Withholding info is key to dismantling the NHS – public deputation to West Yorks Joint Health Scrutiny Committee

Below is Christine Hyde’s public deputation statement to West Yorkshire and Harrogate Joint Health Scrutiny Committee on Wednesday 28th November. 

Relatedly, here’s the  Councillors’ Rough Guide to Accountable Care Systems. (From 999 Call for the NHS)

Jenny Shepherd’s deputation statement is here.

We felt someone had to explain to the Councillors what Accountable Care Systems are and would do, because the Sustainability and Transformation Partnership update report to the Joint Health Scrutiny Committee omitted to tell Councillors of the Sustainability and Transformation Partnership’s intention to become an Accountable Care System next April.

Breaking up the NHS and turning it into a version of the USA’s Medicare

What this means is, the government is proposing to break up the NHS in England into a set of  local public/private organisations called Accountable Care Systems or Organisations that would use a business model similar to the USA Medicare system. This provides publicly-funded basic health care to people who are too poor or ill to get private health insurance.

The Secretary of State Jeremy Hunt says that by next March, he is going to make the necessary regulatory and legislative changes by statutory instrument. This means the biggest change to the NHS since the contentious 2012 Health and Social Care Act would be made with NO parliamentary scrutiny or debate. If you think this stinks, please tell your MP to tell Hunt he must use the proper democratic process and amend laws and regulations by bringing primary legislation to the House of Commons. We all need to be reminding the government we still live in a democracy and will not let it act like a dictatorship.

A report of the Joint Health Scrutiny meeting is on the ck999 blog here. It  focusses on what was NOT said by the West Yorkshire Sustainability and Transformation Partnership officials – and was NOT said by Councillors because they seemed oblivious to all the information the Sustainability and Transformation Partnership officials left out.

Christine Hyde’s deputation

Christine Hyde’s statement opened with the observation that leaving out information is a key manipulative tactic on the part of NHS privatisers. Here’s what she said:

It’s what they leave out that’s important

Rajan Madhoc, a retired Newcastle Hospital Trust consultant and manager who walked from Jarrow to London on the People’s March for the NHS as penance for his part in dismantling NHS services through outsourcing, told me that Board Papers could easily be written to conceal the effect of any proposal.

“It’s what you leave out, that’s important” he said. “When people raise questions later, you just show them where they’d signed off the paper.”

Rob Webster , the West Yorks & Harrogate Sustainability and Transformation Partnership Chief Executive, says that the contract for the Accountable Care System will commission for ‘outcomes’ and leave the operational patient pathway to the ‘organisations’.

What outcomes? Outcomes that matter to patients? Or to bean counters? The West Yorkshire and Harrogate STP Right Care Value Pack shows intended outcomes are reductions in things like hospital bed days for different illnesses and how that affects spending on elective admissions.

The new Musculo Skeletal Contract that North Kirklees has awarded to Connect Health  has a glowing write up on the Clinical Commissioning Group’s website. What outcomes is the Clinical Commissioning Group commissioning for?

At a guess, cutting spending – since the West Yorkshire and Harrogate STP Right Care Value Pack  shows Musculo Skeletal services as a “headline opportunity” – the service with highest “opportunity” for cutting spending.

(Although it’s worth noting that recent research published in the Journal of Public Health concluded:

“RightCare promises illusory savings based on an inappropriate fixed comparator group and faulty statistics…If RightCare is used to justify savings in NHS budgets, it is acting as a cover for cuts.”)

What patients actually get from Connect Health is a phone call following referral, to arrange a telephone triage within a couple of weeks. In that phone call, symptoms are described and some people tick enough boxes to get offered exercise sheets plus, if they want, a physio appointment with several weeks’ wait. After 3 months an appointment comes through for a physiotherapist, who is employed by Mid Yorks Hospital Trust and uses a completely different set of exercises to what is on the Connect Health sheet.

This seems to me, money for old rope for Connect Health. It also looks like a stepping stone on the way to doing away with GPs.

If N Kirklees commissioned Connect Health for the outcome of reducing physio referrals to MYHT, all the company would have to do is raise the bar high enough so that very few people qualify.

Clinical Commissioning Group Governing Bodies’ papers for other areas show that the Social Care sector has been putting pressure on Clinical Commissioning Groups for more money. In a fixed budget, ‘managed market’ as the Accountable Care System would be, and which would include private companies as the Wakefield Care Homes Vanguard  already does – with 25% of Care Homes backed by Hedge Funds – there is a worry that public money will be used, out of public view, hidden by commercial confidentiality, to prop up failing businesses.

In the USA, the biggest cause of death after Heart Attack and Cancer in 2014, was avoidable medical error. Commercial confidentiality allows providers to get away with this – companies will not open up their ‘pathways and procedures’, to the doctors trying to find what had gone wrong. In the scramble for profit profit, many things are skimped on.

At least two aspects of the role of Accountable Care Systems and Accountable Care Organisations make them unfit for the West Yorkshire and Harrogate NHS, and the public:

  • Handing control of the health service to private companies in pursuit of outcomes that have little to do with patients’ needs
  • Reducing health and social care services to match inadequate funding with the mantra ‘self care.’

This seems like a sick joke in society where the working poor cannot eat nutritious food or are lucky to rent dry houses with no black mould growing on the walls, and have to live on a tiny wage in insecure jobs that reduce them to cogs in a machine,. Psychological and non-communicable ill-health has become the hallmark of this profit-driven economic system; inequality, which is linked to ill-health, has grown to levels unseen since the nineteenth century. Promoting self care is an evasion of responsibility for public health.

Please scrutinise the Accountable Care System proposal carefully.

Update: After the meeting, Ian Holmes, Director of the West Yorkshire and Harrogate STP, blogged this response:

“The meeting was also attended by campaign groups concerned with some of the changes taking place in the NHS. They spoke passionately and eloquently about ensuring the NHS treats everyone with respect and dignity, regardless of who they are or what their needs are; about how important it is that the NHS remains publicly funded, and free at the point of need; and about the need for adequate funding for health and care services. There is clearly much more that unites us than divides us. I believe that everyone in the room, campaigners, managers, clinicians and elected members are there because they care passionately about health and social care.”

That would-be flattery erases our focussed criticisms of the existence and future plans of the Sustanability and Transformation Partnership. It does not represent our view of the meeting – you can read our report on it here.

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