotiate the most ambitious agreement ever that would allow British and American companies to compete on a level playing field in each other’s markets across both goods and services. Both countries should accept each other’s regulations on safety and environmental standards and open up all government procurement contracts to both sides.

It also suggests that any British or American citizen should be able to work in both jurisdictions if they have secured a job. It is the group’s proposals to open up the NHS to competition that is likely to prove the most contentious.

Daniel Ikenson, one of the report’s editors, described the NHS as an “incumbent” healthcare provider that should have competition. “The purpose of liberalising trade is to expose incumbent businesses to competition, including healthcare providers,” he added.

A Department for International Trade spokesman said: “We are currently seeking a wide range of views about four potential free-trade agreements, including with the USA, and we encourage all interested organisations and members of the public to make their voices heard through our online consultations.”

Source: Times (pay wall)

Meeting in Parliament on the failure of scrutiny of NHS changes

DCC Health and Wellbeing Scrutiny Committee- and particularly its chair Sarah Randall Johnson – take note:

“NHS campaigners meeting with MPs to call for better scrutiny and review to stop damaging cuts

Defend the NHS campaign groups from across England are to lobby MPs at a meeting in the House of Commons on Monday 10th September.

They will share their experiences of the need to improve the process of scrutiny and review of substantial changes to NHS services, in order to stop damaging cuts and changes.

The meeting is hosted by Paula Sherriff, MP for Dewsbury – where the District General Hospital has lost many of its key services.

Local campaign group, North Kirklees Support the NHS, will explain the risks this has created for the Dewsbury public.

Along with six other campaigns from Lincolnshire, West Yorkshire, Devon, Northumbria, Dorset and Oxfordshire, the Dewsbury group will tell MPs that there is an urgent need to address serious flaws in the process whereby Councils’ scrutiny committees refer proposals for damaging NHS cuts and changes to the Secretary of State for Health and the Independent Reconfiguration Panel.

Christine Hyde, from North Kirklees Support the NHS, said,

“The process of referral to the Secretary of State was opaque. The Independent Reconfiguration Panel is the key body with the power to advise the Secretary of State for Health to stop and/or require changes to major NHS cuts and “reconfigurations” – but there was next to no information about how it worked.

Once we had figured that out, we naively thought public opinion would have some weight. Together with the other five local NHS protector groups, we encouraged Independent Reconfiguration Panel members to visit Dewsbury.

We were ignored.

The Independent Reconfiguration Panel’s decision that local commissioners could sort out the failings in the hospital cuts proposals has not, for the most part, been borne out.

As the hospitals reconfiguration has been implemented, it has created huge problems for the most vulnerable groups – housebound patients, infants, children with disabilities and patients with life threatening illnesses like cancer.

The hospital changes were sold as being ‘better for patients’ but it really was all about the money and even so, the savings are recorded in a response to a Freedom of Information request as ‘nominal’.”

Campaigners will also demand political impartiality in the scrutiny and referral process.

The need for this is shown by Save Our Hospitals Devon’s observation of a discussion and decision by Devon County Council’s health and adult social care scrutiny committee, that reversed an earlier vote to refer the closure of community hospital beds in Eastern Devon to the Secretary of State.

Members of Save Our Hospitals Devon Netti Pearson and Sue Matthews said,

“The feeling among observers was certainly that the decision was a political one rather than one borne of effective and satisfactory scrutiny.”

Steven Carne from 999 Call for the NHS, the national campaign group which has convened the meeting, said,

“We are very excited about the campaign groups coming together from across the country to share their experiences of wrestling with the scrutiny and referral process.

This is key to stopping damaging NHS cuts, closures and inappropriate importation of insurance-based ‘care models’ from USA’s Medicare/Medicaid system. This provides a limited range of state-funded healthcare, on the basis of financial considerations – not clinical need, to people who can’t afford private health insurance. It is not what the NHS is about.

For the first time, campaign groups across England are pooling our knowledge and experience to lobby MPs to make this scrutiny and referrals process work better, because it definitely needs to.

And also to encourage other campaigns to get more actively involved with the process, in defence of NHS and social care services in their area.

The Department of Health guidance on health scrutiny says its primary aim is to strengthen the voice of local people in the commissioning and delivery of health services.

So it needs to make sure this happens.

This meeting is just a start. We are going to pursue this goal through thick and thin.”

http://999callfornhs.org.uk/scrutiny-failing-us/4594418128

“Court of Appeal grants NHS campaign group permission to appeal against NHS England’s new Integrated Care Provider contract”

“The Court of Appeal has issued an order granting campaign group 999 Call for the NHS permission to appeal the ruling against their Judicial Review of the proposed payment mechanism in NHS England’s Accountable Care Organisation contract.

The Accountable Care Organisation Contract (now rebranded by NHS England as the Integrated Care Provider contract) proposes that healthcare providers are not paid per treatment, but by a ‘Whole Population Annual Payment’, which is a set amount for the provision of named services during a defined period. This, 999 Call for the NHS argues, unlawfully shifts the risk of there being an underestimate of patient numbers from the commissioner to the provider, and endangers service standards.

In April, the High Court ruled against the campaign group’s legal challenge to NHS England’s Accountable Care Organisation contract – but the group and their solicitors at Leigh Day and barristers at Landmark Chambers found the ruling so flawed that they immediately applied for permission to appeal.

Although fully aware of this, on Friday 3rd August – the day Parliament and the Courts went on holiday – NHS England started a public consultation on the Accountable Care Organisation contract – now renamed the Integrated Provider Organisation contract.

The consultation document asserts that the payment mechanism in the ACO/ICP contract is lawful, because:

“The High Court has now decided the two judicial reviews in NHS England’s favour.”

Steve Carne, speaking for 999 Call for the NHS, said

“It beggars belief that NHS England is consulting on a contract that may not even be lawful. And a lot of public funds is being spent on developing the ACO model – including on the public consultation. We are very pleased that 3 judges from the Court of Appeal will have time to consider the issues properly. We shall shortly issue our stage 5 Crowd Justice appeal for £18k to cover the costs of the Appeal.

We are so grateful to all the campaigners and members of the public who have made it possible for us to challenge the lawfulness of NHS England’s attempt to shoehorn the NHS into an imitation of the USA’s Medicare/Medicaid system.

We will not see our NHS reduced to limited state-funded health care for people who can’t afford private health insurance.

Jo Land, one of the original Darlo Mums when 999 Call for the NHS led the People’s March for the NHS from Jarrow to London, added,

“All along we have been warning about the shrinkage of the NHS into a service that betrays the core principle of #NHS4All – a health service that provides the full range of appropriate health care to everyone with a clinical need for it, free at the point of use.

Since we first started work two years ago on bringing this judicial review, there have been more and more examples of restrictions and denials of NHS care, and the consequent growth of a two tier system – private for those who can afford it, and an increasingly limited NHS for the rest of us.”

Jenny Shepherd said

“NHS England’s rebranded Accountable Care Organisation contract consultation is a specious attempt to meet the requirement to consult on a significant change to NHS and social care services.

We don’t support the marketisation of the NHS that created the purchaser/provider split and requires contracts for the purchase and provision of services.

Integration of NHS and social care services, in order to provide a more straightforward process for patients with multiple ailments, is not aided by a system that essentially continues NHS fragmentation.

This new proposed contract is a complex lead provider contract that creates confusion over the respective roles of commissioner and provider. It requires multiple subcontracts that are likely to need constant wasteful renegotiation and change over the duration of the lead provider contract. This is just another form of fragmentation, waste and dysfunctionality.

The way to integrate the NHS and social care is through legislation to abolish the purchaser/provider split and contracting; put social care on the same footing as the NHS as a fully publicly funded and provided service that is free at the point of use; and remove the market and non-NHS bodies from the NHS.

Such legislation already exists in the shape of the NHS Reinstatement Bill.”

The campaign team say they are determined in renewing the fight to stop and reverse Accountable Care. Whether rebranded as Integrated Care or not, they see evidence that it is the same attempt to shoehorn the NHS into a limited role in a two tier healthcare system that feeds the interests of profiteering private companies.

Steven Carne emphasised,

“It is vital that we defend the core NHS principle of providing the full range of appropriate treatments to everyone with a clinical need for them.”

999 Call for the NHS hope the 2 day appeal in London will happen before the end of the year. The Appeal will consider all seven grounds laid out in the campaign group’s application – with capped costs.

Details on the first instance judgment can be found here:

http://www.landmarkchambers.co.uk/news.aspx?id=5630

and the judgment itself here:

http://www.bailii.org/ew/cases/EWHC/Admin/2018/1067.html

David Lock QC and Leon Glenister represent 999 Call for the NHS, instructed by Rowan Smith and Anna Dews at Leigh Day.

https://calderdaleandkirklees999callforthenhs.wordpress.com/2018/08/17/court-of-appeal-grants-nhs-campaign-group-permission-to-appeal-against-nhs-englands-new-integrated-care-provider-contract/

Devon CCGs want to merge (but looks like they already did it!)

Owl says: anyone recallveing consulted about this? And surely, if it is for cost-sVing, all previous financial scenarios at the two CCGs must be recalculated. And shouldn’t this be rescrutinised by DCC?

“North East and West (NEW) Devon CCG is hoping to merge with South Devon and Torbay CCG in April next year. Both CCGs have expressed an interest to NHS England to merge the organisations, in what they say is the ‘next natural step’. In May last year, NEW Devon CCG refuted claims it had ‘gone bust’ – though it did have a defecit of £42million in 2016/17.

Last year (2017/18) NEW Devon CCG had a planned defecit just shy of £50million.

It is thought the merger would help both organisations face funding challenges in the years ahead; they have already made a saving of £4million working together in the last year. This has includinged merging the two executive teams and establishing a common governing body and committees.
Executive directors now sit in Devon-wide roles working across both CCGs.

Dr Sonja Manton, director of strategy at the two CCGs in Devon, said: “We have made significant progress working as a health and care system in Devon over the past two years.

“As commissioners (buyer) of health care services for our local population, our two CCGs have worked more closely together for over a year, and this has brought many improvements and benefits such as speeding up decision making and making cost savings and efficiencies of nearly £4million on running costs.

“We have achieved much more together than we would have working separately. “A merger of our two organisations is the natural next step, and we have expressed an interest to NHS England to merge our two organisations from April 2019. “We are working with staff, clinicians, partners and stakeholders to ensure that everyone is involved in the changes as they develop. “This is an important step in our journey to better integrate health and care services to benefit our local communities.

“In Devon, we have well-established joint working arrangements with our local government partners and this will be strengthened as we design a new more integrated approach.”

https://www.northdevongazette.co.uk/news/proposals-to-merge-two-devon-ccgs-1-5642433

“Virgin awarded almost £2bn of NHS contracts in the past five years”

“Virgin has been awarded almost £2bn worth of NHS contracts over the past five years as Richard Branson’s company has quietly become one of the UK’s leading healthcare providers, Guardian analysis has found.

In one year alone, the company’s health arm, Virgin Care, won deals potentially worth £1bn to provide services around England, making it the biggest winner among private companies bidding for NHS work over the period.

The company and its subsidiaries now hold at least 400 contracts across the public sector – ranging from healthcare in prisons to school immunisation programmes and dementia care for the elderly.

This aggressive expansion into the public sector means that around a third of the turnover for Virgin’s UK companies now appear to be from government contracts. …

Sara Gorton, the head of health at the trade union Unison, said: “The company has been so keen to get a foothold in healthcare, it’s even been prepared to go to court to win contracts, moves that have cost the NHS dearly.

“While the NHS remains dangerously short of funds, taxpayers’ money shouldn’t be wasted on these dangerous experiments in privatisation.”

One former surgery manager who spoke to the Guardian said Virgin appeared to be paid more for doing less in her area, although the company said “because the contracts are generally not directly comparable, we don’t believe it to be true”.

Guardian analysis reveals the way the company that began selling records in the early 1970s has diversified in a bewildering way over recent years. …

In March 2017, it had almost 1,200 staff – a five-old increase from the year before. Over the same period, its turnover increased from £133m to £204m and its operating profit rose from £7.3m to £8m.

Though healthcare is a growing part of the group, Virgin still appears to make most of its money from transport.

Virgin UK Holdings, the UK business which holds its rail and healthcare ventures, reported revenues of £1.5bn in 2016 and paid £22m in tax.

Earlier this year, Virgin Trains had its west coast line franchise extended for another year. …

Paul Evans, the director of the campaign group NHS Support Federation, said: “Virgin Care are the biggest private sector winner to emerge out of the NHS experiment with competition and outsourcing.

“We don’t know the final shape of it, but players like Virgin and Care UK clearly see a big opportunities for business to continue to deliver clinical services for the NHS.”

https://www.theguardian.com/society/2018/aug/05/virgin-awarded-almost-2bn-of-nhs-contracts-in-the-past-five-years

Very important case law on consultation

This has great relevance to NHS consultations, the wording of consultation comments, the treatment of those comments and the duties and respinsibility of the DCC Health and Wellbeing Scrutiny Committee to scrutinise evidence presented.

It is going to be much easier to challenge flawed consultations.

Those involved in these matters MUST read the full document (see source at end of post. Only a couple of the relevant sections are published here but should be read with the whole document.

“… “Commentary on
R (ex parte Kohler) v The Mayor’s Office for Policing and Crime
[2018] EWHC 1881

This Briefing Note considers the judgment handed down by Lord Justice Lindblom and Mr Justice Lewis on 20th July 2018. It details the circumstances of the case, its wider context and, in particular discusses practical issues which will be of concern to consultation practitioners.

Background

In common with other police forces, the Metropolitan Police has needed to make huge savings in its budget. Unsurprisingly it has led to a review of what premises they occupy and whether they still need over-the-counter services at their police stations.

In July 2017, the Mayor’s Office for Policing and Crime (MOPAC) published a Public Access and Engagement Strategy, a dual-purpose document simultaneously consulting the public about the future direction of public engagement on policing and seeking views on proposals to close or ‘swap’ 37 police counters.

The consultation was heavily criticised, and at the Institute, we published a detailed critique under the provocative title Is this the worst consultation of 2017?

https://www.consultationinstitute.org/worst-consultation-2017/

Some of the complaints were heeded and a revised set of questions emerged three weeks after its original launch.

The legal challenge

Professor Paul Kohler lives in Wimbledon and in 2014, was subjected to a serious assault. He believes his life was possibly saved only thanks to the prompt response by police from Wimbledon Police Station.

The MOPAC proposal included a provision for that facility to be transferred elsewhere in the London Borough of Merton – to Mitcham, so that the site at Wimbledon could be sold and generate capital receipts. These in turn, according to the consultation document, would help the Met Police fund technology improvements needed to support the case for changing public access and reduce the traditional reliance on police counters. …

The Kohler case spells an end to the practice of sending decision-makers a summary report (or an unreadable tome) with a message ‘Don’t worry, there’s nothing here to stop you from going ahead!’. If a failure to consider a specific argument can spell illegality following a consultation, someone somewhere has to decide what might constitute such an argument. Who can be trusted to decide?

The Consultation Institute View [on the case]

• The Kohler case is a game-changer, placing the Gunning Four Principle of ‘conscientious consideration ‘ at centre stage. There have been few comparable cases, as flawed consultations have, in the past failed the pre-determination or the sufficient information tests. It remains to be seen if the judgment opens the door to more claims that decision-makers never properly studied consultee submissions. It could happen!

• One consequence is that campaigners and other smart stakeholders will structure their comments to ensure that they cannot easily be summarised, and may specifically seek assurances that their submissions will have been read by decision-makers.

• To respond to such pressures and to safeguard themselves, consultors will need to look again at their data analysis practices, possibly strengthening the independent element both in analysis and in reporting to decision-makers. They will also need to be better at political risk assessments. Independent Quality Assurance becomes even more attractive for controversial consultations.

• The case for Public consultation hearings is further strengthened, as decision-makers will be able to prove that they heard and understood particular arguments. …”

Full document here:

http://files-eu.clickdimensions.com/consultationinstituteorg-alksu/files/briefingnote21-mopac.pdf

Sky News claimed 55% of the NHS budget is spent on over 85s – the REAL amount is VERY different

A Sky News article claimed that 55% of all NHS spending went on people 85+:

https://news.sky.com/nhs-in-numbers

An independent fact-checking charity decided to research this claim.

Sky News told them it calculated the figures based on data published by the Institute for Fiscal Studies (IFS), but the IFS told us they don’t recognise these figures. They have asked Sky for more information.

Other figures the charity has seen from the IFS suggest that the proportion of health spending across the UK (rather than just the NHS budget) which goes to those aged 85 and over is likely to be around 10% by 2021/22.

The Institute for Fiscal Studies (IFS) told them it wasn’t familiar with the figures used by Sky News, but did provide them with other information.

When compared to a 30 year-old, spending across the UK on health (not just the NHS) for an 85 year-old is projected to be 5.6 times higher in 2021/22, and twice as much for a 65 year-old. That’s taking account of the fact that not all people of those ages will necessarily need to use health care.

But that doesn’t mean that 85 year-olds will require 5.6 times as much of the budget as 30 year-olds, because there are fewer people at that age.

Using population projections for 2021 we can see that those aged 85 and over are projected to make up just 3% of the population of the UK. Those aged between 65 and 84 made up 16% and those aged 30-64 made up 45%.

Based on this, 10% of health spending across the UK would go to those over the age of 85 by 2021/22, 32% would go to those aged 65 to 84 and 35% would go to those between the age of 30 and 64.

https://fullfact.org/health/how-much-nhs-budget-spent-people-over-85/