Wilmington Healthcare reported in mid-February that – in line with NHS England’s 2018-19 “refreshed” planning guidance – West Yorkshire and Harrogate Sustainability and Transformation Partnership is drafting a memorandum of understanding to commit the area’s NHS organisations to work to a Sustainability and Transformation Partnership-wide financial control total. This means a limit to NHS spending for the whole area. This is something new.
In the first financial year of the STPs, financial control totals were imposed on individual NHS organisations. But now NHS England is putting the UnAccountable Care System Leader in charge of determining how the system-wide financial control total is attained. This gives them “intervention powers” in individual NHS organisations. Where is the legislation that permits this?
The Memorandum of Understanding also involves discarding the NHS standard contract’s ‘payment by results’ mechanism in favour of ‘risk share arrangements’ and ‘outcome based contracting’. This may be code for the Accountable Care Model contract, which is currently subject to two Judicial Reviews that are to be heard this Spring.
What the Accountable Care Model would mean is, that instead of money following the patient – so if a hospital treats you for, say, a broken leg, that is what they get paid for – the money will be allocated on the basis of a fixed amount per member of the population (and Professor Pollock has identified a conundrum about who is to be counted as a member of the population) and will be shoved into one pot that has to pay for NHS care across the whole area.
The risk share agreements also include incentives for under-spending. Put together the risk and the incentives and you have a recipe for cherry picking patients that will be cheap and easy to treat, and for restricting and denying care for those who won’t. And overall, a shift from planning and paying for services on the basis of clinical need, to planning and paying for services on the basis of financial considerations – which is what health insurance companies do.
The memorandum of understanding apparently also provides for the establishment of a new STP-wide oversight and assurance group. Who knows who will be on it or what powers it will have and how it will be lawful? Since like all the other “workarounds” to the fact that there is no legal basis for any of this, it has no statutory basis but it will be overseeing and assuring statutory NHS organisations.
NHS England’s 2018-19 planning guidance tells Sustainability and Transformation Partnerships that want to be part of the next wave of Accountable Care Systems (renamed Integrated Care Systems) to send their applications to NHS England and the quangos will decide on their applications by March 2018.
Has West Yorkshire and Harrogate Sustainability and Transformation Partnership applied? CK999 are asking, you can too.