Kirklees Health & Adult Social Care Scrutiny Panel meeting on 14 November nodded through a proposal for integrated out-of-hospital services. (They’re not calling it Care Closer to Home now.)
Councillors, please get your heads round all this NOW.
What is going on?
Kirklees Sustainability and Transformation Plan (STP) intends to “deliver” out of hospital care for adults (ie adult social care, primary care, community health and public health services ), by shifting to an integrated model of care closer to home, commissioned by an Integrated Commissioning Board made up of both Greater Huddersfield and North Kirklees Clinical Commissioning Groups and Kirklees Council.
The 14th November document doesn’t say that this is part of the Kirklees STP’s £40m cut to Kirklees NHS and social care spending compared to current levels by 2020 (WYH STP 2016), but it is.
Shadowy working group to produce high level model of care
Who knows when and where they meet, whether in public or private? But a working group with members from the Council, CCGs, primary care, Locala, South West Yorkshire Foundation Trust, Calderdale and Huddersfield Foundation Trust, Mid-Yorkshire Hospitals and Kirklees Neighbourhood Housing is tasked with producing with a High Level Model of Care for out of hospital care (formerly called Care Closer to Home).
Primary and Acute Care Systems and Multispeciality Community Providers
The doc (1.17) refers to two NHS England models of out of hospital care:
- Primary and Acute Care Systems (PACS), where the hospital is the main player in joined up GP, hospital, community and mental health services.
- Multispeciality Community Provider (MCP), which moves specialist care out of hospitals into the control of some primary/community health organisation
The doc adds that eight STPs (that have been piloting NHS England’s new care models) are to be fast-tracked to become Accountable Care Systems next April, and later Accountable Care Organisations.
A reasonable inference might be that the high level model of care for Kirklees “out of hospital care” may be either a PACS or an MCP, run by something that walks and quacks like an Accountable Care System – although the doc refers to:
“integrated models of care provided by a collaboration of organisations” and “a single system…with a single commissioning voice”.
What is an Accountable Care System?
NHS England has told Sustainability and Transformation Partnerships to turn into Accountable Care Systems. This is a local public/private health and social care organisation run on a business model like the USA’s Medicare/Medicaid system, which provides basic healthcare to people who can’t afford private health insurance.
Designed to “manage demand”, Accountable Care Systems would end comprehensive NHS care for all, hasten the development of a two tier health and social care system and increase privatisation -potentially putting a private company in a controlling position over NHS organisations through complex contractual arrangements.
Here’s a downloadable Councillors’ Rough Guide to Accountable Care Systems.
Before working out the “High Level Model of Care”, the working group intends to test:
- Local area/hub working – a space based in town halls that “enables and nurtures a multi-disciplinary response to people who have vulnerabilities within communities…growing and encouraging community organisations to lead activities and events rather than council services being the provider.” In other words palming off council services to voluntary sector organisations and firing council staff with professional skills and experience and qualifications.
- Single point of access/single point of contact
- Single Trusted Assessor
- Accountable lead professional/person
- Common pathways
- Digital by Design
What on earth does any of this mean?
The local hub thing seems an abdication of council responsibility for providing adult social care services. This diagram (1.2 in the doc) seems to show that Kirklees folk’s first port of call would be “self care” (code for buying medicine from a pharmacy) and relying on voluntary groups. What about people who can’t afford over the counter medicine? And what about the jobs of skilled, qualified Council staff working in adult social care?
The Kirklees Sustainability and Transformation Plan(2016) is full of neo-con (new right) dog whistles about removing public services under the pretext of increasing the “independence” of health and social care providers and people who use their services:
- Increased privatisation – “development of…independent sector social care provision” to make social care more “sustainable” – code for cheaper.
- “Provider alliances” and “development of business models to encourage providers to maximise independence” – independent of what? Public funding? Democratic accountability?
- “Improving independence of vulnerable adults” – Is their problem a lack of independence? I don’t think so.
Shades here of neo-con/new right sociologist Charles Murray: the one in the 1980s who basically blamed poverty and social problems – and by implication the ill health that accompanies them – on the people who are suffering them. The one who described such people as an underclass, in a move to revive the Victorian concept of the “undeserving poor”, to separate “shirkers” from “strivers”. His remedy was that poor folk living in difficult social circumstances should have their social security support removed because that is what allows them to wallow in their poverty, illness and social problems. A prescription that the mainstream media seized on and broadcast.
This is the ideology that’s implicitly driving the Sustainability and Transformation Plans/Partnerships and the Accountable Care Systems they are spawning.
Two aspects to this integrated care stuff
- Integrated commissioning (both Greater Huddersfield and North Kirklees CCGs and the Council)
- An integrated model for out of hospital care (ie what they would commission)
1.16 of the doc says that Kirklees is integrating the two Clinical Commissioning Groups now, and then will integrate them with the Council, which “commits to aligning its commissioning resources in the short term”. And then an Integrated Commissioning Board would be a Joint Committee of the CCGs and Council, led by a jointly appointed Director of Integrated Commissioning.
1.2 of the doc says that commissioners will carry out “population based commissioning”. This means paying for the whole range of out-of-hospital care through a contract for a fixed annual amount, based on a per person payment for the whole population.
Pooled budgets used for population based commissioning is the basis of NHS England’s new draft Accountable Care Organisation contract that they published last August and that is now the subject of two legal challenges.
Integrated out of hospital care “can significantly affect incumbent NHS providers”
This is the crunch(1.14):
“The procurement phase will be lengthy and needs to recognise a range of key dependencies, including the end date on the current Care Closer to Home contract in 2020. Given the scale and complexity of the potential procurement it is expected that the Integrated Support and Assurance Process (ISAP) will be applicable …the contractual arrangements through which some new care models will be implemented may mean contracting for new models of acre [sic] is ‘novel’ and that the bidder’s organisational forms may be complex and can significantly affect incumbent NHS providers.”
RED FLASHING LIGHTS what kind of significant effect on current NHS providers – ie our hospitals, NHS mental health providers and GPs????Calling them “incumbent” implies that they might no longer be incumbent after a mystery “bidder” has been awarded the contract for integrated out of hospital care.
Councillors, please get your heads round all this now. Here’s the downloadableCouncillors’ Rough Guide to Accountable Care Systems.