Update 9 March 2017
Behind the derisory £325m STP funding in Hammond’s Spring Budget (for a few “most advanced” STPs) is a plan for increased private “investment” in the NHS via Local Economic Partnerships by 2020 – please see section below: “Strategic partnerships with the NHS and the 39 Local Economic Partnerships”
This post updates a previous post giving evidence that the Sustainability and Transformation Plans are a vehicle for greatly increased NHS marketisation and privatisation – contrary to a misleading claim that STPs mark the government’s shift away from further NHS privatisation.
Since the Autumn 2015 Comprehensive Spending Review that created the Sustainability and Transformation Fund, both the government and its quango NHS England have explicitly linked the Sustainability and Transformation Plans to the requirement to “encourage” increased private sector investment and involvement in the NHS.
Some key aspects of STPs’ mandatory “encouragement” of long term NHS “partnerships” with the private sector include
- Strategic partnerships with the NHS and the 39 Local Economic Partnerships.
- The abandonment of “old-style contracting” and the imposition of private company-friendly contracting.
- Embedding digital technology in STPs.
Strategic partnerships with the NHS and the 39 Local Economic Partnerships
This aspect of Sustainability and Transformation Plans seems to be enthusiastically driven by the NHS Confederation – the trade association for all providers of NHS services – whether NHS or private companies.
It involves increased privatisation and public/private partnerships between a vast range of NHS commissioners and providers, private health companies, voluntary and community sector organisations and a range of other companies, as health and social care services are harnessed to Local Economic Partnerships as a vehicle of economic growth and a way of securing “external investment” in the NHS through “a host of new finance mechanisms”.
NHS Clinical Commissioners are gung ho about the opportunities local growth plans provide for Clinical Commissioning Groups to work across organisational boundaries with local authorities to:
“..secure long-term, external funding for health and social care services that are having to adapt to enormous financial and operational pressures.”P5, Shaping healthy cities and economies – The role of clinical commissioning, December 2016
NHS Trusts and Foundation Trusts call for inquiry to get them out of impossible situation created by Sustainability and Transformation Plans
Coupled with NHS Commissioners’ move to supplement inadequate public funding for the NHS by “long term external funding” is a recent outrageous letter from NHS Providers – the trade association of NHS Trusts & Foundation Trusts – to The House of Commons Health Select Committee.
The signatories to the letter say no one wants to:
“depart from the key principle of NHS care being available to all based on clinical need not ability to pay”.
But their call for the Health Select Committee to hold an inquiry into how to get NHS Providers out of the impossible situation they are now in, as a result of NHS underfunding, proposes solutions that mostly would require an explicit, nationwide end to the NHS as a comprehensive health service that provides treatment that is free at the point of clinical need.
The letter says their dilemma is set to continue for the rest of this Parliament, since the additional Sustainability and Transformation funding is not enough to solve the problem.
They basically call for a change to the NHS policy framework that would bring it into line with Sustainability and Transformation Plan – driven withdrawal and/or restrictions of a variety of treatments.
The NHS Providers say this is being done in contravention of the current NHS policy framework of a comprehensive service that is free at the point of clinical need for all patients that have a clinical need for it.
But their suggested change to the NHS policy framework that would effectively turn the NHS into a brand for a public/private partnership operating along the lines of the US health digitech and insurance companies – Cerner and United Health, respectively – that previously employed NHS England head honchos Mathew Swindells and Simon Stevens.
The abandonment of “old-style contracting” and the imposition of Cerner and United Health-friendly contracting
Matthew Swindells recently told Clinical Commissioning Groups to abandon “old style” contracting.
What will replace the “old style” contracting – the current system of commissioning and providing NHS and social care services – is Accountable Care Organisations (ACOs).
ACOs are a form of public-private partnership. Think Private Finance Initiative, but for NHS services as well as buildings. The hot favourite ACO model – plugged by the pro-privatisation think tank the Kings Fund in a health system redisorganisation “masterclass” on 12 October – is South Central Alaska.
Cerner is behind the Kings Fund’s promotion of South Central Alaska ACO as the new STP form of contracting. The company commissioned the Kings Fund report that plugs the South Central Alaska ACO, with the brief to:
“write a report analysing how an intentional whole health system redesign can deliver better health outcomes to a population. The report, based on independent research conducted by The King’s Fund, focuses on Southcentral Foundation”
Delivering better health outcomes to a population sounds like a good goal.
There are just two problems.
There seems to be no reliable evidence that this model of ‘integrating care’ will reduce costs or improve patients’ health.
And there seems to be little faith that it can actually be delivered on the ground. Dr Robert Morley, the Chief Executive of Birmingham GPs’ Local Medical Committee says this model of care is ‘simply undeliverable’:
‘The STP, and in particular the plans to massively increase the delivery of out-of-hospital care, to transform general practice and to give it far greater responsibilities across a range of areas are simply undeliverable bearing in mind the meagre additional investment, the unambitious plans to increase primary care workforce and the woefully inadequate intention to support general practice sustainability and viability.’
So what is driving these ideas? And what are they really designed to achieve?
Clues leak out in the STPs – and earlier documents like Calderdale and Greater Huddersfield’s “Right Care Right Place Right Time” NHS and social care reconfiguration documents and the 2014 Better Care Fund Submission from Calderdale Council and Calderdale Clinical Commissioning Group.
These proposals will ‘create a responsive local market’ for health and social care. They will also ‘reduce the pay bill’ and make increased use of patients’ self management as well as “business-ready” voluntary sector organisations in the new “locality-based” integrated teams.
These are themselves likely to be privatised – with tax avoiding Virgin Care are a contentious front runner that has just mopped up a £700m contract to run Health and Adults Social Care in Bath and NE Somerset.
Embedding digital technology in Sustainability and Transformation Plans
The STPs’ “new models of care” are all dependent on a hugely increased use of health digital technology. Health information systems apparently will deliver a $53 billion market globally in 2019 because of vaguely defined proposals for ‘integrated care’ and ‘care closer to home’. Good news for marketeers, bad news for patients and NHS staff .
This is the route to turning patients into consumers, who dispose of a mix of NHS personal health budgets and – if they can afford it – top ups paid for out of their own purse. So, it is the route to a two tier NHS – like the already totally marketised two tier social care system. And the money the patients/consumers spend goes directly to digitech companies like Cerner.
This is at the say-so of Matthew Swindells, previously Vice President of US health digitech company Cerner, now NHSE National Director for Commissioning Operations and Information
At the September 2016 NHS Expo – a business-sponsored event plugging the wonders of privatisation via personal health budgets and a bonanza for big pharma and big digitech – Matthew Swindells announced that digital technology must be embedded in Sustainability and Transformation Plans.
New STP Digital excellence centres – also announced at NHS Expo – promote patients’ use of smartphones and mobile devices. The Acute Trusts that are centres of digital excellence will set up digital technology so that patients can access more services via smartphones and mobile devices.
Digital technology tie-in with Kaiser Permanente-type Care Closer to Home scheme
This ties in with the so-called Care Closer to Home scheme , mentioned in the previous section, that copies the model for “demand management” used by the American private health care company, Kaiser Permanente.
It requires patients with long term health problems to monitor their own symptoms at home using interactive digital technology that will send data about their bodily processes to specialist nurses and/or GPs.
The aim is to target care without relying on expensive personal contact between doctors/nurses and patients as a way of checking on patients’ health.
The system would also direct behaviour change incentives and messages to people statistically at risk of developing various illnesses. This aims to reduce the the likelihood that they will become ill.
But there’s little evidence that this actually works.
Follow the Sustainability and Transformation Plan money – into the pockets of digitech companies
It looks as if a lot of the much-vaunted increase in NHS funding via the Sustainability and Transformation Fund, is going straight into the pockets of digitech companies like Matthew Swindell’s former employer.
Here is what Cerner has to say about the kind of health digitech that the digital excellent fund is going to pay for:
“Cerner has several exciting projects and relationships related to some key aggregation platforms, including Apple and Validic, which are on the augmented self-management end of the remote monitoring spectrum, and Qualcomm Life, which is active monitoring. Cerner also has a relationship with Livongo to improve outcomes for diabetics. These relationships will increase the ability for Cerner clients to track their patients remotely, whether to manage chronic conditions through a prescribed device or kit, or through an ecosystem of apps enabling patients to manage their day-to-day health.”
The NHS England panel that chose which Trusts to award the centres of digital excellence funds to was apparently led by Professor Keith McNeil, NHS England’s first chief clinical information officer, who reports to Matthew Swindells.
And Simon Stevens had previously announced at the 2016 NHS Confederation conference that:
“…from April next year, we will add a piece to the national tariff system specifically for new med tech innovations that have been shown to be cost-saving or help patients with supported self-management.”
This sounds a lot like a repeat of Blair’s NHS Programme for IT (NHSPfiT), which pretty much ended in tears. Is the STP Digital Excellence scheme going to do any better? And will it even matter to the revolving door merchants Simon Stevens and Matthew Swindells, who are pushing it? After all, as Stuart Player and Colin Leys wrote in 2010 :
“…the plan to turn the National Health Service into a healthcare market does not rest on rational arguments but material interests… the plans are not really new, but are the culmination of a decade-long campaign by the private health industry to get its hands on the NHS budget.”
And that is what the STPs are really about: cuts, privatisation, and a paradoxical central control over “devolved”, fragmented public/private NHS and social care.