STP Agony Aunt usually likes reading Deborah Orr’s columns – so she was dismayed by the reporter’s ill-informed applause in her weekend Guardian column for Simon Stevens’ Next Steps for Sustainability and Transformation Partnerships.
Published last Friday, Simon Stevens’ document takes another big step towards realising Jeremy Hunt’s plans to replace the NHS with an American-style insurance system. It is clear about the intention to make Sustainability and Transformation Plans – now renamed Sustainability and Transformation Partnerships – into Accountable Care Systems.
Accountable Care Systems copy the US health insurance system. They are being spun as A Good Thing because they end the purchaser/provider split. Don’t fall for the spin.
Accountable Care Systems/Organisations are mechanisms for denying care by choosing to treat only patients who represent “best value for money” – ie are cheapest to treat, and most likely to have the best health recovery as a result of treatment. The Next Steps document keeps banging on about how they are going to enable “demand management” ie reduce patients’ access to care.
While it is true that the purchaser/provider split has fragmented the NHS and laid it wide open to competition with private companies, and this needs to end, this is not the way to do it.
We need to end and reverse NHS privatisation through passing the NHS Reinstatement Bill, and to fund the NHS properly.
The whole kit and caboodle is based on the austerity lie – robbing us, the people, of our social wage and transferring this to massive amounts of corporate welfare.
The UK is the sixth richest country in the world, based on the Gross Domestic Product (GDP) per person.
We have the money to pay for public services.
It’s inexcusable that the government fails to find the money to run the NHS safely – in accordance with its founding principles of providing a comprehensive health service, equally accessible to everyone, free at the point of clinical need – because it has made an ideological decision to cut public spending on public services, while spending freely on corporate welfare, to the tune of £85bn/year of public money
This is part of a deliberate decision to run down public sector services like education and the NHS, in order to open them up to competition from the government’s private sector cronies.
The financial regime that Simon Stevens’ Next Steps imposes on the NHS is punitive. Bail outs are disallowed under the government’s Mandate requirement for the NHS to balance its books. If commissioners or providers spend more than their financial controls they will be fined and may be placed in Special Measures.
This could mean dissolution for Clinical Commissioning Groups. Leaving the door wide open for NHS England and its decidedly dodgy Lead Providers for Commissioning Support Units to come in and decide the direction of travel for the NHS in that area.
STP Agony Aunt is still ploughing through the Next Steps in the 5 Year Forward View and keeps having head in hands moments, so it is slow going.
But as well as the Accountable Care System bit (of which more in an upcoming ck999 blog post), a few other things have jumped out at first glance.
Reducing “avoidable demand” for elective care
All the stuff about Right Care – aka value-based commissioning – is about cherry picking patients who will be cheapest and easiest to treat and offer the best return on investment in terms of quality of life years or whatever financialised metric they’re using. But to me NHS care isn’t about a return on investment – that’s what private health insurance systems are about – it’s about the relief of pain and the curing or care of illness. And it seems to me that this is an essential step in turning the NHS into a two tier, insurance-based system that is going to end up like the US Medicare & Medicaid for those who are too poor or ill to get private health insurance – while the rest of patients who have money and are insurable because they’re not suffering from long term illnesses or conditions end up going private.
This is already happening.
A clinician who for obvious reasons wants to remain anonymous says:
“Agree with all your points. I feel uncomfortable as a clinician denying some patients treatment that is not based on evidence of lack of effectiveness but on ‘value for money’ especially with no debate about what the tax paying public should be entitled to from a free NHS.”
This is going to happen more now – unless we stop the NHS and social care turning into 44 Sustainability and Transformation Partnerships which will become Accountable Care Systems and later Accountable Care Organisations.
This is truly the last chance saloon for the NHS.
Sir Muir Gray’s unacceptable conflict of interest
Right Care is promoted in the NHS by Sir Muir Gray, an adviser to Public Health England and the Chair of the NHS Health and Social Care Digital service, which is responsible for maintaining the NHS Choices website.
Sir Muir Gray just happens to be Director of Better Value Healthcare, an Oxford-based company he set up “to promote the practice of value-based healthcare for individuals and organisations in the healthcare sector.” I’m not quite sure what the “for individuals” bit means – can it be about Personal Health Budgets?
Good old Sir Muir Gray’s work at Better Value Healthcare focuses on providing training to healthcare professionals on value based healthcare.
Is this kind of conflict of interest acceptable? I don’t think so.
More bullshit detected
There are many other points in Simon Stevens’ “Next Steps” that need exposing for the bullshit they are. These include a load of requirements for screening patients – something clinicians like Margaret McCartney point out don’t work and waste money that could be better spent on evidence – based treatments that would actually help patients get better – or deal with what isn’t going to get better.
Screening requirements include screening and advising patients who smoke and/or have high alcohol consumption. But the “Next Steps” document says nothing about smoking services cuts, meaning that there is now little or no practical support to back up the empty advice – or about the need to regulate supermarkets selling cheap alcohol.
However, enough for now.
Simon Stevens: A Man with a Plan – but not in a good way
Here is a brief response to Deborah Orr’s unusually ill-informed article by Steve Slator, from Hands off HRI (community campaign to save Huddersfield Royal Infirmary).
“I was absolutely outraged at Deborah Orr’s paean to the head of NHS England, Simon Stevens (Let’s Applaud the NHS boss with a plan, 1 April). A man with a plan? Definitely, but not in a good way.
Unbelievably, Ms Orr seems to have swallowed whole Simon Stevens ‘5 Year Forward View for the NHS’, even down to their fantasy of emergency care being ‘improved’ by “comprehensive front-door clinical streaming”. They’ve done that for years: triage. Or is the idea to use the non-medically qualified? A&E bouncers anyone?
And never mind NHS England’s brutal, so-called, ‘Sustainability and Transformation Plans’ to close hospitals, close – or downgrade to ‘Urgent Care’ Centres with no emergency care facilities, no intensive care capability, and not even any guarantee of a doctor always in attendance – scores of A&E departments; and to recklessly underfund hospital budgets while laughably claiming the overspill will be taken up by (even more hopelessly underfunded)’Care to closer to home’.
So I was getting all hot under the collar at Ms Orr’s apparent (and most out-of-character) ignorance and gullibility. Imagine my relief then on noting the date! Please don’t do that again Ms Orr -some people may be properly fooled.”