NHS quango washes hands of responsibility for redesigning community services to cope with acute hospital services cuts

Community health services are under-resourced and in no way capable of taking on all the extra work that will be needed as a result of cutting hospital services and moving them into the “community”.

This shift is key to the “new care models” being set up by the cost-cutting Sustainability and Transformation Partnerships and their successor Accountable Care Systems (rebranded by NHS England as Integrated Care Systems – but sameold).

Despite this huge intended shift of staff and resources out of hospitals – seen by companies like Totally Ltd as a “massive market opportunity” – the government’s quango NHS England has dropped its intention of working out a national plan for how to successfully carry this out, according to a recent article in the Health Services Journal. It has also denied that it ever said that this would be necessary.

However an NHS England document leaked to the Health Services Journal seems to show that this is a lie.

It identified a bunch of risks that would follow from NOT coming up with a national community services plan or framework:

  • STPs may not be able to “achieve full potential” for redesigned community services
  • They will not be able to make the expected spending cuts from cutting acute hospital beds
  • Community services will not be consistent across England
  • The plan to dismantle traditional family doctor practices and replace them with huge “super practices” with 30K-50K patients (around 10 times bigger than current GP practices) may not be possible “without strategic alignment of community health services…work on community services at national level remains fractured and disjointed.”

Perhaps the government’s NHS England quango has decided to rely on private companies to take care of community services – the fastest growing area of privatisation in the NHS.

The Unison report on Responding to STPs says

“Where privatisation is concerned, it is particularly worth checking what the STP has in mind for primary care and community services, which is currently the part of the NHS most targeted by private providers.”

Companies like Totally Ltd are rubbing their hands at the thought of taking over NHS community services.

New cost-cutting local NHS and social care organisations responsible for redesigning community services

NHS England recently told the Health Services Journal that

“STPs and Integrated Care Systems…will drive the redesign of community services.”

That’s not looking too good.

Update 4.8.2019 PwC and Optum promote Primary Care Networks as opportunity for ‘new entrants’ in health and wellbeing sector

As part of the Optum Alliance, PwC is advising NHS and Local Authority executives on how to set up the Accountable Care models that will enable its global clients to profit from opportunities for “new entrants” to the health and wellbeing sector.

Its 2016 report: Capture the Growth: Opportunities for new entrants in healthcare and wellbeing announced:

“The time is ripe for new ideas in UK healthcare. Some of those new ideas and solutions will come from new sources – organisations which traditionally have not been involved in healthcare, fitness or wellness. Worldwide, the players on the healthcare pitch are changing. And the UK is no exception. New entrants are emerging, disrupting the old ways of doing things.”

The prospect for Calderdale and Huddersfield community services looks grim. In Greater Huddersfield, the company Locala has the huge contract for community services but has earned harsh criticism for its failings from staff, patients and the Care Quality Commission.

The hospitals Trust’s workforce plan in the Full Business Case for radically cutting its services and transferring many into the community has next to nothing on a community services workforce plan.

After repeated requests for over a year to publish the West Yorkshire and Harrogate Sustainability and Transformation Plan workforce plan, in April 2018 it finally came up with a Workforce Strategy.

Update 4.8.19 The West Yorkshire and Harrogate Sustainability and Transformation Plan Workforce Strategy is clear that Primary Care Networks are the main means of providing community and public health services and social care. It admits:

The primary and community care workforce strategy must be seen as a first stage of an evolving approach because as currently constituted it does not fully address the significant workforce change that will be required to achieve the ‘left shift’.

To achieve this, between 2017 and 2021 the Workforce Strategy aims to add 150 new GPs/year and 50 new nurses per year working in general practice. It also aims to increase the numbers of new roles:

“to carry out more routine patient care, freeing up other clinicians to carry out more specialised care or roles that traditionally have not formed part of a primary care team. Examples include

  • 50 new physician associates working in General Practice/year,
  • 50 new clinical pharmacists working in General Practice/year,
  • care navigators,
  • 50 new advanced clinical practitioners (including pharmacists, physiotherapists, podiatrists and paramedics) working in General Practice each year
  • Major development of the support worker based in general practice
    • 70 new clinical support workers (health care assistants) per year.
    • Conversion of 70 practice clerical support workers per year into
    clinical support (patient facing) roles such as care navigators.
    • Expansion of 70 mental health therapists.
    • Training of 70 existing and new volunteers as community
    champions, wellbeing experts and experts by experience.
  • health coaches.

There seem to be huge holes in this primary and community health care workforce strategy. Like, where are the district nurses?

The Workforce Strategy also foresees:

“Opportunities to develop shared roles across primary, community and secondary care.”

The Workforce Strategy envisages this will change the make-up of GP Practice staff:

Regardless of failure of the Primary and Community Care Workforce Strategy to “fully address the significant workforce change that will be required”, both Calderdale Councils and Kirklees Councils are pushing ahead together with their respective area Clinical Commissioning Groups, to turn their “locality” Sustainability and Transformation Plans into Accountable Care Systems that will have the task of delivering Care Closer to Home in order to cut acute and emergency hospital admissions.

But the current round of public health spending cuts gives a foretaste of likely problems with this, given the horrendously harsh cuts that NHS England is ordering the ACSs/ICSs to make  – while seemingly giving huge new powers to do this to Sustainability and Transformation Partnership/Accountable Care System leaders who have no statutory basis for their role and are therefore utterly unaccountable to any democratic processes.

And it’s clear that so-called healthy living programmes that are meant to keep people out of hospital and GP surgeries are going to be yet another bonanza for private companies like PwC’s clients, Optum and ICS Health and Wellbeing. Heyho Slash Trash and Privatise.


  1. My family have witnessed the impact already closing wards at HRI caused my family member who was very poorly with sepsis to transfer wards three times in one day. This meant no continuity of care and loss of proper handover leading to differing treatment plans and confusion. One day one team thought him fit for discharge to be told by another he was definitely staying in hospital. A month later he was discharged without his nebuliser to be admitted the next day following a heart attack. Sadly my family member is now palliative. (He has been chronically ill for along time) My family member is dying but because of no beds and influenza on the ward unfortunately this care is on the ward and not in a side room. This means restriction of his visitors which they understand but his five children need provision for time with their dad sometimes altogether. My family don’t blame staff they are very grateful for care they have received and have seen the enormous pressure these poor professionals are facing on a daily basis. This is before. The cuts in social care is causing a near gridlocked system. #justice4NHS


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