NHS “Accountable Care Systems” – about money not people

Sustainability and transformation partnerships should tell NHS England if it is “getting in the way”, the HFMA annual conference heard yesterday.

Matthew Style, director of strategic finance at NHS England, encouraged local areas to adopt accountable care systems (ACSs) – which evolve from STPs – where possible.

But, speaking at the conference in London, he added: “I am conscious some things we [NHS England] do make local relationships at a local level more strained.

“We get in the way. You do and should keep us to account on that.”

NHS England was committed to ACSs, he said, and areas that did not have them – if they feel ready – should adopt the principles.

“The finance community has a pivotal role to play to drive forward this agenda,” he added. He advised the audience that any investments they made should “show demonstrably [they] are sustainable as a whole”.

Style also told the conference the Budget package “hasn’t taken away stark challenges we are facing” and that NHS England would not be changing the way fund was allocated next year.

Philip Hammond promised £10bn of capital investment to the health service by 2020 in the Budget last month.

Style also predicted there would be clinical commissioning group mergers in the future.

Bob Alexander, the deputy chief executive and director of resources at NHS Improvement, also addressed the conference. He told delegates they were doing a “tremendous job” but warned there was still a reliance on “non-recurrent stuff”. The Treasury stipulates NHS commissioners set aside 1% uncommitted spending at the start of a financial year as a buffer for ‘non-recurrent’ health economic priorities.

Alexander also warned NHS finance managers not to let “risks hang in the air” and advised: “Some of the best help comes from those colleagues who are a little bit removed from the day to day”.

This was Alexander’s last speech to the conference as he is leaving his role to become chair of Sussex and East Surrey STP next year.”


“Shepton Mallet hospital campaigners: “Reopen this hospital or we’ll see you in court”

Any bets on this hospital re-opening!

“A group of campaigners have launched a legal bid to try and prevent the temporary closure of a community hospital in Somerset.

Shepton Mallet Community Hospital Supporters Group have submitted a pre-action protocol letter to the Somerset Partnership Trust in an effort to reverse the temporary closure of the town’s community hospital.

A pre-action protocol letter is sent from one party to another in a dispute to narrow any issues or to see if litigation can be avoided.

Ten in-patient beds were closed temporarily in October due to staffing issues with the trust saying that they hoped to reopen them in March 2018.

Confirmation of the decision to temporarily close the hospital came after an email to staff was leaked on social media, saying that the plans would “proceed”.

This was despite a previous statement which said that it was “considering its next steps”.

The partnership later insisted that “nothing has changed” and that it remains focused on reopening the hospital towards the end of March 2018.

In a statement, a spokesman for the supporters group said that the letter aimed to challenge the alleged “unlawfulness” of the trusts decision and to “achieve the re-opening of the in-patient beds as quickly as possible.”

Paul Turner said: “We have asked the Trust to rescind its decision before a Court quashes it, and if it wants to take any such decision in the future or any other decision on a change in service at SMCH, the Trust must undertake a prior proper public consultation.

“This is nothing new and the point has been made before in meetings with SOMPAR representatives.”

He added: “We are of course also prepared to take part in alternative dispute resolution to avoid going to court.

“We have asked to be kept up to date concerning developments in this dispute.”

Somerset Partnership Chief Executive, Peter Lewis said: “We have received the letter and we are considering our response.

“In the meantime, I want to reassure the Shepton Mallet community that we remain committed to re-opening the community hospital inpatient ward as soon as we can, although we do not expect this to be before the end of March 2018.”

The issue of the temporary closure was raised at a debate in Westminster Hall last month by the MP for Wells, James Heappey.

Mr Heappey said: “The overall nurse rota statistics for both day and night shifts were 100 per cent in Shepton.”


“Labour demands Commons vote on ‘secret’ plan for NHS”

This is the most dangerous thing to happen to our NHS since the Health and Social Care Act 2012 paved the way for wholesale privatisation. Once this goes through (on the nod as it will with this government) our NHS ceases to exist.

Currently, money in the true NHS stays in it and recirculates. With ACOs first big salaries for ACO staff are creamed off, then boardroom and shareholder dividends of the companies concerned and then the NHS gets cut and rationed – with only high-profit interventions (usually things such as elective surgery which can be costed to the penny) made available.

“Party says ministers are trying to push through changes that could lead to greater privatisation and rationing of care

Denis Campbell Health policy editor

Labour is demanding that MPs be allowed to debate and vote on “secret” plans for the NHS that they claim could lead to greater rationing of care and privatisation of health services.

The party says ministers are trying to push through the creation of “accountable care organisations” (ACOs) without proper parliamentary scrutiny.

Jonathan Ashworth, the shadow health secretary, has written to Andrea Leadsom, the leader of the House of Commons, urging her not to let “the biggest change to our NHS in a decade” go ahead without MPs’ involvement.

NHS England’s chief executive, Simon Stevens, and the government see ACOs as central to far-reaching modernisation plans that they hope will improve patient care, reduce pressure on hospitals and help the NHS stick to its budget.

ACOs involve NHS hospital, mental health, ambulance and community services trusts working much more closely with local councils, using new organisational structures, to improve the health of the population of a wide area. The first ACOs are due to become operational in April in eight areas of England and cover almost 7 million people.

Labour has seized on the fact that the Department of Health plans to amend 10 separate sets of parliamentary regulations that relate to the NHS in order to pave the way legally for the eight ACOs.

In his letter, Ashworth demands that Leadsom grant a debate on the plans before the amended regulations acquire legal force in February.

“Accountable care organisations are potentially the biggest change which will be made to our NHS for a decade. Yet the government have been reluctant to put details of the new arrangements into the public domain. It’s essential that the decision around whether to introduce ACOs into the NHS is taken in public, with a full debate and vote in parliament,” he writes.

A number of “big, unanswered questons” about ACOs remain, despite their imminent arrival in the NHS, he adds. They include how the new organisations will be accountable to the public, what the role of private sector health firms will be and how they will affect NHS staff.

Ashworth also says “the unacceptable secrecy in which these ACOs have been conceived and are being pushed forward is totally contrary to the NHS’s duty to be open, transparent and accountable in its decision-making. The manner in which the government are approaching ACOs, as with sustainability and transformation plans before them, fails that test.”

Stevens’s determination to introduce ACOs has aroused suspicion because they are based on how healthcare is organised in the United States. They came in there in the wake of Obamacare as an attempt to integrate providers of different sorts of healthcare in order to keep patients healthier and avoid them spending time in hospital unnecessarily.

A Commons early day motion (EDM) on ACOs also being tabled by Labour on Thursday, signed by its leader, Jeremy Corbyn, and other frontbenchers, notes that “concerns have been raised that ACOs will encourage and facilitate further private sector involvement in the NHS”.

In his letter Ashworth adds: “There is widespread suspicion that the government are forcing these new changes through in order to fit NHS services to the shrinking budgets imposed from Whitehall.” The EDM also notes “concerns that ACOs could be used as a vehicle for greater rationing”.

The King’s Fund, an influential health thinktank, denied that ACOs would open up NHS services to privatisation. “This is not about privatisation; it is about integration,” said Prof Chris Ham, its chief executive.

“There is a groundswell of support among local health and care leaders for the principle of looking beyond individual services and focusing instead on whatever will have the biggest impact in enabling people to live long, healthy and fulfilling lives,” added Ham.

Dr Chaand Nagpaul, the chair of the British Medical Association, backed Labour’s call for greater transparency but said care services should be integrated.

However, he added: “ACOs will not in themselves address the desperate underfunding of the NHS and may divert more money into processes of reorganisation. Current procurement and competition regulations create the potential for ACOs to be opened up to global private providers within a fixed-term contract and with significant implications for patient services and staff.”

The Department of Health refused to say if MPs would be able to debate ACOs. “It is right that local NHS leaders and clinicians have the autonomy to decide the best solutions to improve care for the patients they know best – but significant local changes must always be subject to public consultation and due legal process.

“It is important to note that ACOs have nothing to do with funding – the NHS will always remain free at the point of use,” a spokesman said.”


RDE rushes ahead with unaccountable “Accountable Care Organisation” plans

[By total coincidence, of course, Tiverton has the only local 24 bed PFI-funded community hospital which cannot therefore be closed].

Tuesday 5 December 2017

“Tiverton GP practice due to join hospital trust – pioneering the way for Devon’s first primary and secondary health care integration

On 2 January 2018, Tiverton’s Castle Place Practice and its 50 members of staff*, including GPs, plan to join the Royal Devon and Exeter NHS Foundation Trust (RD&E). This new venture will be the first of its kind in Devon and will provide locally-led seamless care for the Tiverton community
This move fits with the direction of the NHS Five Year Forward View and offers better integrated working by removing organisational barriers. Castle Place is already co-located with Tiverton Community Hospital and has an established close working relationship with the Trust’s community teams so it was a pragmatic option for the practice to approach the RD&E with the proposal to explore a fully integrated model. Whilst offering the opportunity to work differently for the benefit of all the local community, it will also help address some of the challenges faced by primary care, particularly the difficulty in recruiting new GP partners and balancing time for clinical care with the demands of running a business.

Dr James Squire, GP Partner at Castle Place, explains: “This is an exciting new venture for us and one in which our patients’ best interests are central to our rationale for pursuing this change. I’d like to reassure our patients that in the short-term there will be no changes to the services we offer and in the longer-term will only provide better care.

“The ever increasing challenges and pressures are resulting in necessary changes right across the healthcare system. Thankfully, due to our focus on person-centred, continuity of care we have managed to fare some of these challenges well but we know that to maintain this for our current patients and future generations we need to explore new ways of working. There are a number of different ways GPs could adapt but it was important for us that we secured a future which was true to our core values and principles. Joining the RD&E gives us an opportunity to concentrate our efforts on leading and providing excellent clinical care in a way that’s right for our community”.

“This is a bold step for us but the whole team here is motivated to test new ways of working, not only between the practice and the hospital but also with the community services for our population, and we are really keen to share our experiences and learning for the wider benefit.”

Suzanne Tracey, RD&E Chief Executive, said: “At the RD&E we are prioritising working more closely with local health and care partners to support a move towards ‘place-based care’. This is the future of healthcare and we want to help create the conditions which enable communities to take the lead. To achieve this, we envisage working with our partners in a number of exciting and different ways and this proposal initiated by the Castle Place Practice in Tiverton is a great opportunity to put this into practice.

“Whether in primary or secondary care, all of us want to do what’s right for the person and right for a community but sometimes competing demands, targets and finances can get in the way or slow the pace of change. The partnership with Castle Place Practice is a great opportunity for us to work together with GPs to develop more proactive care which keeps people well and independent in their own communities.”

Castle Place Practice’s 15,000 registered patients, which is around half of Tiverton’s population, will see no immediate changes. Staff will continue in their existing roles, patients’ named GP will not change and access to appointments and services will continue in exactly the same way. However, in the longer term it will enable and increase the opportunities for better management of long term conditions plus improve access to care at home and in the community.”

Health care privatisation – largest care home provider on brink of collapse

And who will end up bailing it out if debt restructure doesn’t happen …..?

Four Seasons on brink of collapse

“Four Seasons, Britain’s biggest private care home operator, is at risk of going into administration over a £26m interest payment due on its debts, and amid a dispute between its British owner and its main bondholder, American hedge fund H/2 Capital.

British private equity firm Terra Firma, which owns Four Seasons, has offered to hand over the operator’s 343 care homes to H/2 if the hedge fund created a creditors’ committee to “agree an orderly and responsible handover and to collectively agree with the other bondholders and creditors a new capital structure for the Four Seasons group, new equity ownership and new corporate governance”.

H/2 has not responded to the offer yet, and has previously put forward its own restructuring plan, as it is in dispute with Terra Firma over the ownership of 24 profitable homes.”

Source: The Daily Telegraph, Pages: 1, 3 The Times, Page: 40 The Guardian, Page: 23 Independent i, Page: 9 Financial Times, Page: 19 Evening Standard, Page: 46

A Christmas Carol for the NHS

Good king Jeremy Hunt looked out
so did Simon Stevens
healthcare crisis all about
they were disbelieving.
“There’s no problem on the wards
waiting times are super.
Moan too much, we’ll sell the lot
to our friends at Bupa.”
Long term sick and elderly
shoved where you can’t see’em,
care from cradle to the grave
now in a museum.

Trolleys for the dying poor,
posh wards for the wealthy
don’t expect an ambulance –
pray that you stay healthy.
Give us back our stolen wards,
two hundred beds and counting.
Give us back our hospitals:
hear the anger mounting
Pay our nurses what they’re worth,
cherish those who mend you:
Happy Christmas, NHS,
we’ll always defend you.