Clinical Commissioning Group merger for Devon – good or bad?

Owl says: a bigger group fo DCC NOT to scrutinise – right….

“There are claims a planned merger between two NHS bodies in Devon will result in a less accountable system with no guarantee of improved healthcare for patients.

At present, there are two clinical commissioning groups – or CCGs – which plan and buy healthcare for local people. There’s one covering the North, West and the East of the county – NHS NEW Devon CCG – and the other covering Torbay and the South – NHS South Devon & Torbay CCG. Health bosses want them to merge into one big organisation, claiming this will save money and result in a stronger service. They say there’s already been benefits from the two organisations working more closely together.

But GPs in Torbay have voted against the move and local councillor in the Bay, Swithin Long, is also worried…”

https://www.bbc.co.uk/news/live/uk-england-devon-45865015

“Optum CEO resigns from top NHS Job, Optum partner replaces him”

“This is an everyday story of the sordid revolving door between US Health insurance company United Health and the NHS.

In the UK, United Health’s subsidiary Optum sells the NHS what it needs in order to morph into a version of United Health – the previous employer of NHS England’s boss Simon Stevens.

With NHS England’s blessing, Optum is all over the NHS, installing their technology & redesigning the NHS through its use.

Optum sells the NHS:

Commissioning support services
Scriptswitch decision support for GP prescribing (which United Health UK acquired in 2009) is in most GP surgeries.
Referral management services
GP Empower (accelerating large scale GP practices

Integrated Care Systems support: “Optum® brings practical hands-on experience having delivered integrated care for over 20 years in the US. Our tried and tested approach has helped systems deliver proven results.” This updates an earlier brochure on accountable care systems/organisations which is no longer available. However NHS For Sale quotes Optum’s now defunct webpage: “We currently operate 26 accountable care organisations in the U.S., and are supporting sustainability and transformation partnerships in the U.K. to manage population health risk and deliver care as an integrated group of providers.”

The overall aim is to control, sideline and override doctors’ treatment decisions – as we can see through NHS England’s consultation on stopping funding numerous elective care treatments and its mandatory Integrated Urgent Care Services specification. This removes patients’ direct access to clinicians and redirects them through NHS 111 to a clinical advisory service that works off the algorithms in a clinical decision support tool.

And now it has its finger firmly in the National Institute of Health and Care Excellence pie – the organisation responsible for providing evidence-based guidance and advice to the NHS.

The revolving door that connnects United Health, Optum and the National Institute of Health and Care Excellence

This concerns:

former United Health Director Andrew Witty
Lord Darzi (head of the Imperial College department which is partnered with OptumLabs, a United Health business); and
a new public-private partnership in the National Institute of Health and Care Excellence called the “Accelerated Access Collaborative“, that’s about pushing new technology and drugs through the NHS.
It puts Optum centre stage in the Accelerated Access Collaborative. Now there’s a surprise. Or not. If you have been following United Health’s relatively rapid takeover of the NHS.

As a result of these shenanigans, we would treat any new recommendation from NICE with a pinch of salt.

Here is a short Witty timeline:

March 2017 – Andrew Witty leaves CEO position at Glaxo Smith Kline
August 2017 – Witty joins UnitedHealth’s Board of Directors
November 2017 – Following the Accelerated Access Review, the Department of Health appoints Witty as head of the Accelerated Access Collaborative. The job is to fast track drugs & technology into the NHS, to start April 2018
March 2018 – United Health announces Witty to be new Optum CEO, to start July 2018
Andrew Witty must have been rumbled somewhere along the line as he graciously resigned from the Government position in March 2018, due to the enormous conflict of interest of him starting as Optum CEO in July 2018. Ignored of course was the huge conflict of interest in hiring Witty in the first place while he was a Director of UnitedHealth.

And who replaced him? Lord Darzi.

Who is Lord Darzi

I am tired of writing about Lord Darzi. He stalks the NHS like a zombie. He was behind the New Labour government’s massive, failed and costly privatisation of elective NHS services in the horrible Independent Sector Treatment Centres – one of which totally messed up my son’s broken wrist – twice, before an NHS hospital fixed it for him.

This is what his nasty scheme has come to now. Regardless, he has returned to push his idea a second time as Accountable Care – with the apparent support of the Labour Shadow Health Secretary Jon Ashworth. This time from his perch in the Institute of Global Health Innovation (IGHI) at Imperial College, London.

Which, surprise surprise, is an OptumLabs partner.

What is OptumLabs

OptumLabs (launched in 2013) is all about United Health number crunching and framing raw patient data for academics to play with to derive the “best treatments” for patients.

OptumLabs is desperate to pass itself off as pioneering and respectable in the academic research field. But reality of the profit motive and UnitedHealth’s track record of

“deception, manipulation of data and outright fraud”

(see the Ingenix case ) means their number crunching will most likely point to treatments that United Health finds most profitable, not what’s best for patients. And OptumLabs is useful cover to collect patient data.

We pointed out some time ago Optum’s invidious position as a provider of commissioning support services, able to direct Clinical Commissioning Groups to commission Optum products. Now they have their fingers in the NICE pie too.”

https://calderdaleandkirklees999callforthenhs.wordpress.com/2018/10/16/optum-ceo-resigns-from-top-nhs-job-optum-partner-replaces-him/

What can WE do to save our NHS?

“Greetings, KONP supporters in the South West!
Important information from Keep Our NHS Public on…

Integrated Care Providers

The Government likes to bury its plans to defund, break-up and privatise the NHS in jargon. KONP are producing a series of videos to help you understand what’s going on…

NHS England is consulting on the contract for a new model of health and social care provision that threatens the break-up of the NHS into units run by less accountable ‘Integrated Care Providers’ – or ‘ICPs’. Each of these ‘business units’ would control spend and rationing of healthcare for populations of up to 500,000. These huge contracts will be eminently open to the private sector to compete for.

The ICPs will deliver the dangerous new restructuring plans of government which could see fragments of the NHS managed by non-NHS, non-statutory and therefore less accountable bodies. They are the embodiment of government plans to disperse the NHS and its staff, drive down public funding, promote private contracts and put cost limits and profit before patient safety.

Integrated Care Provider contracts:

Dis-integrate the NHS;
Give control to non-NHS bodies potentially beyond scrutiny;
Threaten public accountability;
Hand over control to these non-NHS bodies for 10-15 years;
Manage multi-billion-pound contracts for blocks of 500,000 population;
Open the door to private companies winning these contracts.

Please watch the video above and share on social media to help spread the word about the Government’s deliberate and insidious privatisation plans.

You can also visit our website:

https://keepournhspublic.com/privatisation/icps-what-are-they/

and our Facebook Page:

https://m.facebook.com/story.php?story_fbid=167804364127012&id=172710059485626&refsrc=https%3A%2F%2Fm.facebook.com%2Fkeepournhspublic%2Fvideos%2F167804364127012%2F&_rdr

for more information, videos and links.

For a written explanation of ICPs and what the represent for the NHS please read and share this briefing (broken link) by HCT co-chair and KONP campaigner Louise Irvine.

How can you help?
1. Along with our friends at We Own It

https://weownit.org.uk

and Health Campaigns Together

https://www.healthcampaignstogether.com

we have created a petition

https://weownit.org.uk/ICP-petition-NHS

calling on the Government to;
a) Abandon the Integrated Care Provider contract model:
b) Guarantee that any Integrated Care Provider organisations will be statutory organisations i.e. NHS bodies, not private providers.
c) Focus health improvement efforts on pressing the government for:

o Sufficient funding and staffing for health and social care.
o Social care to be brought into public provision, free at point of use
o Legislation to end the failed NHS contracting system and to renationalise the NHS: the only sound basis for service integration.

SIGN THE PETITION

https://weownit.org.uk/ICP-petition-NHS

2. NHS England have launched a 12 week consultation on contracting arrangements for Integrated Care Providers. You can read the full consultation document here

Click to access integrated_care_providers_consultation_document.pdf

Please let them know what you think by submitting a response before the consultation closes on the 26 October. You can do this online. HCT have created a document of a sample response

Click to access suggested.pdf

in case you wish to take some guidance from KONP and HCTs position.
You can also see a comprehensive written response:

Click to access Consultation_response_PeterRoderick_FINAL_01Oct18_1_.pdf

to the proposed changes from the JR4NHS team who, along with the late Stephen Hawking, took Jeremy Hunt and ACOs to Judicial Review this year.

3. Share the KONP video, HCT and KONP briefing and the JR4NHS response to the NHSE consulation around your networks and on social media.

“NHS hospitals warn of lack of preparation for winter as figures reveal next year will be ‘tougher than ever’ “

“The NHS is set to face an “even tougher winter” than the record-breaking crisis it weathered less than 10 months ago, as hospital bosses warn of staff and funding shortages.

Despite the government claiming the health service was “better prepared than ever” last year, ambulance queues tripled, there were fewer beds available and doctors wrote to Theresa May warning of patients “dying prematurely” in corridors.

Hospital leaders said the major issues of workforce, funding and social care remain unresolved, and figures released on Thursday show how an unprecedented summer heatwave has left no time to tackle the significant backlog in operations.

Theresa May has pledged an extra £20bn for the NHS by 2023 but this will not start to plug gaps until April 2019.

Meanwhile, hospital heads told The Independent funds usually held in reserve to add capacity in winter were already used up, or useless because there was no one to work.”

https://www.independent.co.uk/news/health/nhs-winter-crisis-emergency-care-extra-funding-summer-heatwave-hospitals-a8579481.html

Torbay GPs may hace scuppered merger of Devon Clinical Commissioning Groups

“The Breeze can reveal GPs in South Devon have voted against plans to merge the area’s CCG with the rest of Devon.

Bosses from the clinical commissioning group made the revelation at a Torbay Council meeting last night.

Apparently, unless a majority of GPs back the idea they can’t do it.

GPs in the area are now being asked to explain their reasons as bosses look to save the merger plans.

To date the two CCGs have saved £4 million by working closely together. [Owl: yeah, right – pinch of salt or whole salt cellar needed here …!]

Torquay councillor Swithin Long, who asked questions at the meeting, said: “At the Overview and Scrutiny Board last night the CCG advised that they were proceeding with the merger – however there is a fly in the ointment.

“In September a poll of GPs was done across the whole of Devon.

“In the rest of Devon (excluding South Devon and Torbay) 59 voted for the merger, 13 against and 3 abstentions.

“In South Devon and Torbay 12 GP practices voted in favour, 14 against and 2 abstentions (so 50% not in favour).

“The meeting was advised that the merger cannot go ahead without the majority of GPs in Torbay and South Devon voting in favour.

“Discussions will be proceeding with the GPs in Torbay and South Devon to see what their concerns are and the CCG will be coming back to Overview and Scrutiny at a date to be confirmed.”

A spokesperson for Devon’s clinical commissioning groups said: “Over the next two months we’re taking the time to meet up with local GP practices in South Devon and Torbay to listen to their views.

“The feedback we receive will help us shape what is the right thing to do next.

“In parallel we’re simply keeping the door open to the possibility of merger by working with NHS England on the next steps.”

For more about the meeting click here:
http://www.torbay.gov.uk/DemocraticServices/ieListDocuments.aspx

Community hospitals in Devon lost to nursing homes in privatisation move

“There was a staggering revelation yesterday at Health Scrutiny from Liz Davenport, Chief Executive of South Devon and Torbay NHS Foundation Trust, that they had made ‘block bookings of intermediate care beds in nursing homes’ when they introduced the ‘new model of care’. South Devon has closed community hospitals in Ashburton, Bovey Tracey, Paignton and Dartmouth and is currently consulting on the closure of Teignmouth – where I spoke at a rally last Saturday.

The ‘new model of care’ is supposed to mean more patients treated in their own homes, and there does seem to have been an increase in the numbers of patients sent straight home from the main hospitals.

But the idea that all patients can be transferred directly from acute hospitals to home is untrue. There is still a need for the stepping-down ‘intermediate care’ traditionally provided by community hospitals – the only difference is that now it’s being provided in private nursing homes instead.

It’s likely to be cheaper to use private homes, because staff don’t get NHS conditions, and crucially it frees up space in the hospitals so that the CCGs can declare buildings ‘surplus to requirements’ and claim the Government’s ‘double your money’ bonus for asset sales. It seems NEW Devon CCG has also made extensive use of nursing home beds, but we don’t yet know if there were ‘block bookings’.

However the private nursing home solution may not last – DCC’s chief social care officer, Tim Golby, reported that nursing homes are finding it difficult to keep the registered nurses they need to operate, and some are considering reversion to residential care homes.

This may be where the South Devon trust’s long term solution comes in – it had already been reported that it is looking to partner with a private company in a potential £100m deal which will include creating community hubs that contain inpatient beds.

The new model of care is also about privatisation.”

Shock revelation at Health Scrutiny suggests the ‘new model of care’ is more about switching intermediate care from community hospitals to ‘block bookings’ in private nursing homes – saving costs and freeing up assets. How long will it last?

“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/