Kirklees Sustainability and Transformation Plan’s new ‘out of hospital care’ organisation could “significantly affect” our NHS hospitals, mental health services and GPs

Calderdale and Kirklees Joint Health Scrutiny Committee have referred Calderdale and Huddersfield hospital cuts plans to the Sec of State for Health as unfit for the people of our areas and our NHS.
 
Regardless, Kirklees Clinical Commissioning Groups and Kirklees Council are bashing on with plans for taking services out of the hospitals and integrating them with adult social care services (without saying where the community health staff are going to come from. They don’t grow on trees.)
Listen to NHS protectors!
Last March, NHS protectors lobbied Kirklees Council about the threat to the NHS posed by integration of health and social care. Kirklees Council doesn’t seem to have taken any notice.

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.

Palming off council social care services to voluntary organisations

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?

Neo-con dog whistles

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)

Integrated commissioning

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.

 

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6 comments

  1. How very interesting however this does not mention the move to create local subsidiary companies who will manage all non clinical services from the start of April 2018. i wonder if your members are aware of this and have looked at it? seems the creation of an SPV (special purpose vehicle) to manage the deficits our Hospitals are seeing currently is great for masking their depts.. not to mention given this will produce a managed service model, the tax benefits of using such an SPV are quite large. i have to ask the question however.. is sharing really caring?

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    • Thanks for your comment. The reason this blog post doesn’t mention the move to create local subsidiary companies who will manage all non-clinical services from April 2018 is because, if I understand this rightly, this is about CHFT setting up a subsidiary company to do all its facilities management work at HRI (although at CRH this is already done by through the PFI by a facilities management company). This article is about out-of-hospital services, so that info is not really relevant to that. But if you have info about hospitals Trusts’ plans to set up these subsidiary companies, happy to do another blog post about that. You can post info here or email to changingmorethanlightbulbs@gmail.com

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  2. Interestingly I can’t find any statutory community mental health services in Kirklees, they are all provided by charities, although please correct me if I am wrong. One of the charities specifically for women, commissioned by Kirklees CCG and the council said that they had experienced a 50% increase in referrals this year, were finding it hard to cope and needed to raise more funds!

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  3. Thanks for your comment, anon. A quick online search came up with this info (and much more that I’ve not yet had time to examine):

    Community mental health services Kirklees

    Folly Hall Mills
    https://www.nhs.uk/Services/clinics/Services/Service/DefaultView.aspx?id=253892

    Community mental health services

    This Department is managed by South West Yorkshire Partnership NHS Foundation Trust
    Admiral Nurses, 3rd Floor, Small Mill, Folly Hall Mills, St Thomas’ Road, Huddersfield, HD1 3LT
01484 343126
    Intensive home based treatment team, Small Mill, Ground Floor, St Thomas Road, Huddersfield, HD1 3LT
01484 343161

    South Kirklees community mental health team, Folly Hall Mills, Small Mill, 3rd Floor, St Thomas Road, Huddersfield, HD1 3LT
01484 343130

    Community therapies team (South Kirklees), 4th Floor, Folly Hall Mills, St Thomas Road, Huddersfield, HD1 3LT
01484 343740

    Admiral Nurses
    Admiral Nurses are registered community mental health nurses who specialise in dementia care. Working in partnership, they provide person-centred support to carers and families of people living with dementia. They also work with other agencies and staff that provide care for people living with dementia, offering invaluable support, education and information.
    Find out more about the team by visiting http://www.southwestyorkshire.nhs.uk. 

    ck999 Comment: Admiral Nurses seem to be employed by Dementia UK, a charity. Working in partnership seems to be code for “charitable or corporate organisation with contract to provide NHS services for SWYPFT – the mental health trust”.

    Intensive home based treatment team
    The Kirklees intensive home based treatment team provides rapid and intensive interventions for people with acute mental health problems in the least restrictive environment as close to their home as clinically possible.
    Find out more about the intensive home based treatment team by visiting http://www.southwestyorkshire.nhs.uk. 

    ck999 Comment: this looks as if it is an NHS service provided by SWYPFT itself rather than suubcontracted to “Partner”.

    South Kirklees community mental health team
    South Kirklees community mental health team (CMHT) provides assessment, support and care to people aged over 65 with dementia and, or mental health conditions.
    The team aims to provide mental health services which put the individual first and recognise the needs of the diverse population of Kirklees. Members of staff from South West Yorkshire Partnership NHS Foundation Trust work with staff from Kirklees Council to form a specialist integrated team.
    Find out more about the community mental health team by visiting http://www.southwestyorkshire.nhs.uk.  

    ck999 Comment: this looks like an NHS/Kirklees Council team.

    Community therapies team (South Kirklees)
    The South Kirklees community therapies team provides assessment and treatment to people who do not have a diagnosis of psychotic illness, but have or are likely to have mental health conditions where there is a significant degree of complexity and disability. Typically this includes people who suffer from depression, anxiety disorders, personality disorders and eating disorders.
    Find out more about the community therapies team by visiting www.southwestyorkshire.nhs.uk.  
    CK999 Comment: Their SWYPFT webpage says “Members of staff from South West Yorkshire Partnership NHS Foundation Trust work with staff from Kirklees Council to form a specialist integrated team.”

    From this quick search, only one of the 4 community mental health teams seems to be provided by a charity. There are loads more links that came up when I put “community mental health services Kirklees” into DuckDuckGo search engine. If you want to find out more info about who provides them, that is probably the quickest and simplest way to do it.

    Thanks again for your comment.

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  4. These are the next links that came up in online search:

    https://www.kirklees.gov.uk/beta/health-and-well-being/mental-well-being.aspx
    Kirklees Council – Adult social care and health – mental health and wellbeing.

    “Most people with mental health problems are cared for by their GP and the Primary Care Team, and this would normally be their first port of call.
    Some people will also need specialist services and a range of organisations, including the NHS, Social Services, the voluntary sector and independent providers, provide these.

    Mental health providers
    The following providers are commissioned by Kirklees Council you can self refer via their websites.
    St Annes Community Services
    SR2 The Great Outdoors
    Richmond Fellowship – Kirklees Employment Service
    HOOT – Out of the Blue
    Community Links Engagement
    WomenCentre Mental Health and Wellbeing Service “

    ck999 Comment – These are all registered charities

    http://www.southwestyorkshire.nhs.uk/our-services/directory/south-kirklees-community-mental-health-team-older-peoples-service/
    Community mental health team (CMHT) older people’s service (South Kirklees)

    ck999 comment – looks like NHS provider – SWYPFT.

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