The Leeds Adult Health Scrutiny Committee meeting at 1pm on Tuesday 14 November at Civic Hall Leeds will consider a paper about setting up a Leeds Accountable Care System that aims to cut £700m NHS and social care spending by 2020/1, compared to current levels.
This seems set to cause a massive upheaval, as the Leeds CCG Partnership says this will:
“require a culture change in the way people think of health and care services and in how health and care professionals work with people to support them.”
“These large scale changes to the way that our health and care system works are crucial because we know that if we do nothing our financial gap will be £700m by 2020/21.”
Accountable Care Systems are a new business model for the NHS and social care in England that will impose cuts, restrict services to patients who offer the best return on investment and dismantle the NHS into local health and social care systems. The probably upshot is that the NHS ceases to provide comprehensive healthcare for all and turns into a UK version of Medicare.
Private health care companies and their lobbying organisation the NHS Partners Network explicitly see Accountable Care Systemss as a route to increased NHS privatisation; the government’s 2015 Spending Review settlement for the NHS committed the government to encouraging long-term partnerships with the private sector in a number of key areas – including the development of Accountable Care Organisations (which Accountable Care Systems are a way station on the road to).
When the current West Yorkshire & Harrogate Sustainability and Transformation Plan leader Rob Webster was Chief Executive of the NHS Confederation he put his name to a Report: Capital, capacity and capability – Independent sector providers helping to develop a strong Sustainability and Transformation Plan. The NHS Confederation represents organisations working in the NHS, and these include the NHS Partners Network – a powerful and influential lobby group of private healthcare companies which is at the heart of the corporate rip off of the NHS.
Lack of evidence
The care models and “modern workforce” that Accountable Care Systems aim to deliver are unevidenced and not in the public interest or the interest of the NHS – as the referral of the Calderdale and Kirklees Right Care Right Time Right Place proposals to the Secretary of State shows.
The Leeds CCGs Partnership paper admits that there is a lack of evidence that this is going to work. Despite this, they claim that the Accountable CAre System will “support delivery of” nine Health and Wellbeing Strategy priorities.
Another Uniting Care debacle?
They are going to “test the approach with frail people” because
“The organisations in the health and care system do not want to implement this new way of working for the whole population straight away…. To begin this process a set of outcomes for people living with frailty and those at end of life will be developed by the end of 2017.”
When the accountable care system is set up, commissioners will set outcomes and
“it will be the job of the providers, working together, to determine how best to use their collective resources to achieve these.”
They explain that this means “commissioning for outcomes” – an example often given is the discredited Alzira system in Spain.
The Health Foundation admits that that while evidence for outcomes-based commissioning exists, it is limited in scope and strength. As a cautionary tale, it cites the collapse of the £726m UnitingCare contract for Cambridgeshire’s older people’s and adult community services.
The CCG Partnership envisages that the new system would occur
“by providers voluntarily agreeing to enter into ‘alliance agreements’ which overlay existing contracts. Alliance agreements would detail how providers would work together to share their resources and work in new ways to deliver the outcomes agreed for the population.”
Alliance agreements are based on a form of contracting initially developed to set up North Sea oil operations: alliance contracts. These involve a prime contractor and a bunch of subcontractors. According to an article by Candesic (a management consultancy that advised the Department of Health on the £200m sale of our publicly-owned Plasma Operations to Bain Capital), in alliance contracting, aka prime contracting, Clinical Commissioning Groups invite:
“expressions of interest from prime contractors who then take over responsibility for services, often to a defined population, negotiating themselves with sub-contractors where necessary…the CCG are effectively passing the risk of looking after a segment of the population onto providers, in some cases private providers.”
The Candesic article bangs on about risks associated with alliance contracts, and how the CCG passes on the risks to the Prime contractor and the provider/s. In this context, “risk” is code for justifying the extraction of ridiculously big profits, as happened with Private Finance Initiative and Public Private Partnership contracts for building hospitals and community health centres, such as Calderdale Royal Hospital and the five Semperian PFI community health centres in Kirklees.
Despite all this, the Leeds Clinical Commissioning Group Partnership claim that the Local Medical Committee, Community Pharmacy West Yorkshire and Healthwatch are in favour of the proposal.
The Leeds Clinical Commissioning Groups Partnership say that commissioning and provider organisations in Leeds have committed to these changes. This is somewhat strange, given that a local government association survey last summer showed that there is no agreement between local authorities and the NHS about Sustainability and Transformation Plans.
Is Leeds Council an exception? Otherwise, how can the Accountable Care System include the Local Authority, Clinical Commissioning Group Partnership, NHS and private providers – all with shared responsibility for delivering all the community/social care/public/primary health and hospital services for their area?
The Clinical Commissioning Group Partnership’s assertion is also somewhat contradicted by their statement that the health and social care organisations do not want to implement this new way of working for the whole population straight away.
To prepare for public “engagement” on these “large scale changes”, they are proposing to hold a “deliberative event” in the New Year with a recruited “demographically representative group of attendees”.